1. World Breastfeeding Trends Initiative (WBTi) Assessment of the Status of Global Strategy for Infant and Young Child Feeding at National Level — achievements and Gaps NEPAL Prof. Prakash S. Shrestha President, Nepal Breastfeeding Promotion Forum

2. Infant and Young Child Feeding Practices: Indicators 1 to 5 IndicatorExisting Status 2006 Status in 2001 1.Percentage of babies breastfed with in one hour of birth 35.4%31.1% 2. Percentage of babies <6 months of age exclusively breastfed in the last 24 hours 53%68.3% 3. Babies are breastfed for a median duration of how many months? 34 months33 months 4. Percentage of breastfed babies less than 6 months old receiving other foods or drink from bottles in the last 24 hours 4%3.9% 5. Percentage of breastfed babies receiving complementary foods at 6-9 months of age 75%66.2%

3. Indicator 6 National Policy, Programme and Coordination Gaps Identified 1.Lack of targeted improvement in national plan. 2.Adequate fund not allocated in the budget. 3.No regular meeting of National Breastfeeding committee. 4.Lack of proper coordination of National breastfeeding committee with other sector. Recomme ndations to bridge the gaps 1.Development of long term plan with targeted improvement. 2.Allocation of adequate funding for IYCF in the budget. 3.Holding regular meeting of National breastfeeding committee. 4.Proper coordination of NBC with other sectors.

4. Indicator 7 Baby Friendly Hospital Initiative Gaps Identified 1.Percentage of hospitals and maternity facilities with BFHI very low (3.5%). 2.Percentage of hospital trained in BFHI for 18 hours very low (3.5%). 3.Standard monitoring system does not exist. 4.Lack of time bound program to increase number of BFHI. Recommend ations to bridge the gaps 1.Percentage of hospitals and maternity facilities with BFHI to increase in phased manner. 2.Training of hospital and maternity facilities in 18 hours BFHI in phase manner. 3.Developing standard monitoring system for BFHI activities. 4.Developing time bound long term program to make all health facilities baby friendly.

5. Indicator 8 Implementation of the International Code Gaps Identified 1.Lack of action is planned/taken or information on International code. 2.Best approach to implement International code not studied. 3.Lack of national measures other than laws is developed for implementation for International code. 4.Administrative directives/circular for implementation of the code for health facilities not developed. Recommendat ions to bridge the gaps 1.To develop action plan for proper implementation of International code. 2.Best possible approach to implement International code to be studied and developed. 3.Other national measures other than laws to be developed for proper implementation of International code. 4.Administrative directive as well as circular to be issued to all health facilities for proper implementation of International code.

6. Indicator 9 Maternity Protection Gaps Identified 1.Maternity leave in public/private sector is less than 14 wks. 2.Women in formal/unrecognized sector not provided same protection. 3.Information about maternity protection laws, regulation or policies is not made available to the workers. 4.There is no legislation prohibiting employment discrimination and assuring job protection for women workers during breastfeeding period. Recommend ations to bridge the gaps 1.Maternity leave in public/private sector should be made 14 wks or more. 2.Women in formal/unrecognized sector should be provided same protection. 3.Information about maternity protection laws, regulation or policies should be made available to the workers. 4.legislation should be made prohibiting employment discrimination and assuring job protection for women workers during breastfeeding period.

7. Indicator 10 Health and Nutrition Care Systems Gaps Identified 1.Infant and young child feeding is inadequately covered in the curriculum of pre service training of health care providers. 2.Standard and guidelines for mother friendly child birth procedure has not been disseminated to all health facilities. 3.Health workers are not trained with responsibilities towards code implementation. 4.Infant feeding related content and skills are not integrated in all training program. Recommend ations to bridge the gaps 1.Infant and young child feeding should be adequate covered in the curriculum of pre service training of health care providers. 2.Standard and guidelines for mother friendly child birth procedure should be disseminated to all health facilities. 3.Health workers should be trained with responsibilities towards code implementation. 4.Infant feeding related content and skills should be integrated in all training program.

8. Indicator 11 Mother Support and Community Outreach Gaps Identified 1.All women does not have access and counselling services on IYCF in the community during pregnancy. 2.Infant and young child feeding counselling services do not have national coverage. 3.Counselling services are not integrated into an over all infant and child health strategy. 4.All community based volunteers and health worker do not possess correct information and training in counselling. Recommend ations to bridge the gaps 1.All women should have access and counselling services on IYCF in the community during pregnancy. 2.Infant and young child feeding counselling services should have national coverage. 3.Counselling services should be integrated into an over all infant and child health strategy. 4.All community based volunteers and health worker should possess correct information and training in counselling.

9. Indicator 12 Information Support Gaps Identified 1.Lack of proper development of comprehensive national IEC strategy for improving IYFC. 2.IEC program that include IYCF are not actively implemented at local level. 3.Individual counselling and group education services related to IYCF is not available in all community outreach. 4.Only limited IEC campaign or program using electronic and print media. Recommend ations to bridge the gaps 1.Development of proper comprehensive national IEC strategy for improving IYFC. 2.IEC program that include IYCF should be actively implemented at local level. 3.Individual counselling and group education services related to IYCF should be made available in all community outreach. 4.Well covered IEC campaign or program using electronic and print media should be developed.

10. Indicator 13 Infant Feeding and HIV Gaps Identified 1.All health staff and community workers has not received training on HIV and infant feeding. 2.Antenatal VCCT is available and offered routinely to couples in limited hospital facilities only. 3.Lack of on going monitoring in place to determine effect of intervention to prevent HIV transmission on infant feeding practices. 4.Lack of BFHI guidance to hospital administrators and staff in setting with high HIV prevalence. Recommen dations to bridge the gaps 1.All health staff and community workers should be given training on HIV and infant feeding. 2.Antenatal VCCT should be available and offered routinely to couples in all health facilities. 3.Proper monitoring to determine effect of intervention to prevent HIV transmission on infant feeding practices. 4.Develop BFHI guidance to hospital administrators and staff in setting with high HIV prevalence.

11. Indicator 14 Infant Feeding During Emergencies Gaps Identified 1.Lack of person tasked with responsibility for national coordination with UN, donors, NGO, security regarding emergency situations. 2.Inadequate plan to undertake activities to facilitate exclusive breastfeeding and appropriate complementary feeding. 3.Lack of resource identification for implementation of the plan during emergencies. 4.Lack of appropriate material on IYCF in emergencies in pre service and in service training. Recommend ations to bridge the gaps 1.Identification of person tasked with responsibility for national coordination with UN, donors, NGO, security regarding emergency situations. 2.Develop proper plan to undertake activities to facilitate exclusive breastfeeding and appropriate complementary feeding. 3.Proper resource identification for implementation of the plan during emergencies. 4.Appropriate material on IYCF in emergencies in pre service and in service training.

12. Indicator 15 Mechanisms of Monitoring and Evaluation System Gaps Identified 1.Lack of proper monitoring and evaluation component in IYCF program. 2.Lack of proper reporting on evaluation on IYCF program to key decision marker at all level. 3.Lack of proper monitoring key IYCF practice in nutritional surveillance and health monitoring system. 4.Lack of adequate base line and follow-up date on major IYCF program activities. Recommen dations to bridge the gaps 1.Develop proper monitoring and evaluation component in IYCF program. 2.Develop proper reporting on evaluation on IYCF program to key decision marker at all level. 3.Develop proper monitoring key IYCF practice in nutritional surveillance and health monitoring system. 4.Develop adequate base line and follow-up date on major IYCF program activities.