1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Thank you for listening