Kulani Mavunda
Polokwane

Mokopane Hospital is considered to be the best hospital in Limpopo to have a baby.

The hospital received a platinum certificate last week for the quality of care it offers to newborn babies and their mothers.

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Posted by Vulie Kunene on 11 Oct 2007 | Tagged as: BFHI, General, South Africa

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Hospitals and maternity units set a powerful example for new mothers. The Baby-Friendly Hospital Initiative ( BFHI ), launched in 1991, is an effort by UNICEF and the World Health Organization to ensure that all maternities,whether free standing or in a hospital, become centers of breastfeeding support.A maternity facility can be designated ‘baby-friendly’ when it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented 10 specific steps to support successful breastfeeding.

The process is currently controlled by national breastfeeding authorities, using Global Criteria that can be applied to maternity care in every country. Implementation guides for the BFHI have been developed by UNICEF and WHO.

FHI Part II provides the Global Criteria and outlines how to transform hospital practices. Part IV and Part VI help to verify the ending of free and low-cost supplies of breastmilk substitutes. Additional BFHI Parts, including questionnaires used by external teams to assess facilities before Baby-Friendly designation, may be requested when appropriate from the breastfeeding authority of each country.

Please see the following list of Baby Friendly Hospitals on a country by country basis. In areas where hospitals have achieved baby-friendly status, more mothers are breastfeeding their infants, and child health improves as a consequence.

Since the BFHI began, more than 15,000 facilities in 134 countries have been awarded Baby-Friendly status. In many areas where hospitals have been designated Baby-Friendly, more mothers are breastfeeding their infants, and child health has improved. News of the BFHI accomplishments and articles about effective breastfeeding programmes have been published for ten years in UNICEF’s BFHI News.

New knowledge about breastfeeding and its management has been provided through publication of four training courses, and through recommendation of selected Breastfeeding Papers of the Month .

Ten steps to successful breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one half-hour of birth.
5. Show mothers how to breastfeed and maintain lactation,even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Source: UNICEF

Posted by ibfanafrica on 05 Jan 2007 | Tagged as: BFHI

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UGANDA A Success Story

UNICEF deployed three external consultants to support 10 national trainee assessors to externally assess 34 health facilities. The assessments covered a period from 19 March to 13 April 2006.

The major objective of this external assessment was to evaluate the extent and quality of care and support given to mothers during pregnancy, labour and puerperium as demanded by Global Baby and Mother friendly Initiative Criteria in the current context of HIV.

Altogether 34 facilities were assessed. These included referral hospitals, General Hospitals, training hospitals and Health care centres Grade IV. Summary results of the external assessments are here presented:

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Uganda has made some gains in BFHI. It has achieved its first externally certified baby friendly facilities as follows:

15 Certified Baby Friendly11 Certified Committed to BFHI

7 Certified to have participated

1 Not certified

IBFAN Africa congratulates Uganda for their success and encourages other countries in the region to follow their example.

IBFAN Africa congratulates Uganda for their success and encourages other countries in the region to follow their example.

Some of the areas that were identified as needing improvement, include but are not limited to, some of the following:

It was evident that many top level decision makers in most health facilities were not very conversant about the benefits of BFHI or about the current knowledge of HIV/infant feeding. There is need for greater awareness among top level decision makers in all facilities.

Training is the critical element of BFHI. As can be seen on Table 2, very few staff have been trained per facility. This is mostly due to the fact that training was conducted centrally and this way it is difficult to reach as many staff as otherwise necessary. Decentralised training is encouraged as much as possible. Training should include non-clinical staff and medical doctors.

Access to information material by mothers at all levels was very low and use of available education materials for handing out to mothers was not appropriate as HIV negative mothers also received leaflets on instructions of preparation of infant formula.

The area of the International Code of Marketing of Breastmilk Substitutes and relevant Resolution in infant nutrition was not understood by all clinical staff.

It is important to note that, although these were noted in the assessment of Uganda, they are prevalent in many countries in the Region. Thus, these are some of the issues that warrant our consideration.

Some recommendations that were made to achieve continuity and sustainability of BFHI, and are also applicable not only to Uganda but to other countries noted that the following needed to be addressed.

The Ministry of Health

A. Our respective Ministries of Health should sensitize all hospital managers (Medical Superintendents, Matrons and Hospital Administrators) on IYCF in general and on BFHI in particular to ensure they understand the health benefits of the initiative, develop relevant health policies at the health facility and become committed to its success.

B. They should immediately decentralise all training on infant and young child feeding and HIV/infant feeding as per integrated training manual to health facilities as done for other primary health care initiatives. Training manuals should be available to key trainers in all facilities to support this. The Districts and regions should support the health facilities as needed. But the leadership of health facilities should be charged with sustenance of the initiative.

They should immediately decentralise all training on infant and young child feeding and HIV/infant feeding as per integrated training manual to health facilities as done for other primary health care initiatives. Training manuals should be available to key trainers in all facilities to support this. The Districts and regions should support the health facilities as needed. But the leadership of health facilities should be charged with sustenance of the initiative.

C. Ministries should finalize and disseminate the counseling and other related IEC materials on IYCF. The health care providers should be oriented on the use of these materials. The utilization of these materials should be monitored.

Ministries should finalize and disseminate the counseling and other related IEC materials on IYCF. The health care providers should be oriented on the use of these materials. The utilization of these materials should be monitored.

D. The Ministry of Health should provide technical support to health facilities in helping to initiate community based support for IYCF. Guidelines to this effect would be very helpful.

The Ministry of Health should provide technical support to health facilities in helping to initiate community based support for IYCF. Guidelines to this effect would be very helpful.

E. The National Authorities on IYCF should be charged with the responsibility to ensure quality and monitoring of its successful implementation.

The National Authorities on IYCF should be charged with the responsibility to ensure quality and monitoring of its successful implementation.

F. Ministries should:

Ministries should:

Ministries should:

a) assign a special body/organisation the responsibility to support and supervise its implementation at all levels.

b) require Districts to include BFHI in their work plans

c) ensure that BFHI, like other maternal and child health services, is integrated with other services such as PMTCT, IMCI, Safe Motherhood, Life Saving Skills, Goal Oriented Antenatal Care, newborn care and UNEPI.

d) consider inclusion of IYCF issues in the teaching agendas of health training institutions

G. For the purpose of monitoring and evaluation, the MOH should:

For the purpose of monitoring and evaluation, the MOH should:

For the purpose of monitoring and evaluation, the MOH should:

a) Demand a minimum infant feeding data from health information systems maintained in health facilities.

b) Conduct bi-annual monitoring through self assessment

c) Strive to widen the scope of the PMTCT supervision tool in order to include IYCF issues.

d) Place BFHI as one of the important indicators in the National Health Sector Performance Report

e) Evaluate participating health facilities through three yearly re-assessments of BFHI status.

Ministries should finalize and disseminate the counseling and other related IEC materials on IYCF. The health care providers should be oriented on the use of these materials. The utilization of these materials should be monitored.The Ministry of Health should provide technical support to health facilities in helping to initiate community based support for IYCF. Guidelines to this effect would be very helpful.The National Authorities on IYCF should be charged with the responsibility to ensure quality and monitoring of its successful implementation.Ministries should: For the purpose of monitoring and evaluation, the MOH should: Our respective Ministries of Health should sensitize all hospital managers (Medical Superintendents, Matrons and Hospital Administrators) on IYCF in general and on BFHI in particular to ensure they understand the health benefits of the initiative, develop relevant health policies at the health facility and become committed to its success.They should immediately decentralise all training on infant and young child feeding and HIV/infant feeding as per integrated training manual to health facilities as done for other primary health care initiatives. Training manuals should be available to key trainers in all facilities to support this. The Districts and regions should support the health facilities as needed. But the leadership of health facilities should be charged with sustenance of the initiative.Ministries should finalize and disseminate the counseling and other related IEC materials on IYCF. The health care providers should be oriented on the use of these materials. The utilization of these materials should be monitored.The Ministry of Health should provide technical support to health facilities in helping to initiate community based support for IYCF. Guidelines to this effect would be very helpful.The National Authorities on IYCF should be charged with the responsibility to ensure quality and monitoring of its successful implementation.Ministries should:For the purpose of monitoring and evaluation, the MOH should:

The Districts

H. The districts should include infant and young child feeding activities in their work plans, including a monitoring and evaluation mechanism.

I. They should work collaboratively with the Development partners, NGOs, religious bodies, Community Groups and relevant movements operating in their areas to support IYCF initiatives.

They should work collaboratively with the Development partners, NGOs, religious bodies, Community Groups and relevant movements operating in their areas to support IYCF initiatives.

J. The infant and young child feeding component and in particular BFHI, should be one of the indicators to be considered when comparing the Health Sector performance of various districts.

The infant and young child feeding component and in particular BFHI, should be one of the indicators to be considered when comparing the Health Sector performance of various districts.

The infant and young child feeding component and in particular BFHI, should be one of the indicators to be considered when comparing the Health Sector performance of various districts.

The infant and young child feeding component and in particular BFHI, should be one of the indicators to be considered when comparing the Health Sector performance of various districts.The districts should include infant and young child feeding activities in their work plans, including a monitoring and evaluation mechanism.They should work collaboratively with the Development partners, NGOs, religious bodies, Community Groups and relevant movements operating in their areas to support IYCF initiatives. The infant and young child feeding component and in particular BFHI, should be one of the indicators to be considered when comparing the Health Sector performance of various districts.

The Health Facilities

K. All facilities to integrate infant and young child feeding, HIV/infant feeding and BFHI issues into their ongoing continuing education that is held weekly or monthly

L. Interpersonal communication between staff and mothers needs to be greatly improved as this will enhance practical lactation management skills before mothers are discharged from health facilities.

Interpersonal communication between staff and mothers needs to be greatly improved as this will enhance practical lactation management skills before mothers are discharged from health facilities.

M. Re-enforce ANC education through rescheduling of hours of education, documenting daily education themes and written information, as well as increasing individual counseling to all mothers on all issues related to infant and young child feeding and BFHI.

Re-enforce ANC education through rescheduling of hours of education, documenting daily education themes and written information, as well as increasing individual counseling to all mothers on all issues related to infant and young child feeding and BFHI.

N. Since mothers are discharged within 24 hours after delivery, the first post natal check-up should be within the first week; because this is the critical time when mothers and babies are likely to experience difficulties

Since mothers are discharged within 24 hours after delivery, the first post natal check-up should be within the first week; because this is the critical time when mothers and babies are likely to experience difficulties

O. Health care facilities should initiate and strengthen community support groups to which mothers can be referred to upon discharge from health care facilities. These groups can serve as vehicles to link mothers and young children to health care facilities.

Health care facilities should initiate and strengthen community support groups to which mothers can be referred to upon discharge from health care facilities. These groups can serve as vehicles to link mothers and young children to health care facilities.

Health care facilities should initiate and strengthen community support groups to which mothers can be referred to upon discharge from health care facilities. These groups can serve as vehicles to link mothers and young children to health care facilities.

Re-enforce ANC education through rescheduling of hours of education, documenting daily education themes and written information, as well as increasing individual counseling to all mothers on all issues related to infant and young child feeding and BFHI.Since mothers are discharged within 24 hours after delivery, the first post natal check-up should be within the first week; because this is the critical time when mothers and babies are likely to experience difficultiesHealth care facilities should initiate and strengthen community support groups to which mothers can be referred to upon discharge from health care facilities. These groups can serve as vehicles to link mothers and young children to health care facilities.All facilities to integrate infant and young child feeding, HIV/infant feeding and BFHI issues into their ongoing continuing education that is held weekly or monthlyInterpersonal communication between staff and mothers needs to be greatly improved as this will enhance practical lactation management skills before mothers are discharged from health facilities.Re-enforce ANC education through rescheduling of hours of education, documenting daily education themes and written information, as well as increasing individual counseling to all mothers on all issues related to infant and young child feeding and BFHI.Since mothers are discharged within 24 hours after delivery, the first post natal check-up should be within the first week; because this is the critical time when mothers and babies are likely to experience difficultiesHealth care facilities should initiate and strengthen community support groups to which mothers can be referred to upon discharge from health care facilities. These groups can serve as vehicles to link mothers and young children to health care facilities.

Development Partners

P. The UN agencies should increase support towards the implementation of infant and young child feeding and BFHI in particular by investing in health facility based training and sensitization of health care staff including medical doctors, nutritionists and non-clinical staff. Additional support will be needed for monitoring and evaluating the initiative.

The UN agencies should increase support towards the implementation of infant and young child feeding and BFHI in particular by investing in health facility based training and sensitization of health care staff including medical doctors, nutritionists and non-clinical staff. Additional support will be needed for monitoring and evaluating the initiative.

Q. Other relevant community based organizations should be sensitized to integrate the BFHI and IYCF issues into their development agendas at all levels.

Other relevant community based organizations should be sensitized to integrate the BFHI and IYCF issues into their development agendas at all levels.

Other relevant community based organizations should be sensitized to integrate the BFHI and IYCF issues into their development agendas at all levels.

The UN agencies should increase support towards the implementation of infant and young child feeding and BFHI in particular by investing in health facility based training and sensitization of health care staff including medical doctors, nutritionists and non-clinical staff. Additional support will be needed for monitoring and evaluating the initiative.Other relevant community based organizations should be sensitized to integrate the BFHI and IYCF issues into their development agendas at all levels.

The Communities

Communities and families are important elements of support to the newly delivered mother. They should be sensitized to this need. Once sensitized, they should

R. Form or identify existing community support systems where mothers can get support when needed.

Form or identify existing community support systems where mothers can get support when needed.

S. Identify young mothers of families that may need extra support and involve them in educational activities.

Identify young mothers of families that may need extra support and involve them in educational activities.

T. Initiate male and youth involvement into family support and care activities.

Initiate male and youth involvement into family support and care activities.

Initiate male and youth involvement into family support and care activities.

Posted by Vulie Kunene on 25 Dec 2006 | Tagged as: BFHI, General, Uganda, Watch the Code

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