Baby Friendly Community Initiative - MEDiCAM

Baby Friendly
Community y Initiative
(BFCI) ( (BFCI) )
CHEA Mary, MD, MHID
National National Nutrition Programme
National Maternal & Child Health Center
Mt Maternal l&Child & Child
Health
O Outline tli
Maternal & Child Health in Cambodia
Infant and Young Child Feeding (IYCF)
Baby Baby Friendly Friendly Community Community Initiative Initiative (BFCI)
(BFCI)
140
120
Current IYCF Community Community-based based activities
What is Baby Baby-Friendly Friendly Community Initiative?
(BFCI)
BFCI Implementation Package
Child Mortality Rates
good progress, on track for MDG 4
100
95
83
80
60
58
66
2000
2005
40
20
0
37
28
37
124
Neonatal mortality Post Neonatal Infant Mortality Under 5
Sources: Cambodia DHS, 2000 & 2005

120
100
80
60
40
20
0
Child Mortality Rates
106
Myyanmar
83 83
Cammbodia
still ill among the h hi highest h i in the h region i
Laao
PDR
38
Indoonesia
Number of under five deaths per 1,000 live births
34 31
Philipppines
China
23 21
‐ 40,000 children under 5 die every year in Cambodia, out of them 10,000 die in the
first month of life
Bb Baby If Infant and dY Young
Child Child F Feeding di (IYCF)
Vieet
Nam
Thhailand
12
Maalaysia
3
Singgapore
Undernutrition in Young g Children
some improvements, but still unacceptably high
Trends in the Prevalence of Child Malnutrition
Cambodia 1996-2008
70
60
50
40
30
20
10
0
59
49
44
40
13 17
8 9
43
40
28 29
Stuntingg Wastingg Underweight g
1996 2000 2005 2008
Source: WHO Global Database on Child Growth and Malnutrition 2007
Wasting & underweight are the most responsive to short-term changes.
This suggests gg that the decline in child malnutrition has now stagnated g
and possibly started to reverse.
Infant and Young Child Feeding Program
Goal
To Improve the survival and well being of infants and young
children by improving their nutritional status, growth, and
development through optimal feeding

Infant and Young Child Feeding Program
Objectives
1. To increase early initiation of brestfeeding within 1 hour of delivery
2. To increase exclusive breastfeeding of infants < 6 months old
3. To Improve appropriate complementary feeding starting at 6 months of age
with continued breastfeeding for at least two years or beyond
4. To support the provision of appropriate care for sick and malnourished
children
80
70
60
50
30
Breastfeeding g Practices
Significant increase in early and exclusive breastfeeding
Trends in early breastfeeding rates, 2000-2005
35 35.1 1
24.4
68.3
40 CDHS 2000
20
10
0
11 11
Early breastfeeding - Early Breastfeeding - Exclusive
within 1 hour within 1 day Breastfeeding
60
CDHS 2005
Source: CDHS 2000 & 2005
Infant and Young g Child Feeding g
Approaches and Strategies
Policy Policy and and legal environment: Sub Sub-decree Sub Sub-decree decree on on Marketing Marketing of Products for IYCF
and National Policy on IYCF
Facility Facility-based based provision of quality IYCF services: Changes in hospital
policies/actions through the the establishment establishment of of Baby Baby Friendly Friendly Hospital Hospital Initiative
Initiative
(BFHI), management of severe malnutrition and IYCF counseling at health
facilities through in-service in service and pre pre-service service training
Community
Community-based y based activities: Community ommunity y nutrition interventions and the
establishment of Baby Friendly Community Initiative (BFCI)
Advocacy and communication strategy strategy: Use se of communication strategy,
including g mass media and behavior change g communications (e.g. ( g World
Breastfeeding Week celebration)
Exclusive Breastfeeding for Infants 00-5
5 months
100
90
80
70
60
50
40
30
20
10
0
11
60
CDHS 2000 CDHS 2005 CAS 2008
49
62
66
40
71
All
Urban
RRural l
Exclusive breastfeeding rate increases from 60% in 2005 to 66% in 2008. But decreases in urban areas.

70
60
50
40
30
20
10
0
Breastfeeding Competitors
Competitors
57 57.2 2 55 55.7 7
existing and emerging issues
36 3.6 52 5.2
1.7 36 3.6
Prelacteal Breastfeeding No
feeding and breastmilk
substitutes
breastfeeding
CDHS 2000 CDHS 2005
Bb Baby Fi Friendly dl
C Community i I Initiative i i i
(BFCI)
months
Age in
70
60
50
40
30
20
10
0
Complementary p y Feeding g
inadequate complementary feeding
33
44
61.7
46.8
6-8 9-11 12-17 18-23
Percent of infants/children
Currently breastfed, fed 3 or more food groups daily, and daily feeding frequency appropriate for age
C Current tIYCF IYCF Community Community-based C it b bbased d activities ti iti
Source: Cambodia DHS 2005
World Breastfeeding Week: since 2001, conducted at all levels
Community nutrition nutrition and and IYCF IYCF education education conducted conducted by by HC
HC
staff, NGOs and village volunteers
Establishment of of Baby Baby Friendly Friendly Community Community Initiative Initiative (BFCI)
(BFCI)
Cooking Demonstration World Breastfeeding Week

What is Baby Baby-Friendly Baby Baby-Friendly Friendly Community Initiative?
Initiative?
(BFCI)
Community Community-based based initiative to
support, promote, and d protect
breastfeeding and to promote
appropriate appropriate complementary complementary feeding
feeding
Main components: Breastfeeding,
Adequate Complementary Complementary Feeding, Feeding
Maternal nutrition, Early Childhood
and Development, Development, p and hygiene yg
Works through formation and
training of “Mother Mother Support Group Group”
at the village level
Close links to Health Centers
BFCI Implementation Package
BFCI Implementation I l t ti Guidelines G id li Communication C CCommunication i ti & &Ad Advocacy
BFCI Training Modules
1. Introduction
2. How to Establish & Maintain
Baby Baby-Friendly Friendly Community
3P 3. Partners
4. Roles & Responsibilities
5. Monitoring & Evaluation
Curricula for training all
partners, staff, and
volunteers involved with
BFCI
1. BFCI Flipchart
2. Advocacy Materials
Baby Baby-Friendly Friendly Community Initiative (BFCI)
2000 2000-2007 2007
IYCF promotion at
community level began in
2000
“BFCI BFCI” began in 2004
By end of 2007, over 3,360
villages “Baby Baby-Friendly Friendly”
villages ill (or ( about b t 20% 20% of f all ll
villages in Cambodia) in 12
provinces
Implemented with support
from o UN UNICEF, C F,C CARE, ,
RACHA, and others
Mother Support Group and health officials
in Kampong Thom Province, Province 2007
o UN C F,C ,
Results achieved (BFCI ( monitoring g data, , UNICEF Jan-Aug g 2007): )
- Early Breastfeeding in Baby Friendly Villages: 72%
- Exclusive Breastfeeding rate in Baby Friendly Villages: 79%
Steps for Establishing Baby Baby-Friendly Friendly Communities
Select Health Centers, build partnerships with Commune
St Step 1: 1 CCouncils, il and d train i HC and d CWCFP
Step 2:
Step 3:
Step 4:
Select BFCI villages
Orient community leaders (village chiefs) to BFCI
Orient existing VHSG members to BFCI
Step 5:
Select and train BFCI volunteers ol nteers

Criteria for maintaining BFCI
Criteria 1: Participation of Commune Council
- At least 2 supervision visits per year to each BFCI village
- Participation in annual planning and review meetings with HC staff
- Comm Commune ne Council Co ncil ffunding nding or tangible ssupport pport
Criteria 2: Regular meetings for BFCI volunteers and follow-up after training
- All BFCI FC volunteers vo u tee s meet eet at the t e health ea t center ce te at least east 2 times t es per pe year yea
- Follow-up from the BFCI training is incorporated into all regular meetings at the health center
that involve BFCI volunteers (VHSG, TBA, BFCI, etc). Follow-up topics may include (but are
not limited to) review of technical information and recommendations, recommendations feedback from volunteers
and problem solving, supervision for reporting forms as needed, etc.
Criteria 3: Monitoring and Supervision
Two reports per year from the village to the health center
At least two supervision visits per year from the Health Center staff to each BFCI village
Cit Criteria i 44: Regular R l Trainings T i i for f BFCI volunteers l t
Existing BFCI volunteers are re-trained every 2 years.Once a year, the complete training is
offered to replacement volunteers (new volunteers that replace drop-out volunteers).
Criteria 5: Targeted home visits and monthly “Baby-Friendly Gatherings”
Mother Support Group (MSG) completes the monthly monitoring forms (Form 1) for all
children under 1 year of age, age every month. month
Supervision reports/checklists from HC staff and CWCFP confirm that the MSG has organized
at least 4 “Baby Friendly Gatherings” in the community in one year.
Monitoring g and Evaluation of BFCI
All partners implementing BFCI should report every six six-months months (April
and October) to the BFCI Coordinator at the National Nutrition
Program
The key “Baby “Baby-Friendly” Friendly” indicators include:
1. Proportion of infants who are put to the breast within 1 hour after
delivery (early initiation of breastfeeding) (0 (0-11.9 11.9 months of age)
2P 2. Proportion i of fif infants that h are exclusively l i l breastfed b fdi in the h first fi 6 6 months h
of life (0 (0-5.9 5.9 months of age)
3 3. Proportion P i of f children hild who h receive i any pre pre-lacteal l llacteal lf feeds d
4. Proportion of children aged 66-9
9 months who receive complementary
f food d( (semi (semi-solid i solid lid or solid) lid) in i addition dditi to t breastmilk. b t ilk
5. Proportion of children aged 66-12
12 months of age who ate any animal
products in the last 24 24 hours. hours
Roles and Responsibilities p of Key y
Players in BFCI
Responsibilities p of Mother Support pp Group p
Commune Council, Committee for Women and Children
Focal Point Point (CWCFP)
(CWCFP)
Health Center staff
Operational District
Provincial Provincial Health Department
National National- BFCI Coordinator at National Nutrition Program
M Monitoring i i and dE Evaluation l i of f BFCI(C BFCI (Con’t) ’ )
NNP will also collect programmatic indicators every six
months (April and October) on the following:
1. Number of BFCI villages g
2. Number of Health Centers trained in BFCI
3. Number of Operational Districts implementing BFCI
4. Number Number of of BFCI BFCI trainings trainings conducted conducted in in the the last last 6
6
months
5 5. Number N b of f BFCI BFCI volunteers l trained i d in i the h last l 6
6
months

Evaluation E EEvaluation l ti of f BFCI
BFCI
Evaluation of BFCI should be conducted by an
external evaluation team.
This should be done every two to three years.
The method method of of the the evaluation evaluation should should be to to survey survey a
a
random selection of BFCI and non non-BFCI BFCI villages, with
a sample p size that will y yield meaningful g comparisons p of
the key indicators in BFCI and non non-BFCI BFCI areas.
This is also an opportunity pp y to collect more detailed
information on child feeding practices, food availability,
household economic status, access to health services,
and other related factors according to the UNICEF
conceptual framework of child health and nutrition.
T Trainings i i for f BFCI
BFCI
BFCI Training of Trainers to
PHD/OD: 6 6 day. day
The optimal number of participants
for a a TOT TOT is is 8 8 to to 12 12 participants. participants
All 27 Lessons are used in the BFCI
TOT
BFCI Training of Trainers to HC
& CCWC staff: staff: 6 6 day
day
BFCI Training to Mother Support
Gro Group: p: 5 day
Flow of Trainings for BFCI
Master Trainers (NNP)
(TOT)
National level MOH
and NGO staff
(TOT)
PHD and OD Community Leaders
(1-day orientation)
(TOT)
Health Center Staff
(MSG Training)
Mother Support Group (MSG)
Advocacy yMaterials &BFCI Flipchart p
Flipchart messages developed based on key messages
agreed g to by y IYCF Technical Working g Group p (NNP ( and
partners)
BFCI Advocacy Ad
materials, including g cost
estimates for establishing
and maintaining BFCI
(brief presentation and 1-
page flyer will be
included in in Section 3, 3
“Partnerships”)

S Sample l of fB Budgeting d ti
BBBudgeting Budgeting dd ii should should hh ldb ldbbe be covered covered ddto to the the hh
following following gg activities: activities:
Orient community leaders (CCWC, village chiefs) to BFCI
Sl Select BFCI BFCI villages ill
Train BFCI volunteers
Supervision visits to community (HC, CCWC(?), OD,
PHD PHD, etc) t )
Annual BFCI review meeting (several HC together)
Th Thank k you f for your attention
tt ti
Allocate Allocate funds funds for for ––
What NGOs can help?
p
training for Mother Support Group volunteers on breastfeeding and
complementary feeding,
buying local foods foods- such as oil, vegetables, meat, iodized salt- salt for monthly
mother’s meetings/cooking demonstration (no milk donations please! Mother’s
milk is best)
scales l f for weighing i hi children hild
operational costs for MOH staff (PHD, OD, HC) and Commune Councils to
supervise Baby Baby-Friendly Friendly Community activities
Refer new mothers leaving hospitals to BFCI volunteers (Mother Support
Group) in their communities (for (for BFHI BFHI hospital hospital staff) staff)
Give supplementary training to BFCI volunteers on how to appropriately
support s ppo HIV V positive pos ve women wo e in infant a feeding eed g in the e community co y (for (for ((
PMTCT PMTCT staff) staff)