Download - October 13-14, 2005 Martinique
Caribbean Workshop on the WHO/UNICEF Global Strategy for
Infant Young Child Feeding and the New WHO Child Growth
Standards
Caribbean Workshop on the WHO/UNICEF Global Strategy for
Infant Young Child Feeding and the New WHO Child Growth
Standards October 13-14, 2005
MartiniqueOctober 13-14, 2005
Martinique
Working Group 1Objectives
Working Group 1Objectives
• To review the status of infant and young child
feeding (IYCF) policies and programs;
• To identify critical barriers to, and opportunities and priority actions for improving the protection, promotion and support of optimal IYCF practices based on the aims and objectives and recommended interventions outlined in the Global Strategy; and
• identify critical barriers, opportunities, and priority actions required for strengthening national growth monitoring/promotion programs and the incorporation of the new international growth standards in child health services.
Summary of Group Discussions
English-speaking Caribbean Countries (16)
& Suriname
Summary of Group Discussions
English-speaking Caribbean Countries (16)
& Suriname
Anguilla, Antigua & Barbuda, Bahamas, Barbados, Belize, British Virgin Islands, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, St. Lucia,
St. Kitts & Nevis, St. Vincent & the Grenadines, Suriname, Trinidad & Tobago, Turks & Caicos Islands
IYCF Policies and Targets
IYCF Policies and Targets
1. Development/Implementation of National Comprehensive Policy on IYCF
1. Development/Implementation of National Comprehensive Policy on IYCF
Achievements
Barriers Opportunities
Priority Actions
Preparation of IYCF guidelines for the Caribbean
Breast feeding policy officially adopted in 4 countries. In draft form – in others
Limited human resourcesLack of data for policy developmentLack of awareness by decision makersInadequate training in medical educationLack of orientation to existing policies
The need to revise/update existing policies based on the Global Strategy
Development of national strategic plans (ongoing)
Nutrition personnel & MCH Coordinators sensitized to spearhead the process
Advocacy to policy makers for support of Global Strategy implementation
Prepare plan of action for revision of existing policies
Conduct research on IYCF practices
2. Appointment of National Coordinator and Committee Responsible for IYCF
2. Appointment of National Coordinator and Committee Responsible for IYCF
Achievements
Barriers Opportunities
Priority Actions
IYCF Coordinators and Committees appointed in 2 countries
Breastfeeding Coordinators and Committees in 4 countries
Posts not established and extra responsibilities assigned to busy staff
Roles and responsibilities of Committees and Coordinators not clearly delineated
Possibility of extending mandates of existing committees; extend membership e.g. media personnel
Advocacy for policy development
Revamp, strengthen and expand committees with set targets to sustain continuity
3. Adoption of measures for implementation of the International Code
3. Adoption of measures for implementation of the International Code
Achievements
Barriers Opportunities
Priority Actions
No legal framework in place for Code implementation
Adoption of some measures as voluntary measures
Preparation of drafts of national Codes completed in 2 countries
Lack of awareness of rationale and relevance of the Code
Link between Government and the corporate world
Attitudes of health workers
Link to implementation of CRC
Establishment of Early Childhood commissions with support from UNICEF
Availability of trained persons in some countries
To develop National Codes; implementation plans
To sensitize policy-makers, distributors of BMS and the general public
Training for health workers
4. Adoption of Legislation consistent with ILO Standards for Protecting and Supporting Breastfeeding
among working Women
4. Adoption of Legislation consistent with ILO Standards for Protecting and Supporting Breastfeeding
among working Women
Achievements
Barriers Opportunities
Priority Actions
The ILO Maternity Protection Convention (No.183) has not been fully ratified or enacted
In all countries, minimum of 12 weeks paid maternity leave; benefits tied to NIS contributions
Lack of political will
No strong lobbying or advocacy for protecting and supporting breastfeeding in the workplace
Lobbying through strengthened BF/IYCF Committees
Solicit support at regional level for implementation of ILO Convention (183)(CARICOM, UNICEF)
Review current legislation in light of ILO conventions
Organize consultations with stakeholders to sensitize them to issues related to breastfeeding promotion and support
IYCF Programs IYCF Programs
1.Development/Implementation of National IYCF Programs with Measurable Objectives
1.Development/Implementation of National IYCF Programs with Measurable Objectives
Achievements
Barriers Opportunities
Priority Actions
National programs outlined in 4 countries
Some aspects of IYCN promotion form part of MCH services in all countries
Lack of integration among program generally
Lack of human resources – frequent staff turnover
Lack of data on IYCF practices for program planning
Sensitization to the Integrated Approach to ECD
Plans to incorporate behaviour change strategies at program level
Review program objectives and indicators in keeping with MDGs and Global Strategy
Develop/review national programs where necessary
Strengthen information systems on IYCF practices
2. Full Implementation and Active Monitoring of the BFHI
2. Full Implementation and Active Monitoring of the BFHI
Achievements
Barriers Opportunities
Priority Actions
Full implementation and certification of main hospitals in 5 countries
Active promotion of BFHI in 5 other countries
No national policy for BFHI promotion High staff turnover; lack of orientation and ongoing training for new staff
Inadequate monitoring of progress in BFHI
Sensitization of hospital administrative personnel (Cost Benefit Analysis)
Strong antenatal programs exist
Availability of training materials from WHO & UNICEF
Public Communication Strategy to heighten Public Awareness on BFHI
Preparation/review of plans for achieving full BFHI implementation and/or re-assessments of certified hospitals
3. Development /Implement of standards and Guidelines for Mother-Friendly child birth procedures
3. Development /Implement of standards and Guidelines for Mother-Friendly child birth procedures
Achievements
Barriers Opportunities
Priority Actions
Some relevant standards and guidelines are included in Breastfeeding policies
Lack of awareness of medical and nursing staff about relevant procedures
Increased consumer awareness and demand for these procedures
Incorporate standards and guidelines in relevant policies
Monitor adherence of Standards and guidelines
4. Review of IYCF Curricula in Pre-Service Education Programs for Health Care Providers
4. Review of IYCF Curricula in Pre-Service Education Programs for Health Care Providers
Achievements
Barriers Opportunities
Priority Actions
IYCF-related topics are included in pre-service education programs for nursing categories
Insufficient attention to topics related to complementary feeding
Non- participation of MCH or Nutrition personnel in the review process
Resistance to change
Availability of scientific evidence for optimal IYCF practices
Availability of training materials from WHO & UNICEF
Sharing of revised curricula with other countries.
Evaluation of current training curricula
Initiate discussions with relevant training institutions
Review/infuse in the training curricula
5. Review /Strengthening and Organization of In-service Training Programs for health care providers
5. Review /Strengthening and Organization of In-service Training Programs for health care providers
Achievements
Barriers Opportunities
Priority Actions
Ongoing in some countries
BFC & HIV/IFC courses introduced in region
BFC has been conducted in 9 countries; HIV/IFC in 5 countries
No overall in-service training plans
Lack of human & financial resources
Attitudes of some health care workers - do not avail themselves for training
Availability of training courses from WHO/UNICEF
Strengthened IYCF Committees to be proactive – piggy back on ongoing training programs
Development of IYCF training plans
Compile/update data base of trained persons
6. Implementation of Effective Community-based IYCF outreach and support activities
6. Implementation of Effective Community-based IYCF outreach and support activities
Achievements
Barriers Opportunities
Priority Actions
Ongoing to some extent in all countries, mainly through NGO activities
Insufficient support & direction from health system
Lack of consistency in educational messages
NGOs may have access to funds
Free access to media in some countries
Integrate with Health & Family Life Education and Youth-friendly services
Incorporate practical aspects in relevant syllabi of Caribbean Examination Council
Sensitize decision-makers at the community level
Conduct training for community personnel e.g. CBOs; service clubs
Conduct training of Community and Peer counsellors
7. Implementation of Comprehensive IEC Strategy for improving IYCF
7. Implementation of Comprehensive IEC Strategy for improving IYCF
Achievements
Barriers Opportunities
Priority Actions
None of the countries have a comprehensive IEC strategy
Observance of World Breastfeeding Week in 9 countries
May have integration of IYCF theme with other observances eg. World Health Day 2005
Ad hoc IEC programming
Lack of information on local practices, attitudes & perceptions
Possibility of integration with existing health promotion strategies
Create linkages with other programs through integration
Conduct research on IYCF practices & determinants
Development of comprehensive IEC strategy
Strengthen and evaluate strategies
8. Development/Implementation of Standards and Guidelines for Provision of Contraceptive support to BF Women
8. Development/Implementation of Standards and Guidelines for Provision of Contraceptive support to BF Women
Achievements
Barriers Opportunities
Priority Actions
Inclusion in family planning protocols in some countries
Inadequate understanding of conditions for use of LAM
Cultural and religious beliefs
Affordability &availability of preferred types and methods
Religious support for promoting breastfeeding as natural contraceptive
Availability of relevant information from WHO
Review/update/develop standards & guidelines
9. Development/Implementation of Policies forIYCF Counseling & Support to HIV-positive mothers
9. Development/Implementation of Policies forIYCF Counseling & Support to HIV-positive mothers
Achievements
Barriers Opportunities
Priority Actions
Protocol and/or Manual for PMTCT completed in majority of countries but limited provision for infant feeding counseling and support
Lack of integration with breastfeeding or IYCF policies
Counselors not sensitized to HIV/and Infant Feeding recommendations
Integration of PMTCT policies with MCH policies and standards of care
Revision of policies to incorporate new recommendations
Training and sensitization of VCT counselors
Supervision & monitoring of infant feeding counseling & support services
10. Development/Implementation of Policies and Plans related to IYCF in Emergencies
10. Development/Implementation of Policies and Plans related to IYCF in Emergencies
Achievements
Barriers Opportunities Priority Actions
None Lack of awareness of rationale & relevance
Existence of national emergency & disaster plans
Existence of national committees/agencies responsible for emergency preparedness & management
Develop relevant policies & plans; seek approval and inclusion in national emergency plans Training of shelter managers
11. Strengthening of Growth Monitoring/Promotion (GMP) including updating of growth charts
11. Strengthening of Growth Monitoring/Promotion (GMP) including updating of growth charts
Achievements
Barriers Opportunities
Priority Actions
GMP of under-fives ongoing in all countries; in some, limited coverage of older children (24 – 59 months) 15 countries use WHO/NCHS standard
4 countries routinely measure length & height
Inadequate supervision of GMP activities
Lack of attention to maintenance of equipment Poor weighing &measuring techniques
Availability of new growth standards in ‘06
Link to revision of child health records to incorporate new recommendations related to IYCF, immunization schedules etc
Sensitize officials in Ministry of Health to rationale & importance of new growth standardsObtain new standards & support materials from WHO Conduct training to implement the revised growth charts
12. Development of nutrition surveillance system including monitoring of IYCF practices
12. Development of nutrition surveillance system including monitoring of IYCF practices
Achievements
Barriers Opportunities Priority Actions
Surveillance ongoing in 7 countries
Nutrition indicators not included in HIS
Lack of resources for proper data management
Untimely reporting & feedback
Utilization of reports to guide National Plans & programs
In some countries, close collaboration exists between MCH & Nutrition Units
Define key indicators to be monitored
Implement measures for strengthening nutrition surveillance within framework of HIS