(malaysian round table) - rokiah don · 2011-03-07 · revised malaysian breastfeeding policy...

BREASTFEEDING PROMOTION BREASTFEEDING PROMOTION EFFORTS IN MALAYSIA EFFORTS IN MALAYSIA

ROKIAH DONMINISTRY OF HEALTH MALAYSIA

Global Breastfeeding Partners’ ForumOctober 17 - 19, 2010

Penang

CONTENTCONTENT

DemographyOrganisationHealth Care Delivery SystemBreastfeeding StatusPromotional Strategies Challenges

DEMOGRAPHY (2009)DEMOGRAPHY (2009)

Population Total Male Female

Total Population 28,306,700 14,407,200(50.9%)

13,899,400 (49.1%)

Population by Age Group

• Below 15 years 9,014,700 (31.9%)

4,647,100 (32.2%)

4,367,700 (31.4%)

• 15-64 years 18,005,700 (63.6%)

9,157,400 (63.6%)

8,848,300 (63.7%)

• 65 years & above 1,286,200 (4.5%)

602,800(4.2%)

683,500(4.9%)

Maternal Mortality Rate (per 100,000 live births) 28.9 (2008)40.0 (2001)

- 28.9 (2008)40.0 (2001)

Perinatal Mortality Rate (per 1,000 births) 7.4 (2008)3.9 (2000)

7.9 (2008) 6.8 (2008)

Neonatal Mortality Rate (per 1,000 live births) 4.0 (2008) 4.5 (2008) 3.5 (2008)

Infant Mortality Rate (per 1,000 live births) 6.4 (2008)7.5 (2000)

7.0 (2008) 5.7 (2008)

Toddler Mortality Rate (per 1,000 population aged 1-4 years)

0.4 (2008) 0.5 (2008) 0.4 (2008)

Under-5 Mortality Rate (per 1,000 live births) 8.1 (2008) 8.9 (2008) 7.3 (2008)

Life Expectancy at Birth (in years) - 71.56 (2008) 76.40 (2008)

Source : Health Facts 2009

ORGANISATION CHART MINISTRY OF HEALTH MALAYSIA

MINISTER OF HEALTH

•Human Resource

•Manpower Planning & Training

•Management Services

•Competency Development

DEPUTY MINISTER OF HEALTH

PARLIAMENTARY SECRETARY OF HEALTH

SECRETARY GENERAL OF HEALTH

PUBLIC RELATIONS OFFICER

LEGAL ADVISOR

INTERNAL AUDITOR

DEPUTY SECRETARY-GENERAL (MANAGEMENT)

DEPUTY SECRETARY-GENERAL (FINANCE)

•Finance

•Procurement and Privatisation

•Accounts

•Communication & Information Technology

DIRECTOR-GENERAL OF HEALTH

DEPUTY DG OF HEALTH (MEDICAL)

DEPUTY DG OF HEALTH (PUBLIC HEALTH)

DEPUTY DG OF HEALTH (RESEARCH & TECHNICAL

SUPPORT)•Medical Development

•Medical Practice

•Telehealth

•Disease Control

•Dental Services

•Family Health Development

•Nutrition

•Food Safety & Quality Control

• Health Education

• Planning & Development

• Pharmacy Services

• Engineering Services

• National Institute of Health

•Traditional & Complimentary Medicine

13 State Health Directors

INDUSTRIAL HEALTH & CORPORATE POLICY

ORGANISATION CHART OF NUTRITION DIVISIONORGANISATION CHART OF NUTRITION DIVISION

Director

Nutrition Policy & Standard Section

Nutrition Operational Section

Nutrition Promotion

Nutrition Surveillance

Nutrition Rehabilitation

Professional Development

Nutrition Development NPANM/ TWG

Standard & Quality

Infant & Young Child Feeding

Adolescent Nutrition and Schools

Nutrition Information Centre

Research

Nutrition Surveillance

MicronutrientDeficiency

Macronutrient Deficiency

Nutrition & Disease

Adult, Elderly and People with Special Needs

HEALTH SERVICES AT DISTRICT LEVELHEALTH SERVICES AT DISTRICT LEVEL

DISTRICT HEALTH OFFICEDISTRICT HEALTH OFFICE

HEALTH CLINICHEALTH CLINIC

COMMUNITY CLINICS / COMMUNITY CLINICS / KLINIK DESAKLINIK DESA

RURAL HEALTH SERVICES : 2RURAL HEALTH SERVICES : 2--TIER SYSTEMTIER SYSTEM

HEALTH CLINICHEALTH CLINIC15,000 15,000 -- 20,000 POP.20,000 POP.

COMMUNITY CLINICSCOMMUNITY CLINICS/ / KLINIK DESAKLINIK DESA

4,000 POP.4,000 POP.

NUMBER OF HEALTH FACILITIES IN MALAYSIA NUMBER OF HEALTH FACILITIES IN MALAYSIA (2009)(2009)

HEALTH CARE FACILITIES TOTAL

GOVERNMENT (MOH)

• HOSPITALS 130• DISTRICT HEALTH OFFICES 131• HEALTH CLINICS 808• COMMUNITY CLINICS/ KLINIK DESA 1920• MATERNAL & CHILD HEALTH CLINICS 90• MOBILE HEALTH CLINICS 196

PRIVATE (LICENSED)

• HOSPITALS 209• MATERNITY HOMES 21• NURSING HOMES 12

Source : Health Facts 2009

MMR MALAYSIA 1991 - 2008

MMR in 1991 = 44 per 100,000 livebirths

MMR in 2008 = 28.9 per 100,000 livebirths

Source : Department of statistics, Malaysia

EVER BREASTFED TREND EVER BREASTFED TREND IN MALAYSIAIN MALAYSIA

Source : Malaysian Family Life Survey & National Health and Morbidity Survey

COMPARISON WITH OTHER COUNTRIESCOMPARISON WITH OTHER COUNTRIES

Country (Maternity leave) Year % Infants ever breastfed

Malaysia (8 weeks) 2006 95.0

Indonesia 2002/03 95.9

Philippines 2003 86.5

India 1999/98 96.5

Egypt 2003 95.2

Armenia 2000 88.1

United Kingdom (52 weeks) 2005 76.0

Canada (17 weeks) 2006/07 90.3

Sweden (14 weeks) 2007 97.3

Switzerland (8 weeks) 2003 94.0

Source : World Health Organization

22.3%*

EARLY INITIATION OF BREASTFEEDING

Source : National Health and Morbidity Survey II & III

EXCLUSIVE BREASTFEEDING AT 6 MONTHS EXCLUSIVE BREASTFEEDING AT 6 MONTHS COMPARED WITH OTHER COUNTRIESCOMPARED WITH OTHER COUNTRIES

Source : World Health Organization

MATERNITY LEAVE (WEEKS)MATERNITY LEAVE (WEEKS)

Source: ILO Maternity Leave Data Base – accessed on 28 May 2009

BREASTFEEDING PROMOTION

Curriculum Development

Training

Social Support

Baby Friendly Hospital Initiative

Environmental Support

Breastfeeding Education

Mass media advertisement

Code of Ethics for the Marketing of Infant Foods and Related Products

Research

Breastfeeding data collection

• in-service for all health professionals

• teachers

• government• private

• public• mass media

• milk industries

• HMIS• Child Health Card

• maternity leave• mother-support group• legal provision

(Food Act 1983) • employer

• school (2o children)• nursing colleges• in-service• medical school

• building by laws• hospital infrastructure• BP facilities in shopping

centres

Mid 2005

Actions by Ministry of

Health Malaysia

National Breastfeeding Policy (1993) reviewed

September 2005

Revised Malaysian Breastfeeding Policy

announced

2006

Guideline of Infant &

Young Child Feeding

reviewed, in line with new Malaysian

Breastfeeding Policy and RNI (2005)

August 2008

Launch of the National

Lactation Centre and New

Revised Code of Ethics

2010

Review the BFHI

implementation

PROMOTIONAL STRATEGIESPROMOTIONAL STRATEGIES

• Growth monitoring (home-based card)

• Nutrition advice/ talks (individual & groups)

• Nutrition counselling

• Cooking demonstrations (clinics & community)

• Video shows

via

Child health clinicsAntenatal clinicsPostnatal clinicsHome visits for priority cases

Nutrition Education


- Lactation Management Education for health professionals (18/20 hours)

- Breastfeeding Counselling Course for health professionals (40 hours)

- Mother-to-mother support training for breastfeeding mothers

- Post-basic training for nurses (long distance)

- Pre-marital counselling course

- Training of extension workers co-ordinated by the Technical Working Group (Training) under the National Plan of Action for Nutrition of Malaysia (NPANM) – intersectoral collaboration

Training


Introduced 1993Designated 123 government hospitals within MOH

6 private hospitalsConsequences - improvement in maternity careof BFHI - ↑ ever breastfed rates

- ↑ public and policy makers awareness- Improve early initiation of breastfeeding- positive response of public towards the health system- multidisciplinary teamwork- paediatric wards; mothers caring for and nursing infants

Sustenance - monitoring & re-assessment toolsCommittee - BFHI Recognition Committee

Baby-friendly Hospital Initiative (BFHI)


1) Food Regulations 1985 and Food Act 1983 have several provisions to protect infant feeding

- Section 389 Devoted to provisions for Infant Formula (15 subsections) to protect breastfeeding

- Section 390 Canned food for infants and children

- Section 391 Cereal-based food for infants andchildren

Regulatory and ethical measures


2) Code of Ethics for Infant Formula Products1979 (revised 1983, 1985, 1995, 2008)

: Covers the basic principles of marketingand product information of designated productsand complementary foods in Malaysia. It alsoprovide guidelines on ethical practices formanufacturer and distributors of designated products and complementary foods; and health professionals and health personnel in the health care system

: National CommitteeVetting CommitteeDisciplinary CommitteeState Committee

: State Monitoring Team- Health care system- Retail outlets- Child care centre

Scope

Organisation

Monitoring

Regulatory and ethical measures

School Curriculum

Form fourForm four

Form fiveForm five


The Ministry of Education has taken steps to include breastfeeding in a section on infant and child care for the Secondary 4 and 5 in the Physical and Health Education Curriculum


Printed and electronic media to create public awareness on nutrition in line with the thematic Healthy Lifestyle Campaign since May 1991– Leaflets, booklets, pamphlets, flyers, posters– Publication of advertorials, feature articles, quizzes in local

vernacular newspapers and magazines on healthy eating for all age groups

– Radio (interviews and spot announcement)– Television (talk shows, nutrition segments, commercials)– Billboards– Cinema advertisements– Bus panel advertisements– Messages on Ministry of Health vehicles– Portal MyHEALTH (www.myhealth.gov.my)

Media


60 days paid maternity leave↓

1,825 days (5 years) no-pay leave (Pekeliling Perkhidmatan Bil. 15 Tahun 2007)

90 days paid maternity leave (Budget Announcement 2011)7 days paternity leaveBreastfeeding facilities at workplace (Health clinics)Breastfeeding facilities at shopping centre (SOGO, Jaya Jusco)Tax relief for companies that make available child care facilities at workplace (Sime Darby)Active involvement of NGOs → information, support and counselling to mothers (PPPIM, PPPLM)World Breastfeeding Week (1-7 August)

Social Support


Various studies and surveys have been undertaken. These include :

1) The National Health and Morbidity Surveys2) Health Systems Research: “To study the Strengths & Weaknesses

in Implementation of the 10 Steps To Successful Breastfeeding inKluang Hospital

3) A study on the “Knowledge of Doctors & Nurses regarding Breastfeeding: Effect of Lactation Management Education”

4) A study on the “Assessment of the Baby- Friendly Hospital Initiative in 5 General Hospitals using WHO Assessment Tools”

5) A study on the “Breastfeeding Practices in Negeri Sembilan”

Research

CHALLENGESCHALLENGES

Working mothers and breastfeeding– work patterns– facilities for breastfeeding and breast milk expression

Established mother – support groups

BFHI implementation in private hospitals– strategies ?

Role of professional bodies in breastfeeding promotion– eliminate dependency on commercial sources of funds ?

Reported violations of the Code of Ethics for the Marketing of Infant Foods and Related Products– role of international organisations

Thank youThank you

(malaysian round table) - rokiah don · 2011-03-07 · revised malaysian breastfeeding policy...

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