Dr Nils Bergman, Western Cape, South Africa.

The Ottowa Charter followed the Declaration of Alma Ata, and focussed specifically on health promotion. As we believe KMC to be a healthier alternative for prematures than the incubator, with positive health effects on family and society, we have in the Ottowa Charter an invented wheel ready for use. Five wheels in fact: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services. KMC will be considered with respect to each of these five principles.

In particular, we are striving to "reorient health services": and the Ottowa charter states that this responsibility is shared between "individuals, community groups, health professionals, health service institutions and governments". These are the stake holders we must be considering when implementing health and KMC.

Behavioural change is not a key subject in our medical schools, yet for health promotion it is the key. A number of stages have been described in changing behaviour. For addiction, these have been described as pre-contemplative, contemplative, preparatory, action, maintenance and relapse. In counselling and helping an addict it is vital to establish at which stage the addict is in. These stages can be "transcribed" to our context of implementing KMC.

Implementing any change requires "energy". There must be some motivation or pressure which induces a change, whether for the better or for the worse. Motivation for KMC implementation most commonly comes in the form of enthusiastic individuals, but other "drivers" or "pressures" should be identified and enlisted where possible. It should be recognised also that unlike an individual addict, implementing KMC requires change to an entire system, which is a science of its own in the business world.

Each field requires an information set to be provided, and a strategy to deliver.

With the above framework or matrix, a comprehensive implementation plan can be drawn up suitable for any circumstance or context. This will be illustrated by many mishaps and misadventures (and a few small successes) from the author's experience.