PESTANA ROVUMA HOTEL, MAPUTO, MOZAMBIQUE,
13-18 AUGUST 2007

IBFAN Africa hosted it 7th Regional Conference in Maputo, Mozambique from 13th-18th August 2007, with the theme: Revitalisation of the Mother and Baby Friendly Health Facility and Community Initiative in Africa: Successes, Challenges and Forging Ahead.
The Conference was attended by 137 participants from all around the African Continent. These included participants from both Civil Society and Governments, and also incorporated participation from organizations such as UNICEF and WHO.

The objectives of the Conference were to:

1. Update participants on current issues/developments on infant and young child nutrition;
2. Discuss the New WHO/UNICEF BFHI training and assessment tools;
3. To review progress made in the BFHI and Community Support, and share best practices;
4. Consolidate lessons from IBFAN Africa Capacity Project in 5 countries to increase visibility of IBFAN at the national level; and
5. Come up with strategies for scaling up implementation of BFHI in the region drawing from the best practices in the Region.

Major issues covered during the conference included:

1. The Nutrition Status of Children Under the age of five.

2. Breastfeeding in the context of HIV, including the New WHO Consensus Statement on HIV and Infant Feeding.

3. Lessons from ESAR selected Countries in Strengthening the IYCF Components of PMTCT programmes.

4. The International Code of Marketing of Breastmilk Substitutes.

5. Infant Feeding in Emergencies

6. Maternity Protection for Working Women

7. AU and NEPAD Commitment to Maternal, Infant and Young Child Nutrition;

8. Child Survival and Partnership for Maternal, Neonatal and Child Health programmes

9. Evidence for BFHI and new BFHI training tools

10. Gender Mainstreaming, Men and Youth involvement

11. IBFAN visibility-Lessons on the Capacity Building Project in 5 Pilot Countries.

12. Country Progress Reports on Infant and Young Child Nutrition with particular emphasis on the Baby Friendly Hospital/Community Initiative (BFHI).

13. Continued Network Sustainability.

Opening Session
The Regional Conference began with a welcome song sung by members of REENCONTRO, which is one of the IBFAN Mozambique groups at 8.40 am followed by a big welcome to the participants by Mrs. Rufaro Madzima the then IBFAN Africa Board Chairperson. This was followed by an introduction of all the dignitaries in attendance, namely: Dr. Aida Libombo, the Honorable Deputy Minister for Health, Mozambique, Dr Daisy Travoada, WHO, Mozambique, Dr Saba Mebrahtu, UNICEF, ESAR, Mrs. Pauline Kisanga, IBFAN, Africa and Mrs. Margaret Kyenkya, the 1st IBFAN Africa Regional Coordinator and Keynote Speaker.

After a short prayer, Mrs. Dikoloti Morewane, the Board Member for Southern Africa, coordinated the introduction of participants, followed by a warm welcome from Mrs. Kisanga, who then outlined the Conference objectives and gave a detailed analysis of the proceedings for the next five days. She thanked UNICEF, the WHO Regional Office and WHO Mozambique for their participation; the Government of the Republic of Mozambique, in particular, the Ministry of Health for their support; the local organizing committee members for their hard work, the IBFAN Africa Youth Groups in Mozambique for their attendance and commitment; the participants and the governments for releasing their staff to participate in this important meeting; the donors- SIDA, Dutch government, ICCO, UNICEF, WHO Mozambique; facilitators, IBFAN Africa Youth Group and the IBFAN Africa Regional Office Staff for all the work that had gone into the preparation for the Conference.

The Coordinator continued further to give background of the meeting mentioning that such a meeting is held every 3 years and the current was the 7th one. The Conference was aimedat providing a forum for sharing of experiences and information, enriching and updating participants on new knowledge and developments, create consensus on some issues, formulate the next 3 year action plan and goals, and elect a new Advisory Board. She also mentioned that there were about 100 participants from 24 out of 32 countries.

The Regional Coordinator also highlighted that the Conference gave an opportunity to update members on IYCF with relation to HIV. This had been confusing in the past, but now the role of exclusive breast feeding and counselling had been more clearly enunciated in the recently formulated WHO Consensus Statement on Infant and Young Child Feeding.

This was followed by the launching of IBFAN Mozambique Consortium of 10 NGO and the Regional Youth Network by the Honorable Deputy Minister of Health Dr Aida Libombo. During the launching of IBFAN Mozambique, Olinda Mugabe, Reencontro Coordinator expressed her gratitude to IBFAN Africa and ICCO, the donor for facilitating the formation of the IBFAN Mozambique, which is a coalition as experience had shown that…working alone did not have much impact… and hence the reason for forming the network. During the launching of the Youth Network, Vulie Kunene, Youth Project Officer in the Regional Office called for meaningful involvement of the Youth in IYCF issues including representation in decision-making and policy formulation. Certificates of appreciation were awarded to various groups and individuals in recognition of their dedication and devotion to the work of IBFAN Africa. The criteria used for the award were: innovative ideas or strategies in implementing national IYCF programmes; significant progress in establishing community based support for pregnant, lactating and newly delivered mothers; and excellent communication. Countries awarded include: Cameroon, The Gambia, Sudan and Mauritius whilst some organizations were also recognized including: Biligert, SABA, IBFAN Uganda, BPCG, NaNA and Counsenuth along with some individuals including James Achanyi-Fontem and Dr. Florence Nwazor.

In the keynote address, Dr Margaret Kyenkya, the first Regional Coordinator gave the participants a brief outline of the origins of IBFAN Africa, almost 28 years ago, and how we have come a long way. She also posed a question to the participants asking…do African leaders know what we have been/are doing? She finished off by acknowledging the hard work and efforts of Pauline and her staff and encouraged the membership to…stay strong and keep working.

In the remarks by the UNICEF Nutrition Advisor, Dr Saba Mebrahtu, she expressed her thanks for the invitation extended to UNICEF to participate in this important event. She noted that the theme of the current 7th Regional ConferenceRevitalization of the Mother and Baby Friendly Health Facility and Community Initiative in Africa: Successes, Challenges and Forging Ahead. was timely and relevant to the on going efforts to improve maternal nutrition and health and optimal infant and child feeding practices, hence enhance child survival growth and development. She further highlighted that the importance of tackling some of the main serious challenges affecting infant and young child nutrition one of which has been the HIV pandemic remained a global challenge. She went on to say thatFood Security and Nutrition was Key to Africa Achievement of MDG 4 of the Millennium Development Goals.
This was then followed by a series of presentations and discussions on the issue at hand. Some of the issues that were raised in the discussions included the following:

1. Malnutrition has not improved in the region and in Sub-Sahara there are countries where it is increasing-the role of exclusive breastfeeding was well recognized;

2. IYCF components of the PMTCT programmes were on the whole very weak as observed from the WHO/UNICEF IATT reviews in 9 countries;

3. The WHO Consensus Statement is not yet well understood and the information needs to be widely disseminated ;

4. Some current studies such as Mitra Plus that provide triple ARV to HIV+ mothers who are breastfeeding for 6 months further reduce the risk of HIV transmission for babies. Rates of transmission of around 1% were observed in exclusively breastfed infants in a study by Dr Augustine Massawe from Tanzania; and

5. The involvement of civil society was seen as critical in sustaining BFHI and IYCF. In countries where IBFAN NGOS are well involved, sustainability seemed better.

Some observations were evident from the different Country presentations on their Baby Friendly Hospital/Community initiatives.

1. Countries have done better in developing National Strategies and Policies or Guidelines but implementation remains low in all countries for all aspects of the IYCF including BFHI;

2. Country reports indicated serious decline in BFHI, though much commitment is shown for reactivation in all countries;

3. Most BFHI training is still centrally conducted and has low staff coverage which affects qualityhowever, a few best examples of facility based training were reported in a few countries;

4. In countries where large numbers of mothers deliver outside health facilities (60-90%) Somalia, Gambia, Rwanda, Sudan there are better community based initiatives (BFCI);

5. Many countries have not yet adopted the New BFHI Training Tool but there are some countries that are adopting the tools at National level and developing Integrated Minimum Training Packages to incorporate all elements;

6. In-service training of health workers is proving very expensive and participants called for urgent efforts to integrate IYCF in pre-service training;

7. Many countries have Draft Codes and are committed to speeding up Code enactment process but COUNTRIES report subtle company tactics that undermine this process - e.g. Companies calling for Code reviews that have no actual meaning;

8. There is little monitoring of the Code by countries apart from that supported by IBFAN Africa-many countries renewed requests for training in this area;

9. Nurses and doctors are not the only targets for baby milk companies: nutritionists are also being targeted and tend to work for companies- hence the need to target training on the Code to all cadres;

10. Companies were shown to be taking advantage of emergency situations-the need to monitor the Code in any food aid projects was noted.

Several challenges were noted to the implementation of BFHI/BFCI in countries. These include the following

1. Implementation of new training tools needs extra resources-funding and staff time and facilitators;

2. High staff turnover;

3. Difficulty of including medical doctors in training;

4. Quality of training;

5. Local companies are becoming code violators - e.g. In Mauritius, Zambia and Swaziland;

6. National Nutrition Institute in South Africa is offering health professional training in many countries in Africa misleading them in the guise of HIV prevention; and

7. NGO collaboration (lack of) with governments and in some countries WHO poses major challenges.

Some recommendations were made that could assist in the management of IYCF in countries. These included the following:

1. There are too many training tools, there is a need for an integrated training tool, making it a single package;

2. Regional partners to develop self teaching modules since governments are reluctant to release staff for in-service-training;

3. IBFAN Africa to develop a training module and assessment indicators for community support;

4. WHO and UNICEF to support Integration into pre-service training Curriculum;

5. The BFHI training modules on the Code and HIV and infant feeding should not be optional in African countries;

6. There is need for a coordinated regional response to scaling up of BFHI and other IYCF;

7. Regional partners to mobilise resources including facilitators for scale up of national integrated packages;

8. Regional bodies to increase high level advocacy for implementation of the Code and resource allocation to IYCF-ex-IBFAN Africa visits made to countries were reported to have to have made major impact in the 5 Capacity Building project countries; and

9. IBFAN to increase advocacy to WHO country offices for support with high level advocacy to governments on the need for Code enactment and other infant and young child feeding issues.

The representatives of the various Countries made certain commitments. These included the following:

1. We need to scale up BFHI using the new training tools and incorporating the modules on the Code of Marketing and HIV/infant feeding;

2. Each country thought that exclusive breastfeeding cannot be achieved without community support and therefore we need to support toward exchange visits to countries with successful community initiatives so that each country can initiate effective community support;

3. We need to apply more multi-sectoral approach and active involvement of civil society in our programmes;

4. We need a greater involvement of youth and men groups in improving Code monitoring and information dissemination on infant and young child nutrition;

5. We need more training on Code monitoring for cadres targeted by the companies; and

6. We needSelf Training Manuals as well as spread-out training that avoids high costs and formal timing

* A prototype of a feeding cup developed by the Health Department in the Republic of South Africa was distributed to encourage cup feeding.