Slide 1

The Mother Baby Friendly Initiative (MBFI) In South Africa

The South African Mother BabyFriendly Initiative Experience

9th International Baby Food Action Network (IBFAN)Africa Regional Conference 1-4 February 2016, Kampala,Uganda

Z. KUBEKA

On behalf of:

NDOH : CHILD , YOUTH HEALTH & NUTRITION

Outline of the Presentation

•Brief History of MBFI in South Africa

Current MBFI status in South Africa

Lessons learned

Strengths & opportunities

Implementation challenges

Scaling up plans

Brief history of the SA Baby FriendlyHospital Initiative (BFHI)

•Adopted the Global Strategy in 1994

•Set targets- National, Provincial and District target

•Initially supported by UNICEF

•Trainers and assessors trained by IBFAN Africa,

•Used International assessors to assess and mentor NationalAssessors

•A BFHI implementation strategy was developed

•Provincial Managers have included MBFI in their KPAs

Outline of the Strategy

•Outlined roles and responsibilities at various levels

–Including funding mechanism for the assessment process

•Outlined the capacity building plan

•Decisions on the skills mix for assessors (Nutrition,Nurse etc)

•Outlined BFHI roll out plan

•Planning and Assessment cycle

•The accreditation process

Decentralization and coordinationof BFHI

National

Province

District level

Facility level

Policy developmentCapacity building, co-ordinate assessments,set National targets

Capacity building,implementation bodyfund travel betweenprovinces, overall prov.Coordination, setProvincial targets

Capacity building,support monitoring offacilities

Support internalassessments

Conduct training, selfappraisal, formed hospitalBFHI implementationMultisectoral teams

Process and planning cycle

Strategic planning session:

Provinces set targets

Budget for assessments

National targets aligned toProvincial

Assessments spread /Quarter

Facilities supported byProvince and district

National- allocateassessors team

Provincial & nationalreports on current status

•BFHI assessmentsinitially conduced byinternational assessors

Not sustainable

•Currently assessmentsare carried out by ateam of trainedassessors (Dietitians,Professional Nurse,Midwife

•Local teams werecapacitated

More sustainable

•Provinces conductProvincial monitoringyearly.

•National Reassessmentsconducted every threeyears

Plaque removed if thefacility does notmaintain status

Assessment Process.

Health Facilities declared as MBFI 1995 to 2014Health Facilities 545

BFHI In SA was not yielding the desired results. ExclusiveBreastfeeding rates still low, Infant and child mortality rates high but gradually declining

Challenges:

•Perception that MBFI is the solution to all problems MBFI still implemented

as a vertical programme &

• not integrated into other child survival strategies.

• Poor follow up of mothers after discharge

• Most mothers go back to work/school, maternity leave paid 16 weeks

• Lack of involvement of Community and family support on breastfeeding

• Too much window dressing in facilities just to get the award

Outcomes of BFHI in SA

THE STRATERGY NEEDED TO BE REVISED

Revitalization of BreastfeedingCont.

2011

Breastfeeding ConsultativeMeeting

•The term Mother, Baby Friendly Initiative wasadopted

2012- Development of a clinic tool

•Aimed to extend MBFI to clinics (strengthening ANC,PNC & community support)

Incorporating MBFI into otherchild health processes

•Breastfeeding training package included into NNCtraining package, incorporating in initiatives fornewborn care (INC, LINC, WINC)

2013/14

•Inclusion of breast feeding Indicators in the DistrictHealth Information System

2014

• MBFI tools revised to align SA Context - 2013 revisedIYCF & PMTCT guidelines (HIV & Infant feeding &Regulations)

2015

•Establishment of the Breastfeeding technical workinggroup at national level

Infants exclusively breastfed at 14 weeks ( Link with Immunization visit)

Lessons learned

•MBFI without strong community support does not translateinto increased breastfeeding rates.

•Start with facilities with a higher deliveries in order to reachmore mothers

•Advocacy to policy makers and managers at differentimplementation levels is critical.

•Resource constraints (finance, high staff rotation)

•MBFI not fully adopted as routine maternity standard

•Lack of opportunity for training, staff not release for training

•Lack of adequate monitoring by District, only waiting for the re assessment year

•Limited lodger facilities for mothers with babies in special care although this ispolicy- needs scaling up

•Sophisticated infant food marketing practices

•Contradictory views of medical practitioner’s regarding exclusive feeding

Challenges at Implementation level

Next Steps in the following 12 months

•Continuous Advocacy for MBFI across all levels

•Include MBFI on the package for PHC

•Strengthen Community representation in thefacility committees

•Continuous accreditation of Assessors skills &updates every 2 years (maintain quality)

•Strengthen capacity for CHW to support BF

I THANK YOU ALL FOR LISTENING