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Outline Introduction BFHI Ten Steps Country situation on IF practices Implementation of BFHI under Lishe Ruvuma Program Methodology Results Recommendation/Way forward Conclusion
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Making BFHI a Standard of Care in Health Care will Improve
Implementation of 10 Steps in Health Facilities: Tanzanian
HypothesisPresented at IA Conference, Kampala UgandaBy: Belinda
Liana Pauline Kisanga COUNSENUTH January 2016 Outline Introduction
BFHI Ten Steps Country situation on IF practices
Implementation of BFHI under Lishe Ruvuma Program Methodology
Results Recommendation/Way forward Conclusion Introduction Baby
Friendly Hospital Initiative (BFHI)
is a global effort initiated to implement practices that protect,
promote and support breastfeeding Intends to ensure that all women
are enabled to practice EBF for 6 months and continue to breastfeed
their babies to the age of 2 years and beyond 10 steps to
successful breastfeeding forms the basis for BFHI Ten steps to
successful breastfeeding
Have a written breastfeeding policy that is routinely communicated
to all health care staff Train all health care staff in skills
necessary to implement this policy Inform all pregnant women about
the benefits and management of breastfeeding Help mothers initiate
breastfeeding within a half-hour of birth Show mothers how to
breastfeed and how to maintain lactation, even if they should be
separated from their infants Give new born infants no food ordrink
other than breast milk unlessmedically indicated Practice
rooming-in - allow mothers and infants to remain together - 24
hours a day Encourage breastfeeding on demand Give no artificial
teats or pacifiers (also called dummies or soothers) to
breastfeeding infants Foster the establishment ofbreastfeeding
support groups andrefer mothers to them on dischargefrom the
hospital or clinic Source: WHO and UNICEF, 2010 Implementation of
BFHI under Lishe Ruvuma Program
Overview An integrated community based nutrition programme
implemented in 2 district councils (Tunduru and Songea) of Ruvuma
region BY COUNSENUTH & TFNC + Local government authorities
Objective: Reduction of childhood stunting in Ruvuma by 10% in 5
years through emphasis on the first 1000 Days and accelerated
community actions for nutrition Primary beneficiaries - children
under two years of age - pregnant women Key Interventions under
Nutrition Ruvuma Program
MIYCF/IFA suppl. pregnant women/WASH Key Approaches BCC messages in
print/multi-media/digital media Training of HW on package
ofMIYCF/WASH/IFA HWcounseling skills on (MIYCF/IFA/WASH) Problem
Statement Short training-5 days/multiple issue training
Trainingdone outside of health facility Country Situation of Infant
Feeding Practices
Age National% children Ruvuma Region Baseline Tunduru DC 2013
Baseline Songea DC 2014 1. Early initiation (within 1 hour) of
delivery At delivery 49% 46.5% 58.6% 74.6% 2. Exclusive
breastfeeding 6 months 50% 20.6% 41.2% 3. Exclusive breastfeeding
by age 0- 2months 81% 2-3 months 51% 4-5 months 23% 4. Early
initiation of complementary foods Below 2 month 11% 13% 19% 2 3
month 33% 29% 4 - 5 month 64% 34.7% 30% 5. Late initiation of
complementary foods 8 -9 months 7% Source: TanzaniaDemographic
Health Survey 2010 Objectives of Assessment of 10 Steps
Lapse Time Conducted one year after training Objectives To find out
the impact of a combined /out of facility HW training on
implementation of Ten Steps in HF To identify betterways to
motivate HW to implement Ten Steps in HF Assessment
Methodology
Identified & oriented assessment team on BFHI assessment tools
Assessment Conducted by 2 experts on status ofBFHI Ten Steps using
standard tool by UNICEF/WHO in 4 HF one year after HW training Data
collection methods (using interviews HW/women, observations,FGD
with preg and Lactating women) as per tool Respondents: HW, women,
Hosp. leaders Results Only three steps were well implemented and
met the global BFHI criteria: Step 6-Do not give food or drink to
the baby Step 7: Promote rooming in Step 9: No artificial feeds or
dummies The rest of the steps were very poorly implemented SUMMARY
RESULTS/OBSERVATION
10 STEPS 1 2 3 4 AV 1. Have a written breastfeeding policy that is
routinely communicated to all health care staff 4 2. Train all
health care staff in skills necessary to implement this policy 2 3.
Inform all pregnant women about the benefits and management of
breastfeeding 5 4. Help mothers initiate breastfeeding within a
half-hour of birth 0 5. Show mothers how to breastfeed and how to
maintain lactation, even if they should be separated from their
infants 6. Give new born infants no food or drink other than breast
milk unless medically indicated 10 7. Practice rooming-in - 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 Optional step:Implementation of the CODE: Requires all
facilities which provide maternity services 3 Total Average 4.3 1.
TUNDURU 2. SONGEA 3. KIUMA 4. MBESA Green:well scored Red: not well
scored Intervention Post Assessment
Meetingswere held with Hospital Management Teams, HW and doctors in
each health facility to discuss the results of the assessment One
week Coaching and Mentoring and demos of skills were conducted in
each health facility on how to implement theBFHI Ten Steps
Hospitals informed about an announced repeat evaluation after 6
months The repeat results will be shared with IBFAN Family Our
Hypothesis The second approachwill have better impact on the
implementation of the BFHI Ten Steps inthe majority of health
facilities despite using the same minimum package of information
(MIYCF/IFA/WASH) The results of the repeat assessment after 6
months will be shared with the region and recommendations made
Conclusion The implementation of BFHI is very low in Tanzania
The Tanzania IBFAN Team is looking for ways toimplement BFHI in a
more streamlined and costeffective method. Thechecklist of messages
used in the mentorship ofHealth facilities will be further
developed and tested Our hypothesis is that strengthening HF based
BFHIcoaching and mentorship within other services willenhance
achievement of Ten Steps in health facilitiesand impact EBF rates
Thank you for listening