1. World Breastfeeding Trends Initiative (WBTi) Perspectives in challenges and future actions Name of the Speaker: Prof. Prakash S. Shrestha Prof. Prakash S. Shrestha President President Nepal Breastfeeding Promotion Forum Name of the Country: NEPAL

2. What has changed since 2005 assessment  % of babies breastfeed within one hour of birth increased by 4.3% (Current 35.4%)  Median duration of Breastfeeding increased by 1 month (Current 34 months)  % of babies receiving complementary foods at 6 – 9 months increased by 8.8% (Current 75%) (Current 75%)

3. What has changed since 2005 assessment cont …….  Maternity leave in Government office increased by 15 days (Current 60 days)  Some improvement in Information Support  Some improvement in Monitoring and Evaluation

4. List of partners for the assessment process 1.Nepal Breastfeeding Promotion Forum (NEBPROF) 2.Nepal Paediatric Society (NEPAS) 3.Perinatal Society of Nepal (PESON) 4.Department of Child Health, IOM 5.Maharajgunj Nursing Campus, IOM 6.TU Teaching Hospital 7.Nutrition Section, Child Health Division 8.Kanti Children’s Hospital 9.Bhabisya Nepal 10.Terredes Homes 11.Democracy for Election Alliance 12.Stupa College of Nursing 13.Mother and Infant Research Activity (MIRA)

5. Challenges faced during the process  National Demographic Health Survey is done once in 5 years  Annual Health Report does not have all data required for WBTi Assessment  Much variation in the pre-service curriculum of different Institutions  Variation in the figure coated in different source of the material available  Much variation in maternity leave provides by private organizations  Data of various NGOs conducting IYCF service at local level is not available

6. Challenges faced during the process cont……  Getting participation of all INGOs & NGOs working in IYCF during workshop on WBTi  Lack of fund for participation by NGOs working outside valley  Limited data is available on out reach clinic  Lack of support from government & INGOs for such activities  No uniformity in different materials on IYCF produced by different organizations  Difficult to collect exact information on emergency situation carried out at local level

7. Methods used to tackle the challenges  Use of National Demographic Data of 2006 in assessment of 2008  Used whatever latest data available in Annual Health Report  Collected curriculum of many Institutions & discussed in workshop  Used the mainly data produced by Government & INGOs  Maternity leave provided by Government was mainly used

8. Methods used to tackle the challenges cont…..  Used whatever data could be collected regarding IYCF service at local level  Tried to get maximum participation of INGOs & NGOs by sending official invitation & reminder by telephone  NGOs working within Kathmandu valley only was included  1998 data of Nepal Paediatric Society on BFHI was used  Compiled whatever data could be collected on outreach clinic

9. Methods used to tackle the challenges cont…..  Need of uniformity in material was discussed during workshop  Tried to collect as much information as possible on Emergency Situation  To get support for Government, Chief of the Nutrition Section was involved in assessment process.

10. Positive experiences during the process  Bringing different organizations working on IYCF in one platform  Compiling National data on breastfeeding & IYCF  Identification of existing gaps for the improvement of IYCF in the country  Bringing many pre-service trainers in Health Professional in one platform

11. Positive experiences during the process cont…..  Preparing WBTi report 2008 of the country  Nepal Breastfeeding Promotion Forum acting as Nodal Point  Drawing attention of Government for need of more action plan with budgetary provision for Improvement of IYCF in country

12. Suggestion for improving the process  Such assessment should be done annually or once in two year  Providing some seed money to each country for this activity  Getting support from WHO/UNICEF or other INGO at country level for such activity  Getting commitment from the National Government for such activity

13. Suggestion for improving the process cont…..  Making some changes in the WBTi tool:-  Using % prelactal feed as an indicator  Including quality of complementary food as also an indicator  Sub grading some degree to < 25%, 25-50% more than 50% for indicator numbers 10, 11, 12, 13, 14, 15  Scoring for International Code implementation should be readjusted depending on strict implementation of the Code as law, monitored and enforced. e.g. Just having some Code as law gives a score of 7, irrespective of how it is implemented. 7, irrespective of how it is implemented.