1. The South African Mother Baby Friendly Initiative Experience
The Mother Baby Friendly Initiative (MBFI) In South Africa
The South African Mother Baby Friendly Initiative Experience
9th International Baby Food Action Network (IBFAN) Africa Regional Conference 1-4 February 2016, Kampala, Uganda
Z. KUBEKA
On behalf of:
NDOH : CHILD , YOUTH HEALTH & NUTRITION

2. Outline of the Presentation
4/27/2017
Outline of the Presentation
Brief History of MBFI in South Africa
Current MBFI status in South Africa
Lessons learned
Strengths & opportunities
Implementation challenges
Scaling up plans

3. Brief history of the SA Baby Friendly Hospital Initiative (BFHI)
4/27/2017
Adopted the Global Strategy in 1994
Set targets- National, Provincial and District target
Initially supported by UNICEF
Trainers and assessors trained by IBFAN Africa,
Used International assessors to assess and mentor National Assessors
A BFHI implementation strategy was developed
Provincial Managers have included MBFI in their KPAs

4. Outline of the Strategy
4/27/2017
Outlined roles and responsibilities at various levels
Including funding mechanism for the assessment process
Outlined the capacity building plan
Decisions on the skills mix for assessors (Nutrition, Nurse etc)
Outlined BFHI roll out plan
Planning and Assessment cycle
The accreditation process

5. Decentralization and coordination of BFHI
National
Province
District level
Facility level
Policy development Capacity building, co-ordinate assessments, set National targets
Capacity building, implementation body fund travel between provinces, overall prov. Coordination, set Provincial targets
Capacity building, support monitoring of facilities
Support internal assessments
Conduct training, self appraisal, formed hospital BFHI implementation Multisectoral teams

6. Process and planning cycle
Strategic planning session:
Provinces set targets
Budget for assessments
National targets aligned to Provincial
Assessments spread /Quarter
Facilities supported by Province and district
National- allocate assessors team
Provincial & national reports on current status

7. Plaque removed if the facility does not maintain status
Assessment Process.
Not sustainable
BFHI assessments initially conduced by international assessors
More sustainable
Currently assessments are carried out by a team of trained assessors (Dietitians, Professional Nurse, Midwife
Local teams were capacitated
Plaque removed if the facility does not maintain status
Provinces conduct Provincial monitoring yearly.
National Reassessments conducted every three years

8. Health Facilities declared as MBFI 1995 to 2014 Health Facilities 545
Since 1994 to date
70% (382/545) facilities with maternity beds accredited at the end of 2014/2015 financial year against a target of 75%

9. Outcomes of BFHI in SA
BFHI In SA was not yielding the desired results. Exclusive Breastfeeding rates still low, Infant and child mortality rates high but gradually declining
Challenges:
Perception that MBFI is the solution to all problems MBFI still implemented
as a vertical programme &
not integrated into other child survival strategies.
Poor follow up of mothers after discharge
Most mothers go back to work/school, maternity leave paid 16 weeks
Lack of involvement of Community and family support on breastfeeding
Too much window dressing in facilities just to get the award
THE STRATERGY NEEDED TO BE REVISED

10. Revitalization of Breastfeeding Cont.
2011
Breastfeeding Consultative Meeting
The term Mother, Baby Friendly Initiative was adopted
2012- Development of a clinic tool
Aimed to extend MBFI to clinics (strengthening ANC, PNC & community support)
Incorporating MBFI into other child health processes
Breastfeeding training package included into NNC training package, incorporating in initiatives for newborn care (INC, LINC, WINC)
2013/14
Inclusion of breast feeding Indicators in the District Health Information System
2014
MBFI tools revised to align SA Context revised IYCF & PMTCT guidelines (HIV & Infant feeding & Regulations)
2015
Establishment of the Breastfeeding technical working group at national level

11. Infants exclusively breastfed at 14 weeks ( Link with Immunization visit)
4/27/2017
This is a new indicator which has only been collected since the beginning of the 2012/13 financial year.
It is encouraging to note that seven provinces have shown good progress in increasing the proportion of infants who are exclusively breastfed.
The low rates in Gauteng and Western Cape are of concern – these are populous provinces and the low rates impact negatively on the national average.
The high rate reported in Free State, whilst encouraging, appears improbably high, and should be verified.
All provinces should ensure that:
The data are being collected correctly at all facilities.
All districts monitor the proportion of infants who are exclusively breastfed in their district, and include interventions to increase the proportion in their district health plans
Collection challenges – 24 hour recall is recommended to get a true reflection what the mother feeds the infants

12. Lessons learned
MBFI without strong community support does not translate into increased breastfeeding rates.
Start with facilities with a higher deliveries in order to reach more mothers
Advocacy to policy makers and managers at different implementation levels is critical.

13. Challenges at Implementation level
Resource constraints (finance, high staff rotation)
MBFI not fully adopted as routine maternity standard
Lack of opportunity for training, staff not release for training
Lack of adequate monitoring by District, only waiting for the re assessment year
Limited lodger facilities for mothers with babies in special care although this is policy- needs scaling up
Sophisticated infant food marketing practices
Contradictory views of medical practitioner’s regarding exclusive feeding

14. Next Steps in the following 12 months
Continuous Advocacy for MBFI across all levels
Include MBFI on the package for PHC
Strengthen Community representation in the facility committees
Continuous accreditation of Assessors skills & updates every 2 years (maintain quality)
Strengthen capacity for CHW to support BF

15. I THANK YOU ALL FOR LISTENING