Update on BFHI in CEE/CIS

1
Update on BFHI in CEE/CIS
Code workshop, Tirana4 July 2007

• Arnold Timmer, Nutrition Specialist
• UNICEF Regional Office CEE/CIS, Geneva

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BFHI origin

• In 1991 WHO and UNICEF launched the Baby-Friendly
  Hospital Initiative (BFHI). The Initiative was
  launched to support one of the Innocenti
  Declarations primary objectives
• Ensure that every facility providing maternity
  services fully practises all 10 of the Ten Steps
  to Successful Breastfeeding set out in the joint
  WHO/UNICEF statement, Protecting, Promoting and
  Supporting Breast-feeding

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BFHI aims

• A maternity facility can be designated
  'Baby-Friendly' when it does not accept free or
  low-cost supplies of breastmilk substitutes,
  feeding bottles or teats, does not advertise or
  promote any products within the scope of the
  International Code and has implemented the 10
  Steps to successful breastfeeding
• Ensures all mothers assisted to start
  breastfeeding early, within the first hour
  following the birth of the child,
• Mother and baby stay together in the maternity
  hospital
• Mother receive counselling support
• Follow-up after discharge from the maternity
  takes place

4
2006 Renewed call for BFHI

• Implement and revitalize the initiative
  reflecting new developments in infant and child
  care
• research and the experience gathered over the
  first years of the BFHI
• to reinforce the International Code of Marketing
  of Breast-Milk Substitutes
• to support mothers who are not breastfeeding
• to provide modules on HIV and infant feeding and
  mother-friendly care
• to give more guidance for monitoring and
  reassessment

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Global BFHI progress 20,000 in 152 countries
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Progress in CEE/CIS until 1996

• 110 hospitals designated Baby-Friendly between
  1993 and 1996, half of these (56) were in Turkey,
  
• however in some countries no hospitals had been
  designated Baby-Friendly by 1996
• importance International Code recognized across
  the region however few effective governmental
  mechanisms in place to control free or low-cost
  supplies of breastmilk substitutes.
• National Breastfeeding Committees been put in
  place in almost every country, though the
  specific budget allocations needed for the
  implementation are small

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Progress in CEE/CIS until 1996

• regional and international training courses
  organized and replicated national/sub-national in
  most countries proportion staff trained at
  Maternal and Child Health (MCH) level relatively
  small
• Many mass media campaigns involving television,
  radio and the press were organized in several
  countries of the region
• In 1996, a small number of countries in the
  region had routine monitoring systems and no
  country-specific evaluations had been carried out

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Progress in CEE/CIS until 2006
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Progress in CEE/CIS until 2006

• 1336 (out of 6988) Baby-Friendly hospitals in the
  region
• Increased in 10 countries, decreased only in
  Romania
• 5 countries have proportion of BFHI facilities gt
  80 (Macedonia 93 )
• 4 countries gt 50
• considerable progress in last two years
• 776 in 2004 ? 1336 in 2006
• especially Russia, Turkey, Azerbaijan, Ukraine

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of BF facilities - of births in BFHs in 2006
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of babies born in baby-friendly-facilities
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Exclusive breastfeeding rate (lt 6 months)
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Innovations Turkey baby friendly provinces

• BFHI programme decentralized to provincial level,
  mobilizing all health staff and society with the
  goal of creating baby-friendly provinces
• At least 20 of the maternity hospitals BF
• Training health workers, availability of
  breastfeeding counselling services, ban on
  advertisement breastmilk substitutes
  introduction complementary foods at six months
  relevant information to pharmacists
• Award to governor of the province ? support from
  outside health
• Health staff beyond hospital staff, focus on
  large hospitals, support from high levels

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Innovations Armenia- Baby-friendly Polyclinics
BFPI

• Expand BFHI to polyclinic, adapt 10 steps
• All training, IEC material, tools adapted
• Mothers support groups actively engaged in
  educating and supporting mothers in polyclinics
• BF rates increased
• 8 polyclinics included so far
• Lesson Follow up after discharge from hospital
  in polyclinic

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Ukraine - BFHI include PMTCT and prevention of
abandonment of newborns in hospital

• Expand to include PMTCT and HIV child care
• Child abandonment and discrimination reduced,
  attitude of staff
• HIV mothers no more separated in infection
  section
• 10 of BFH in Ukraine now expanded
• Lessons need to expand further to antenatal
  clinics, children hospitals and family medical
  centers, foundation for successful PMTCT,
  friendliness of hospital goes beyond 10 steps

16
Bosnia and Herzegovina- Expansion from hospitals
to Early Childhood Development

• National action plan ECD with focus on IYCN,
  focus on IDPs and Roma
• Schools for future parents and parents support
  groups and outreach, close to BFH
• Training of health staff on maternal and child
  care
• Holistic focus on child development
• Parent support groups were established in 21
  health centres and were integrated and linked to
  BFH
• Lesson BFH to be part of ECD policy and across
  activities in maternities immunization, PMTCT,

17
Russian Federation- Decentralizing BFHI to the
Regional level

• Regional BF centers and link with Ministry of
  Public Health and Social Development and Center
  for Promotion Support BF (SPC)
• SPC support regional centers and train
  managers/maternity staff, provide consultation
  and assistance to maternity and child care
  facilities, preparing and disseminating
  informational and methodological brochures,
  analyzing breastfeeding trends, and interacting
  with the mass media and public association of
  Media
• Programme active in 40 regions of the 7 federal
  districts
• 240 baby-friendly certified programmes
• Lesson decentralize BFHI when health services
  are decentralized

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Macedonia- Using emergency funds to promote BFHI

• Rehabilitation of maternity wards, furniture
  supply and equipment, training and assessments
• 100 mother support groups established, materials
  (Welcome to Life package including BF),
  commission for BF promotion established, child
  birth education classes
• By 2002 28 of 29 maternity facilities baby
  friendly covering 90 of births
• Lesson opportunities to integrate BFHI into
  other activities - scale up BFHI in a short
  period of time

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Romania- Integration with the MCH programme

• Integration BFHI in national MCH Programmes,
  training of trainers and networks, organisation
  of national annual BFHI workshops
• In 2003 National Strategy for Breastfeeding
  Promotion
• local trainers training staff in each maternity
  UNICEF 18 hour course supplemented with extra
  modules on communication skills for health
  workers and breastfeeding management at PHC level
  
• National BFHI workshops to exchange, review,
  evaluate, monitor
• Lessons official recognition of BFHI eg National
  Strategy, strong Committee for Breastfeeding to
  ensure BFHI standards, permanent training plan in
  each maternity, active breastfeeding coordinator

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Challenges and future directions

• Goal move from a stand-alone initiative to
  integration into a comprehensive package to
  address the needs of early childhood
• Challenges
• Commitment and staff turnover
• Sustainability ? integration into certification
  and QC for health institutions budget allocation
• Confusion re HIV/AIDS CEE/CIS countries adopted
  replacement feeding not in line with global
  policy
• Revitalize BFHI government ownership improving
  skills health care providers ? counselling
• Extending care to the mother and baby into the
  community