new sar ws report - bpni
TRANSCRIPT
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5
6
plans of the global Breastfeeding Initiative for Child Survival (gBICS), over the next 10 years to meet the goal of such scaling up.
IBFAN Asia organized a ‘Planning Workshop on Strengthening Infant and Young Child Feeding Practices and Programmes’ in South Asia Region (SAFANSI Project), in New Delhi on 10th December 2012. It brought together 54 participants from 8 SA countries ‐ Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka, and experts from SAIFRN and World Bank. At the workshop an IBFAN South Asia regional plan of action for advocacy and capacity building, was developed with inputs from national CSOs and governments. As a way forward it was recommended to organize advocacy and media events to strengthen regional/country IYCF policy and programme capacity and to develop a South Asia analytical report on Infant and Young Child Feeding to have improved evidence and analysis of IYCF policies and programmes.
As a recommendation and way forward of the above mentioned planning workshop, the South Asia report “Are We Doing Enough for Our Babies” was developed which shows the trends analysis in infant and young child feeding policies programmes and practices in South Asia. This analytical report is based on assessments carried out by national teams in 2005 and 2008 by the eight countries and the third assessment in 2012 by five countries to study trends. The report highlights the need for high level political will, programme focus and concurrent action in all areas of the global strategy if breastfeeding and complementary feeding rates are to be enhanced. The report has been shared widely with country partners, governments, donors, other regions etc.
As part of advocacy efforts IBFAN Asia organized a roundtable discussion on “Infant and Young Child Feeding: unpacking the 12th five year plan: Beginning of the Rise of Breastfeeding” on 8th April 2013. It brought together the views of key leaders of civil society, professionals, public health and nutrition experts, representatives of MWCD, MOHFW, international development partners, academia, and medical colleges. The meeting was chaired by Dr.Syeda Hameed, Member, Planning Commission, Government of India. Various issues related to breastfeeding and IYCF like breastfeeding in the food security bill, maternity entitlements, capacity building, training, IMS Act etc, were discussed. The recommendations have been put up with the planning commission for necessary action to be taken by key ministries.
A Media event “Heinz, Nestle, Abbott: Breaking the Rules, Misleading Mothers” was organized to expose the baby food giants indulging in violation of India’s Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003 (IMS Act) on the 31st July 2013. It was a significant media advocacy activity and witnessed an overwhelming response from the media personnel. The event was covered and reported across the globe by reputed electronic media houses and agencies like Thomson and Reuters Foundation, The Hindu, Asian News International (ANI), Indo Asian News Service (IANS), Zee News, One World Asia, Down to Earth etc. Also presented were findings from an internet study which shows that internet shopping websites such as babyoye.com; healthkart.com and firstcry.com are promoting baby food products from Heinz, Nestle and Abbott and violating the Code/law.
BPNI/IBFAN Asia organised the ‘Policy Dialogue on Scaling Up Breastfeeding and Infant and Young Child Feeding Rates –What Will it Cost?’ at New Delhi on 7th and 8th October 2013 and shared the results of their exercise to estimate indicative global costs for the protection, promotion and support of breastfeeding as part of the World Breastfeeding Costing Initiative (WBCi). The WBCi comprises of an advocacy document for investing in comprehensively implementing the Global Strategy and an excel‐based web tool for
7
assisting in preparing and budgeting work plans for this. The meeting was attended by PAHO (WHO), governments from Bangladesh, Philippines, Afghanistan, UN agencies, media etc.
India launched the World Breastfeeding Costing Initiative (WBCi) report “The Need to Invest in Babies” on the 10th December 2013. The report was launched by the Deputy Chairperson of the Planning Commission of India, Sh.Montek Singh Ahluwalia. The report calls upon governments and global communities to invest at least US$ 17.5 billion annually if they genuinely want to improve optimal breastfeeding practices. Women need support for breastfeeding, and this support has to take into account maternity benefits, especially for women living in poverty, strict enforcement of the International Code for Marketing of Breastmilk Substitutes, massive media promotion, creating baby friendly health systems and communities, where every woman has access to counseling and support for carrying out optimal breastfeeding and central coordination system that oversees implementation of the interventions.
BPNI has developed a cascade training package titled “The '4 in 1' Infant and Young Child feeding Counseling: A training programme, (Integrated breastfeeding, complementary feeding, infant feeding & HIV counseling and Growth Monitoring)”. It is based on the WHO/UNICEF’s three training courses on breastfeeding counseling, complementary feeding, and HIV infant feeding. The fourth component of ‘Growth Monitoring’ has been added to the course to make it ‘4 in 1’.BPNI with support from World Bank, under the South Asia Food and Nutrition Security Initiative (SAFANSI) project titled “Strengthen IYCF Capacity in SAR”, was assigned the task of comprehensive review of the training programme by an independent expert. The task has been accomplished and the findings and recommendations have been shared by the expert at the “Consultation meeting for sharing views on evolution and implementation and review of BPNI¹s IYCF training programme” held on 19th February 2014.
An International Training‐of‐Trainers in Infant & Young Child Feeding Counseling: a 4‐in‐1 course (An Integrated Course on Breastfeeding, Complementary Feeding, Infant Feeding & HIV counselling and Growth Monitoring) was organized by BPNI/IBFAN Asia to develop six Master Trainers and twenty five IYCF Counseling specialists. The 13 days training programme was held from 24th June to 7th July 2013 at New Delhi. Three (3) health professionals each from Afghanistan and Nepal were trained as master trainers, who further trained the twenty five IYCF counselling specialist. The training helped in assessing the practicality of running the 13 days training course.
IBFAN Asia organized the One Asia Breastfeeding Partners Forum‐9 on theme “Maternal and Infant and Young Child Feeding and Nutrition” from 28‐30 October 2013 at Luang‐Prabang, Laos. More than eighty participants from 28 countries representing diverse groups including governments, breastfeeding organisations, health providers, peoples’ organisations and movements, international NGOs and individuals participated and discussed core issues around breastfeeding and infant and young child feeding and its relation with maternal, infant and young child nutrition. The Luang‐Prabang Call to Action on Infant and Young Child Feeding was adopted on last day of forum.
Nepal Nepal has shown significant reduction in child mortality over the years The IYCF indicators show exclusive breastfeeding rates at 4‐5 months 53%, median duration of breastfeeding 4.2 months, and complementary feeding at 6‐9 months is about 70%. Survey findings shows that about 47% of children 6‐23 months consumed foods rich in vitamin A and consumption of iron‐rich foods is highest among children age 18‐23 months, living in urban area and relates to education of mother. Nepal Breastfeeding Promotion Forum (NEBPROF) organized national advocacy for strengthening IYCF in April 2013. Various recommendations emerged in the advocacy meeting like reactivation of national committee on promotion and protection of
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10
11
Only 499 hospitals were made BFHI by 2005 and the evaluation shows deterioration in most of the hospitals. Recommendation on revitalization of BFHI emerged during the South Asia Breastfeeding Partner’s Forum held at New Delhi in 2007.
The evaluation of BFHI shows a down slide due to varied reasons like lack of hospital monitoring committee for effective implementation of 10 steps to successful breastfeeding, transfer of trained health staff, and lack of resources being a few. There is an urgent need for reviving the evaluation and certification process, capacity building and skilled training to health staff, and need for stringent monitoring system etc.
DAY 3: March 25th 2014 Session 4: World Breastfeeding Costing Initiative (WBCi) In this session Dr. Arun Gupta, IBFAN Asia emphasized on the proposed planning steps in moving from global strategy to national action. The WHO/UNICEF’s Global Strategy for Infant and Young Child Feeding was adopted at the World Health Assembly in 2001 with the objective to improve infant and young child feeding practices. The WHO in 2007 provided with a Planning Guide for national implementation of the Global Strategy for Infant and Young Child Feeding with the following Seven Steps.
1. Identify and orient key stakeholders and prepare for developing a comprehensive strategy
2. Assess and analyze the local situation
3. Define preliminary national objectives
4. Identify and prioritize actions
5. Develop a national strategy
6. Develop a national plan of action
7. Implement and monitor
WBTi &WBCi: The two important tools addressing the 7 steps of Global Strategy In 2003‐04, the W.H.O. had developed a tool for assessing national practices, policies and programmes on infant and young child feeding, and IBFAN Asia adapted this tool and developed the World Breastfeeding Trends Initiative (WBTi). The WBTi measures inputs and generates national action and also studies trends. It leads to documentation of gaps in policy and programmes, a collective thinking helps to to develop a set of recommendations based on these gaps, and advocacy steps to bridge these gaps. The WBTi has been introduced and tested successfully in 83 countries and has led to documentation of state of policy and programmes in 51 countries. Work is in progress in other countries on WBTi.
This tool brings people & organizations together, and helps develop a national plan of action addressing several of first 6 steps.
While doing this work, it was noted that country after country was found lacking in action due to lack of clear action plans, budgeting and funding. That inspired BPNI to undertake a pioneering step and initiate a global policy dialogue to develop an advocacy paper that would stimulate investment for infant and young child feeding as well as develop a tool to budget.
The WBCi has been launched globally in many countries including India, Canada, Mexico, Colombia, Costa Rica, Guatemala, Bangladesh, Nepal, Australia, Indonesia, Egypt, and Afghanistan. We plan to introduce the WBCi in 20 more countries by the end of 2014.
12
There have been several positive experiences at these places including one from Mexico and Afghanistan where the Government or donor allocated funding.
Positive Experience in WBCi
The success of WBTi and WBCi led to donor allocating funding to breastfeeding work in Afghanistan. The World Bank under the Ministry of Public Health announced support to 18 of the 34 provinces for Infant and Young Child Feeding, World Vision would support 3 provinces and Save the Children for 6 provinces. UNICEF has also agreed to IEC support in the whole of Afghanistan
During the WBCi launch in Mexico, the government of Mexico announced that of the 290,000 millions Mexican pesos of the stellar Crusade Against Hunger, 1000 million will be used for the protection, promotion and support f breastfeeding.
Panel Discussion on Launch of WBCi Tool The next session was a panel discussion to report on the launch of WBCi tool with panelist Dr. S.K. Roy‐Bangladesh, Dr. Prakash Shrestha‐Nepal and Dr. Homayoun Ludin‐Afghanistan.
Bangladesh ‐ The launching ceremony of WBCi was successfully accomplished in Bangladesh on 29 January 2014 with participation from more than 152 representatives from 37 organizations. The key recommendation emerged was to have coordinated efforts and investment in all components (maternity entitlement, training of the health workers and regular monitoring, coordination, monitoring violations of the International Code, maternity benefits, data management, research, and updating of policies and legislation and awareness program for the mothers) of IYCF are required urgently to get the highest benefit. There is need for area specific investment during the allocation or reallocation of the national budget.
Afghanistan ‐ the Ministry of Public Health launched the WBCi tool in Afghanistan in January 2014. The response was tremendous as it is a friendly financial tool. This was followed up by costing exercise training for various cadres of health professionals to get hands on experience of using the tool (program managers and the Nutrition Technical Officers).
Nepal‐ Nepal Breastfeeding Promotion Forum (NEBPROF) did the launch of WBCi on the 10th December 2013 along with 10 other countries globally. ‘The Need to Invest in Babies’ was presented to the gathering present at the launch and highlighting the existing situation of breastfeeding and complementary feeding in the world, and how breastfeeding can save lives by reducing morbidity and mortality in infants. There was concern raised by the media present as to the existing situation and the need for creating more awareness in general community regarding breastfeeding and appropriate complementary feeding.
Session 5: Costing exercise using WBCi tool The next session was on the costing exercise using the WBCi tool to work out budget on specific indicator. The objective of this session was to provide hands on experience on the use of the tool to the participants and also take feedback on the ‘user‐friendliness’ and relevance of the tool. The participants were grouped as per country and given an indicator to work out the budget for its implementation using their country data. Some of the country representative were aware of the tool but few were new to the concept. It was a learning experience in the process as we got to know the glitches while using the tool.
Each country then presented their experience of having worked on the tool, glitches, future use of the tool in their respective country and the help required in the process from the RCO.
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13
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14
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15
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16
DAY 4: March 26th 2014 Session 8: Planning Ahead 2014‐2015 Dr.J.P.Dadhich coordinated the session on the Planning Ahead 2014‐15. There was discussion on additional activities as proposed under SAFANSI additional funding and WBTi assessment, given in table 1 and 2 respectively.
Table 1: SAFANSI Additional Funding Activities
Orientation workshop on Code
TOT on Code Implementation
Knowledge building on IYCF
National Workshop to support development of provisional IYCF Plan
Capacity Building for IYCF
SAR WS 3 with focus WBCi
WBCi Launch & Use
Afghanistan 34 govt. officials, 34 NGOs, 20 UN Agencies & Donors Date‐15 June 2014 Venue‐Kabul
Training Workshop June 2014
Bangladesh 14 workshops‐2 hospitals in each division Start‐May 2014 Finish‐Jan 2015
Training workshop July 2014
Nepal July 2014 2 Trainings of 67 days each, participants health professionals, nursing staff September 2014 (both training) Venue‐Kathmandu
Training workshop during WBW 2014
India 5 workshops of 1 day each (Punjab‐2, Haryana‐3) May 2014
Qualitative study in Lalitpur Proposal‐April 2014 Data Collection‐June‐Sept 2014 Finalize‐December 2014
TOT on IYCF August 2014 Venue‐Delhi
December 2014 Venue Tentative (Goa/Colombo)
MOH & WCD work on feasibility of Joint workshop with both ministry with participation from few states
Bhutan Launch during WBW 2014
Sri Lanka Launch July 2014
Maldives Launch during WBW 2014
Pakistan To discuss the possibility
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Table 2: WBTi Assessment 2015
Country Proposed time period
Afghanistan May‐August 2015
Bangladesh September‐October 2015
Bhutan August‐September 2015
India July‐September 2015(Approach both ministry to partner)
Maldives December 2014‐February 2015
Nepal March‐July 2015
Sri Lanka July‐September 2015
Pakistan TBC
Session 9: Summing Up, Next Steps & Way Forward In conclusion Mohini Kak, World Bank felt that the workshop was a learning experience in itself, but also that over the duration of the grant, through the grant activities, a lot of knowledge had been built. The scaling up costing study, the WBCi tool and the 4‐in‐1 training review were examples of this. BPNI had helped mobilize IYCF advocacy work in systematic manner and hoped that the efforts would continue in the future as well. There was a need to take the success so far to the next level and actively work with government to see how the knowledge and tools developed could be implemented/ institutionalized. There was also a need to work on complementary feeding as the discussions clearly highlighted that this was an important gap area in existing efforts and both government and IBFAN need to work together on this. Continuing such learning exchange and experience sharing programs was equally important as it helped motivate action and lead to new solutions.
Dr. Arun Gupta thanked everyone present for making the workshop a success. He called for action to be taken by all the countries to enhance infant and young child feeding practices. He urged the countries to work on bridging the gaps and to reveal more positive change by next assessment. Every country needs to work on protecting, promoting and supporting breastfeeding and complementary feeding in order to ensure that every child born meets its rights to survival with health. He made a point to remain alert from commercial entities and public private partnership offers as these usually lead to weak regulatory practices or weakening of existing regulations of marketing of baby foods on which the protection of breastfeeding rests.
Session 10: Discussion on Scaling Up Nutrition (SUN) Most recent interest in the area of nutrition is the new partnership called Scaling Up Nutrition – SUN. The World Bank, Bill & Melinda Gates Foundation and some donors like DFID have supported SUN movement. While leaders of the SUN have been representatives of UN organizations, SUN is not a UN initiative and is NOT approved by the Member States of the UN. The SUN involves United Nations agencies, and several international non‐governmental organizations, traditional donors, developing countries and the business sector for solving the problems of child malnutrition in the world. Its operational framework is structured around five networks of equal weight: from the countries, organizations of the civil society, the UN agencies, the business sector, and the donors. The attribution of same weight to each one of the five networks was found to be questionable by BPNI within the context of sovereignty and the role of the
18
United Nations. Dr. Arun Gupta raised the question, “how can private sector’s role be equal to a Member States’ role?”; an issue that has also been questioned by Brazil. http://www.ghwatch.org/sites/www.ghwatch.org/files/Recine&Beghin_201140306_InternationalNutritionAgenda_En.pdf
Private sector engagement in nutrition needs to be carefully navigated, and it is unclear whether SUN is up to the challenge on this front. SUN’s governing body includes major corporations and a key factor of SUN’s approach, is the establishment of Public Private Partnerships in developing countries ‐ with businesses at their core. SUN does it all without tackling or having mechanisms to prevent or manage conflicts of interest in place. SUN has a business alliance that is steered by GAIN, the Global Alliance for Improved Nutrition, an organization of the industry that focuses on fortification, benefitting billions of people and 600 or more companies.
So far 50 countries have joined SUN, in Asia and Africa. Brazil and India have not yet joined SUN movement, however efforts are underway to make that happen. It is important for governments and civil society to understand the challenges of private sector engagement in nutrition, especially in an environment where private or business sector enterprises like Bill and Melinda Gates Foundation and Global Alliance for Improved Nutrition are leading or are at the forefront of the health and nutrition initiatives. It is resulting in malnutrition and hunger, often being presented as technological problems in global platforms, with solutions such as fortified foods, or ready to use foods, or genetically modified foods being promoted, taking away from the real issues. Such as issues of hunger and undernutrition, water, sanitation, universalization of services, the prices of food or even how trade can potentially impact the health of citizens. Over the past few months in India for example there have been two national consultations on “acute malnutrition” presenting ready to use foods as the solution.
Given these ever growing interests in products and linking malnutrition with corporate social responsibility, it is becoming more difficult to push for public sector solutions and investments for improving undernutrition, especially for the poor.
To ensure continued information sharing and generating a discussion on private sector engagement in nutrition, it was decided to form a google/email group coordinated by Dr. Arun Gupta comprising of workshop participants as a start.
Court Case Update on Nestle
In compliance of the Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003, Arun Gupta as a representative of ACASH, filed a complaint against Nestle who was found violating the law in 1994… violating in which way? What did they do?. The Court took cognizance of offence 1995. However it took 17 years for the Court to charge Nestle. During this period several eventful things happened that included court evidence was found missing in 2004. Nestle filed a Writ Petition in High Court to challenge the Union of India for making this law, saying they were confused between the two laws like PFA Act and IMS Act and chose to follow the PFA Cat. Nestle later revised this Petition to ask for quashing the proceedings of lower court whatever happened during 1994 to 1998. In 2012 The Court charged Nestle with the offence. Nestle then challenged this in the High Court. All this went to High Court. The High Court took exceptional opinion on Nestle, and declared in favor of Nestle that the company could be confused for implementing two legislations. In fact the High Court did allowed Nestle scot‐free because they were implementing another law. We took that Declaration to Supreme Court also but it did not help. Important fact in this matter is that Government of India was the main player and did not take any interest and we were the interveners. Lessons we draw from here is that the powerful corporations do have their way and they impress the judiciary. The case was never pursued on its merit. It was fought only on the legal issues. It got delayed to 20 years and no body even took note of ‘who was responsible for theft of the court evidence’, and ‘that Nestle was even violating both the legislations PFA Act and IMS Act’ on that given day.
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Annexure 1
Participants of South Asia Regional Workshop
S.No. Name Organization Address e‐Mail
1 Dr.Homayoun Ludin
National IYCF Consultant Ministry of Public Health
District 10, Kabul Afghanistan
2 Dr.Zahir Rodwal IYCF Technical Officer Ministry of Public Health
District 10, Kabul Afghanistan
3 Dr.S.K.Roy Chairperson, BBF Room 197‐200 IPH Building Mohakhali, Dhaka Bangladesh
4 Dr.Hedayetul Islam
Director IPHN, and Line DirectorNational Nutrition Services
Institute of Public Health Nutrition Mohakhali, Dhaka‐1212 Bangladesh
5 Dr.Moudud Hussain
Deputy Director, DGHS and Program Maneger National Nutrition Services
Institute of Public Health Nutrition Mohakhali, Dhaka‐1212 Bangladesh
6 Ugyen Dendup Programme Officer Nutrition Programme Ministry of Health
Ministry of Health Thimphu Bhutan
7 Pema Dolma Senior Staff Nurse, Pediatrics Department Jigme Dorji Wangchuk National Referral Hospital Bhutan
Jigme Dorji Wangchuk National Referral Hospital, Thimphu Bhutan
8 Mohini Kak Nutrition & Health Specialist The World Bank
70, Lodhi Estate, New Delhi‐3
9 Dr.Sila Deb Deputy Commissioner (Child Health) Ministry of Health & Family Welfare
431‐C Wing, Nirman Bhawan Maulana Azad Road New Delhi‐110001 India
[email protected] [email protected]
10 Dr.J.H.Panwal Joint Technical Adviser Food and Nutrition Board Ministry of Women & Child Development
105, Jeewandeep Building Sansad Marg, New Delhi‐110001
[email protected] jtafnb‐[email protected]
11 Shalini Gupta Asst. Technical Adviser Food and Nutrition Board Ministry of Women & Child Development
105, Jeewandeep Building Sansad Marg, New Delhi‐110001 India
12 Suresh Dalpath Deputy Director (Child Health, Nutrition, Immunization) National Health Mission Govt. of Haryana
Bays No. 59‐62, Sector 2, Panchkula, Haryana India
[email protected] [email protected]
13 Manisha Choudhury
State Reproductive & Adolescent Health Consultant National Health Mission Govt. of Assam
C/o Mr.B.C.Das, College Road Barpeta, Assam‐781301 India
[email protected] [email protected]
14 Dr.Arun Gupta Central Coordinator Breastfeeding Promotion Network of India
BP‐33, Pitampura, Delhi‐110034 India
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S.No. Name Organization Address e‐Mail
15 Dr.J.P.Dadhich National Coordinator Breastfeeding Promotion Network of India
BP‐33, Pitampura, Delhi‐110034 India
16 Radha Holla Campaign Coordinator Breastfeeding Promotion Network of India
BP‐33, Pitampura, Delhi‐110034 India
17 Dr.Shoba Suri Senior Programme Officer Breastfeeding Promotion Network of India
BP‐33, Pitampura, Delhi‐110034 India
18 Nupur Bidla Programme Officer Breastfeeding Promotion Network of India
BP‐33, Pitampura, Delhi‐110034 India
19 Dr.Mohamed Saeed
Coordinator Society for Health Education (SHE)
Sunbam 904, S.Hithadhoo Addu City, Maldives
20 Dr.Prakash Shrestha
President, Nepal BreastfeedingPromotion Forum
Deptt of Child Health Institute of Medicine Kathmandu Nepal
21 Dr.Srijana Basnet Asst. Professor Institute of Medicine Tribhuvan University Teaching Hospital Kathmandu
269/16, Chabahil, Kathmandu Nepal
22 Dr.Lalith Chandradasa
Nantional Coordinator National Nutrition Council
Nutrition Secretariat President's Office Colombo Sri Lanka
23 Wimala Ranatunga
President Sarvodaya Women's Movement
Sarvodaya Head OfficeNo. 98, Rawatawatta Road Moratuwa, Colombo Sri Lanka