Implementing an Integrated Nutrition Programme - Health Systems ...

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Chapter Three: Nutrition-related activities within the district 1 Facility-based activities Most primary health services are provided by Local Authorities. Integrated Primary Health Care is provided by a number of types of facilities. These include: • Community health centres which provide primary health care services including supervision of deliveries. They provide a 24 hour service. • Fixed clinics – these are for the most part situated in the small towns and fall under the local municipalities. They provide services during working hours only. • Satellite clinics. These are fixed clinics which are visited by the mobile services. They are usually open one or two days a week. • Mobile services provide services to farm workers. The frequency of the visits to farms varies – some remote areas are visited only on a quarterly basis. Until recently the mobile and satellite clinics fell under the District Council. They have now been taken over by the district. In addition there are three hospitals in the district. These are: • Gordonia Hospital acts as a community hospital for the Upington sub-district and as the referral hospital for other hospitals in Lower Orange. The hospital provides a limited range of secondary level services and serves as the referral hospital for two neighbouring districts (Hantam and Namaqualand). • Kakamas and Keimoes have small community hospitals. 1.1 Breastfeeding promotion Promotion of breastfeeding is regarded as a key activity. The following activities take place on a ongoing basis: • Promotion of breastfeeding as a key part of nutrition education. • Implementation of the Baby Friendly Hospital Initiative • The nutrition team is actively involved in Breastfeeding promotion activities during National Breastfeeding Week in August each year. 1.2 Baby Friendly Hospital Initiative Hospital management at Keimoes and Kakamas Hospital have been made aware of the Baby Friendly Hospital Initiative and the importance thereof. Gordonia hospital has been implementing the Baby Friendly Hospital Initiative. In 1997, four Department of Health officials (the nutritionist, the hospital dietician and two professional 26
nurses) attended an eighty hour course where they were trained as trainers in lactation management. The course was presented by UNICEF in Kimberley. After the training, a meeting was held with the management of Gordonia Hospital during which they agreed to implement the Baby Friendly Hospital Initiative. A Breastfeeding Committee was established consisting of the following people from the hospital: • The obstetrician • The paediatrician • The professional nurse from maternity • The dietician • The professional nurse responsible for training • A health advisor Interventions • A breastfeeding policy for the hospital was developed and communicated to all staff members • In September 1997 formal in-service training of hospital started. All categories of staff, including nurses, housekeepers and general assistants, were trained by the district nutritionist and the hospital dietician using courses based on the 18 hour UNICEF standard. By mid-1999 80% of staff had received training. • All the categories of nursing staff form Upington Municipality and Lower Orange District Council were trained so as to ensure that the ante-natal and post-natal management of breastfeeding at primary health care clinics is done according to the Ten Steps. • Personnel of other departments in Gordonia Hospital (administration, kitchen and laundry staff) attended a one hour information sessions about the BFHI. • Ten short breastfeeding related messages were developed. These messages will form the basis of breastfeeding education at Gordonia Hospital’s ante-natal clinics and at all PHC facilities in the district (which provide the bulk of ante-natal care). • Procedures were introduced to ensure that mothers initiate breastfeeding within an hour of delivery. • A standard procedure/ routine on how to show all mothers in the maternity ward how to breastfeed was implemented. • “Acceptable medical conditions” where breastfeeding is not recommended were developed for the maternity ward, • Rooming-in was introduced. The nursery is now used as a special care unit where the premature babies lie with their mothers. Breastfeeding on demand is encouraged and is possible because babies stay with their mothers for 24 hours. Premature babies who cannot breast or cup-fed, receive expressed breastmilk through tubes administered by the mothers themselves. • Breastfeeding on demand is encouraged. There are no feeding schedules. • Mothers at discharge are referred to PHC clinics in their areas. A standard procedure of referral, which ensures that mothers are seen regularly at the clinics, must still be developed. 27
Page 1 and 2: Implementing an Integrated Nutritio
Page 3 and 4: Framework for District INP Situatio
Page 5 and 6: List of Tables Table 1: Admissions
Page 7 and 8: Table 1: Admissions to Gordonia Hos
Page 9 and 10: Department of Health survey The Nat
Page 11 and 12: serum ferritin levels below 12ug/l
Page 13 and 14: 15% 1% 11% 1% Tap in house Tapwater
Page 15 and 16: On average socio-economic condition
Page 17 and 18: Breastfeeding and weaning practices
Page 19 and 20: Chapter Two: Management of the INP
Page 21 and 22: Step 3: Orientation on programme pl
Page 23 and 24: Five key performance areas were ide
Page 25: Transport The district has a pool o
Page 29 and 30: In theory every preschool child who
Page 31 and 32: • The mothers of children on the
Page 33 and 34: 1.9 Parasite control There are no p
Page 35 and 36: Development Forum (LDF) and the UNI
Page 37 and 38: Other concerns raised included that
Page 39 and 40: Chapter Five: Factors which facilit
Page 41 and 42: Integrating Nutritional Surveillanc
Page 43 and 44: APPENDIX A: RESULTS OF DEPARTMENT O
Page 45 and 46: 1. Implementation of the policy 2.
Page 47 and 48: APPENDIX C: DISTRICT NUTRTION PLAN
Page 49 and 50: 3. Monitoring and Evaluation Implem
Page 51 and 52: 5. Community Development + Intersec
Page 53 and 54: APPENDIX D: SCHOOLS PARTICIPATING I
Page 55 and 56: APPENDIX E: PROJECTS FUNDED BY ALLE

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