1. Effectively Building Code Monitoring and Enforcement: Experience from Botswana IBFAN Africa 9 th Regional Conference 2016 IBFAN Africa 1-4 February 2016 Imperial Royale Hotel, Kampala By Hussein H.T.Tarimo Nutrition and Food Control Division Public Health Department Ministry of Health Private Bag 00269 Gaborone, Botswana email: htarimo@gov.bwhtarimo@gov.bw

2. Monitoring the International Code of Marketing of breastmilk Substitutes IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Published: August 2015

3. Art. 11 - Implementation and Monitoring IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Who should monitor? 11.2 Monitoring the Code responsibility of governments. Companies, NGOs, professional groups and consumer organisations, to collaborate with governments. 11.4 NGOs, professional groups, individuals should inform companies and governments about violations of Code.

4. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala WHA Resolution 49.15 (1996) Monitoring should be carried out in a transparent, independent manner, free from commercial influence

5. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Also: Responsibility of Companies Article 11.3 Independently of any other measures taken for implementation of the Code, companies are responsible for monitoring their marketing practices and to ensure that their conduct at every level conforms to it. Article 11.5 requires manufacturers and distributors to inform their marketing personnel of responsibilities under the Code

6. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala What to monitor ? products under the scope hospitals/clinics new products new tactics websites video clips new technologies

7. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Monitoring under exceptional circumstances Are companies using HIV/AIDS to by-pass the Code & Resolutions? or national laws? … in the context of HIV donations of breastmilk substitutes? misrepresenting formula feeding as best option for HIV+ mothers in all situations ?

8. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Monitoring under exceptional circumstances … in the context of emergencies Informed Parenting Are companies using emergencies to increase market share? In emergencies, donations of BMS are not needed and may put infants lives at risk. Inappropriate donations of infant feeding products

9. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Monitoring can be done anytime, anywhere! CONFIDENTIALITY – protect your source Information is effective when it is: accurate shared published

10. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Information is effective when it is accurate, shared and published (Report violations to IBFAN-ICDC) Code Reports by IBFAN-ICDC

11. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Companies behave better when they know they are being monitored Monitoring is everyone’s responsibility Act against commercialisation of infant feeding Prevent mothers from being misled or trapped into accepting second-rate feeding Monitor – don’t let companies get away with Code violations Most of the Code violations are not localized to one country. At regional level we need to work as a team

12. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala  be brief, logical, based on evidence address to industry, government, health care facilities and other organizations make recommendation for change submit to ICDC Penang for review share evidence for international reporting How to prepare a monitoring report

13. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Name and shame violators of the Code Share evidence with breastfeeding advocates nationally, regionally and internationally. Seek advice from experts. (e.g. legal Code experts from UNICEF and IBFAN ICDC) INFORMATION IS POWER

14. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala What makes a good law? Implementation & Enforcement Clarity, strong and effective Mechanisms: administration, monitoring and enforcement ____________________________________. Botswana Marketing of Foods for Infants and Young Children, Regulations, 2005,has all the makings of a good law

15. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Products coved in the Botswana law Designated products- infant formula, formulas for special medical purposes, follow-up formula, complementary foods, beverages for infants and young children, feeding bottles, teats, pacifiers or dummies, breast pumps, cups for feeding infants and such other product as the Minister may designate

16. Promotion to the Public R 8(2) No person shall – (a) promote or cause to be promoted, foods for infants and young children or other designated products; (b) engage in promotional activities of any designated product; (c) publish or cause to be published any advertisement for any designated product; (d) advertise or cause to be advertised any designated product. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala

17. Promotion to the Public R 8(2) No person shall – (a) promote or cause to be promoted, foods for infants and young children or other designated products; (b) engage in promotional activities of any designated product; (c) publish or cause to be published any advertisement for any designated product; (d) advertise or cause to be advertised any designated product. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala

18. Conventional challenges: Constraints in implementing national measures  Lack of commitment  Limited action  Frequent change in leadership  Lack of resources  Lack of appreciation  Attitude of some health professionals  Political, economic and social considerations  Positions taken by companies  Spill over violations from other countries ( Media)

19. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala POSITIONS TAKEN BY COMPANIES markets where there are minimal or no measures Wrong interpretation that Law e.g applies only to “infant formula” holding up legislation process attempts to invalidate/amend legislation which is already in place Lobbying with politicians to have charges against violations withdrawn. Sponsoring Health professionals to attend Industry organized conferences etc e.g. NNI events.  Maneuvers in the dark by the violating companies

20. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala New Challenges: HIV The Code & Resolutions are relevant in the context of HIV/Aids as they ensure: proper use of breastmilk substitutes that breastfeeding presents the best possible feeding option for most mothers.

21. 21 Social media Internet & TV

22. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Code Implementation in Botswana Achievements 2006- 2016  All Code violations reported have been addressed with warnings or fines.  Botswana be exemplary in the African region  Several delegations from other countries have come to Botswana on Code Benchmarking missions  The 2015 State of the Code in Africa- in 32 countries Report shows that Botswana has scored Excellent in all the three parameters- (implementation, monitoring and enforcement )

23. Protecting Infant Health in Botswana

24. IBFAN Africa 9 th Regional Conference 1-4 February 2016 Imperial Royale Hotel, Kampala Conclusion  Regional approach to implement the Code is long overdue. It a challenge for each country to do it alone. Thank you Asante Obrigado Merci