SECOND WORLD BREASTFEEDING CONFERENCE 5/12/2018 SCALING UP INTEGRATED INFANT AND YOUNG CHILD FEEDING TRAINING: Experiences and Lessons learnt A BEHR National Department of Health P BAXEN, Nutrition Director, FHI360, CDS, NACS

Rationale for the development of a breastfeeding training package 5/12/2018 Presentation Outline Acknowledgements Rationale for the development of a breastfeeding training package Breastfeeding training package FHI360 – IYCF training

FHI360 for the support of training of health care workers on IYCF ACKNOWLEDGEMENTS 5/12/2018 FHI360 for the support of training of health care workers on IYCF UNICEF, USAID, PATH Provincial Nutrition Units

Rationale for the BF Course for HCPs Health workers received training on BF Landscape Analysis, 2010

Rationale for the BF Course for HCPs 2011 National Breastfeeding Consultative Meeting SA committed to actively promote, protect and support breastfeeding as a public health intervention to optimise child survival and health

Development of the Training Package to Protect, Promote and Support Breastfeeding 5/12/2018 Tshwane declaration – “skilled support by health workers at all levels of the public and private health services including hospitals, primary health care facilities and community based services” Implementation plan for Breastfeeding Support to scaling up Breastfeeding Activities

Development of the Training Package to Protect, Promote and Support Breastfeeding 5/12/2018 South2South was contracted by USAID to assist NDOH with the development of a harmonized BF training package to be in line with the Tshwane Declaration Commitments and the IYCF Policy Breastfeeding technical working group consisting of representatives of NDOH, USAID, FHI360, UNICEF, PATH South to South was contracted to assist the Department of Health (DoH) to produce breastfeeding training materials aimed at improving knowledge and skills of healthcare providers in South Africa.

Review of Multiple training materials Breastfeeding Training Package to Protect, Promote and Support Breastfeeding 5/12/2018 Review of Multiple training materials Differences in content, design and quality Lack of content-specific information needed in SA Lack of firm stance on exclusive breastfeeding Lack visual appeal Lack of review exercises Need for a standardised course for the South African context

Breastfeeding Training Package to Protect, Promote and Support Breastfeeding 5/12/2018 Consist of the following three courses: Health care provider’s course (3-5 days) Train the Trainer’s course (5 days) Decision Maker’s course (1/2 day) The materials available for each course: A toolkit containing technical content A facilitator’s Guide Participant’s worksheet PowerPoint presentations

5/12/2018

Breastfeeding Training Package - Strengths 5/12/2018 In line with the policies and commitments Included the SA context Address areas not covered by the WHO 20 hour course for maternity staff namely complementary feeding, HIV/AIDS, focus on Quality Improvement Approach guide strengthening of MBFI, Training tools – videos, power-point Flexible and can be used a modular approach Guidance for trainers

Updated and finalise the Breastfeeding training package WAY FORWARD 5/12/2018 Updated and finalise the Breastfeeding training package Ensure that breastfeeding is part of the pre-service curriculum for nurses, doctors and dietitians Introduce the breastfeeding training package as an online course In line with the updated policies and commitments Included the SA context New areas not covered by the WHO 20 hour course – complementary feeding, incorporation of HIV/AIDS guidelines, More focus on Quality Improvement Approach guide strengthening of MBFI, Training tools – videos, power-point Flexible using a modular approach Provide more guidance to deliver the

FHI 360

Integrated IYCF Training PMTCT –Professional nurses, dietitians, tutors nursing colleges and dietetic students Severe Acute Malnutrition Training for medical practitioners and senior managers Nutrition Assessment and Counseling Support Early Childhood Development training Mother Baby Friendly Initiative training

Nov 2012 – Dec 2015 Trainees per Province Number of Trainees EASTERN CAPE 153 FREE STATE 158 GAUTENG 146 KWA-ZULU NATAL 428 LIMPOPO 301 MPUMALANGA 443 NORTHERN CAPE 186 NORTH WEST 46 WESTERN CAPE 675 Total 2536

Nov 2012 – Dec 2015 Total Numbers of Participants by Province   EC FS GA KZN LIM MP NW NC WC TOTAL 5-day Breastfeeding Training 35 37 10 82 5-day BFHI Assessors 17 20 30 24 84 27 18 220 5-Day South African Regulations Related to Foodstuffs for Infant Feeding and Children (R991) Workshop 33 25 43 101 3-Day Integrated Severe Acute Malnutrition And Infant And Young Child Feeding Training for Medical Doctors and Senior Managers 36 22 56 34 15 12 23 240 5-day ECD Cooks Trainings 58 48 106 5-day Facilitation Skills Training of Trainers Course 2 6 64 3 1 52 133 3-Day Infant and Young Child Feeding Counselling Course 76 54 179 357 666 5-Day Infant and Young Child Feeding Counseling Course 5-day NACS training 44 32 154 10-day Integrated PMTCT 67 26 31 28 275 3-Day Abridged Integrated PMTCT Training 55 81 5-day Abridged Integrated PMTCT 108 124 137 455 Total 153 158 146 428 301 443 186 46 675 2536

Nov 2012 – Dec 2015 Total Numbers of Participants by Cadre   EC FS GA KZN LIM MP NW NC WC TOTAL Early Childhood Development (Professionals) 25 1 26 Early Childhood Development (Non-professionals) 29 Educators 13 14 Health Care Providers (Professionals) 146 155 76 284 246 277 92 43 268 1587 Health Care Workers (Non-professionals) 84 151 86 302 649 Managers 2 5 9 Students (University, College or equivalent institution) 6 3 16 45 8 28 148 Health Support Services Staff 74 Total 153 158 428 301 443 186 46 675 2536

Challenges Lack of mentoring and coaching Lack of commitment in conducting the portfolio of evidence for the MBFI training of assessors Selection criteria of participants Duration 5 days actual training is less Nutrition not core activities

On the job mentoring and coaching Quality Improvement Lessons Learnt On the job mentoring and coaching Quality Improvement Use of service delivery data Involvement and training of Operational Managers and PHC supervisors

Model for Nutrition Implementation Advocacy at national, provincial, district, sub-district, & facility levels Monitoring & Evaluation Site readiness - identify & analyse gaps Knowledge and skills development Breastfeeding, NACS, Data management Introduce quality improvement process Mentoring and coaching

Thank you