The Mother Baby Friendly Initiative (MBFI) In South Africa

The South African Mother Baby Friendly Initiative

Experience9th International Baby Food Action Network (IBFAN) Africa Regional

Conference 1-4 February 2016, Kampala, Uganda

Z. KUBEKAOn behalf of:NDOH : CHILD , YOUTH HEALTH & NUTRITION

Outline of the Presentation

• Brief History of MBFI in South AfricaCurrent MBFI status in South AfricaLessons learnedStrengths & opportunitiesImplementation challengesScaling up plans

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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 National Assessors

• A BFHI implementation strategy was developed

• Provincial Managers have included MBFI in their KPAs

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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 coordination of BFHI

National

Province

District level

Facility level

Policy development Capacity building, co-ordinate assessments, set National targets

Capacity building, implementation body fund travel between provinces, overall prov. Coordination, set Provincial targets

Capacity building, support monitoring of facilitiesSupport internal assessments

Conduct training, self appraisal, formed hospital BFHI implementation Multisectoral teams

Process and planning cycle

Strategic planning session:Provinces set targets

Budget for assessments

National targets aligned to Provincial

Assessments spread /QuarterFacilities supported by Province and district

National- allocate assessors team

Provincial & national reports on current status

• BFHI assessments initially conduced by international assessors

Not sustainable

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Assessment Process.

Health Facilities declared as MBFI 1995 to 2014Health Facilities 545

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BFHI In SA was not yielding the desired results. Exclusive Breastfeeding 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 Breastfeeding Cont.

2011Breastfeeding Consultative Meeting

•The term Mother, Baby Friendly Initiative was adopted

2012- Development of a clinic tool •Aimed to extend MBFI to clinics (strengthening ANC, PNC & community support)

Incorporating MBFI into other child health processes

•Breastfeeding training package included into NNC training package, incorporating in initiatives for newborn care (INC, LINC, WINC)

2013/14 •Inclusion of breast feeding Indicators in the District Health Information System

2014 • MBFI tools revised to align SA Context - 2013 revised IYCF & PMTCT guidelines (HIV & Infant feeding & Regulations)

2015 •Establishment of the Breastfeeding technical working group at national level

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

ProvinceTarget

FY 2015/16FY

2013/14FY

2014/15Progress FY

2015/16Progress2015/16

Q1 FY 2015/16

Excl breastfeedingQ1 2015/16

Eastern Cape 50 40.9 41.6 42.1 42.1 12,518

Free State 50 78.0 83.1 52.5 52.5 5,926

Gauteng 50 16.1 25.8 30.4 30.4 16,313

KwaZulu-Natal 50 49.0 50.2 49.5 49.5 26,214

Limpopo 50 58.0 56.8 47.7 47.7 14,344

Mpumalanga 50 36.8 55.9 53.5 53.5 10,472

North West 50 47.4 58.6 49.9 49.9 7,881

Northern Cape 50 60.5 62.9 58.4 58.4 3,178

Western Cape 50 19.5 24.7 27.9 27.9 6,832

National 50 39.5 45.1 42.7 42.7 103,678

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Lessons learned

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

• Start with facilities with a higher deliveries in order to reach more mothers

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

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• 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 is policy- needs scaling up

• Sophisticated infant food marketing practices

• Contradictory views of medical practitioner’s regarding exclusive feeding

Challenges at Implementation level

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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 the

facility 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

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