Making BFHI a Standard of Care in Health Care will Improve Implementation of 10 Steps in Health Facilities: Tanzanian Hypothesis Presented at IA Conference, Kampala Uganda By: Belinda Liana Pauline Kisanga COUNSENUTH January 2016

Outline Introduction BFHI Ten Steps Country situation on IF practices Implementation of BFHI under Lishe Ruvuma Program Methodology Results Recommendation/Way forward Conclusion

Introduction Baby Friendly Hospital Initiative (BFHI) is a global effort initiated to implement practices that protect, promote and support breastfeeding Intends to ensure that all women are enabled to practice EBF for 6 months and continue to breastfeed their babies to the age of 2 years and beyond 10 steps to successful breastfeeding forms the basis for BFHI

Ten steps to successful breastfeeding Have a written breastfeeding policy that is routinely communicated to all health care staff Train all health care staff in skills necessary to implement this policy Inform all pregnant women about the benefits and management of breastfeeding Help mothers initiate breastfeeding within a half-hour of birth Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants   Give new born infants no food or drink other than breast milk unless medically indicated Practice rooming-in - allow mothers and infants to remain together - 24 hours a day Encourage breastfeeding on demand Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic Source: WHO and UNICEF, 2010

Implementation of BFHI under Lishe Ruvuma Program Overview An integrated community based nutrition programme implemented in 2 district councils (Tunduru and Songea) of Ruvuma region BY COUNSENUTH & TFNC + Local government authorities Objective: Reduction of childhood stunting in Ruvuma by 10% in 5 years through emphasis on the first 1000 Days and accelerated community actions for nutrition Primary beneficiaries - children under two years of age - pregnant women

Key Interventions under Nutrition Ruvuma Program MIYCF/IFA suppl. pregnant women/WASH Key Approaches BCC messages in print/multi-media/digital media Training of HW on package of MIYCF/WASH/IFA HW counseling skills on (MIYCF/IFA/WASH) Problem Statement Short training-5 days/multiple issue training Training done outside of health facility

Country Situation of Infant Feeding Practices Age National% children Ruvuma Region Baseline Tunduru DC 2013 Baseline Songea DC 2014 1. Early initiation (within 1 hour) of delivery At delivery 49% 46.5% 58.6% 74.6% 2. Exclusive breastfeeding 6 months 50% 20.6% 41.2% 3. Exclusive breastfeeding by age 0- 2months 81% 2-3 months 51% 4-5 months 23% 4. Early initiation of complementary foods Below 2 month 11% 13% 19% 2 – 3 month 33% 29% 4 - 5 month 64% 34.7% 30% 5. Late initiation of complementary foods 8 -9 months 7% Source: Tanzania Demographic Health Survey 2010

Objectives of Assessment of 10 Steps Lapse Time Conducted one year after training Objectives To find out the impact of a combined /out of facility HW training on implementation of Ten Steps in HF To identify better ways to motivate HW to implement Ten Steps in HF

Assessment Methodology Identified & oriented assessment team on BFHI assessment tools Assessment Conducted by 2 experts on status of BFHI Ten Steps using standard tool by UNICEF/WHO in 4 HF one year after HW training Data collection methods (using interviews HW/women, observations, FGD with preg and Lactating women) as per tool Respondents: HW, women, Hosp. leaders

Results Only three steps were well implemented and met the global BFHI criteria: Step 6-Do not give food or drink to the baby Step 7: Promote rooming in Step 9: No artificial feeds or dummies The rest of the steps were very poorly implemented

SUMMARY RESULTS/OBSERVATION   10  STEPS 1 2 3 4 AV 1.  Have a written breastfeeding policy that is routinely communicated to all health care staff  4 2.  Train all health care staff in skills necessary to implement this policy  2 3.  Inform all pregnant women about the benefits and management of breastfeeding  5 4.  Help mothers initiate breastfeeding within a half-hour of birth  0 5.  Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants 6.  Give new born infants no food or drink other than breast milk unless medically indicated  10 7.  Practice rooming-in - allow mothers and infants to remain together - 24 hours a day 8.  Encourage breastfeeding on demand 9.  Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants 10.  Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic Optional step: Implementation of the CODE: Requires all facilities which provide maternity services  3 Total Average 4.3 1. TUNDURU 2. SONGEA 3. KIUMA 4. MBESA Green: well scored Red: not well scored

Intervention Post Assessment Meetings were held with Hospital Management Teams, HW and doctors in each health facility to discuss the results of the assessment One week Coaching and Mentoring and demos of skills were conducted in each health facility on how to implement the BFHI Ten Steps Hospitals informed about an announced repeat evaluation after 6 months The repeat results will be shared with IBFAN Family

Our Hypothesis The second approach will have better impact on the implementation of the BFHI Ten Steps in the majority of health facilities despite using the same minimum package of information (MIYCF/IFA/WASH) The results of the repeat assessment after 6 months will be shared with the region and recommendations made

Conclusion The implementation of BFHI is very low in Tanzania The Tanzania IBFAN Team is looking for ways to implement BFHI in a more streamlined and cost effective method. The checklist of messages used in the mentorship of Health facilities will be further developed and tested Our hypothesis is that strengthening HF based BFHI coaching and mentorship within other services will enhance achievement of Ten Steps in health facilities and impact EBF rates

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