Caribbean Workshop on the WHO/UNICEF Global Strategy for

Infant Young Child Feeding and the New WHO Child Growth

Standards

Caribbean Workshop on the WHO/UNICEF Global Strategy for

Infant Young Child Feeding and the New WHO Child Growth

Standards October 13-14, 2005

MartiniqueOctober 13-14, 2005

Martinique

Working Group 1Objectives

Working Group 1Objectives

• To review the status of infant and young child

feeding (IYCF) policies and programs;

• To identify critical barriers to, and opportunities and priority actions for improving the protection, promotion and support of optimal IYCF practices based on the aims and objectives and recommended interventions outlined in the Global Strategy; and

• identify critical barriers, opportunities, and priority actions required for strengthening national growth monitoring/promotion programs and the incorporation of the new international growth standards in child health services.

Summary of Group Discussions

English-speaking Caribbean Countries (16)

& Suriname

Summary of Group Discussions

English-speaking Caribbean Countries (16)

& Suriname

Anguilla, Antigua & Barbuda, Bahamas, Barbados, Belize, British Virgin Islands, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, St. Lucia,

St. Kitts & Nevis, St. Vincent & the Grenadines, Suriname, Trinidad & Tobago, Turks & Caicos Islands

IYCF Policies and Targets

IYCF Policies and Targets

1. Development/Implementation of National Comprehensive Policy on IYCF

1. Development/Implementation of National Comprehensive Policy on IYCF

Achievements

Barriers Opportunities

Priority Actions

Preparation of IYCF guidelines for the Caribbean

Breast feeding policy officially adopted in 4 countries. In draft form – in others

Limited human resourcesLack of data for policy developmentLack of awareness by decision makersInadequate training in medical educationLack of orientation to existing policies

The need to revise/update existing policies based on the Global Strategy

Development of national strategic plans (ongoing)

Nutrition personnel & MCH Coordinators sensitized to spearhead the process

Advocacy to policy makers for support of Global Strategy implementation

Prepare plan of action for revision of existing policies

Conduct research on IYCF practices

2. Appointment of National Coordinator and Committee Responsible for IYCF

2. Appointment of National Coordinator and Committee Responsible for IYCF

Achievements

Barriers Opportunities

Priority Actions

IYCF Coordinators and Committees appointed in 2 countries

Breastfeeding Coordinators and Committees in 4 countries

Posts not established and extra responsibilities assigned to busy staff

Roles and responsibilities of Committees and Coordinators not clearly delineated

Possibility of extending mandates of existing committees; extend membership e.g. media personnel

Advocacy for policy development

Revamp, strengthen and expand committees with set targets to sustain continuity

3. Adoption of measures for implementation of the International Code

3. Adoption of measures for implementation of the International Code

Achievements

Barriers Opportunities

Priority Actions

No legal framework in place for Code implementation

Adoption of some measures as voluntary measures

Preparation of drafts of national Codes completed in 2 countries

Lack of awareness of rationale and relevance of the Code

Link between Government and the corporate world

Attitudes of health workers

Link to implementation of CRC

Establishment of Early Childhood commissions with support from UNICEF

Availability of trained persons in some countries

To develop National Codes; implementation plans

To sensitize policy-makers, distributors of BMS and the general public

Training for health workers

4. Adoption of Legislation consistent with ILO Standards for Protecting and Supporting Breastfeeding

among working Women

4. Adoption of Legislation consistent with ILO Standards for Protecting and Supporting Breastfeeding

among working Women

Achievements

Barriers Opportunities

Priority Actions

The ILO Maternity Protection Convention (No.183) has not been fully ratified or enacted

In all countries, minimum of 12 weeks paid maternity leave; benefits tied to NIS contributions

Lack of political will

No strong lobbying or advocacy for protecting and supporting breastfeeding in the workplace

Lobbying through strengthened BF/IYCF Committees

Solicit support at regional level for implementation of ILO Convention (183)(CARICOM, UNICEF)

Review current legislation in light of ILO conventions

Organize consultations with stakeholders to sensitize them to issues related to breastfeeding promotion and support

IYCF Programs IYCF Programs

1.Development/Implementation of National IYCF Programs with Measurable Objectives

1.Development/Implementation of National IYCF Programs with Measurable Objectives

Achievements

Barriers Opportunities

Priority Actions

National programs outlined in 4 countries

Some aspects of IYCN promotion form part of MCH services in all countries

Lack of integration among program generally

Lack of human resources – frequent staff turnover

Lack of data on IYCF practices for program planning

Sensitization to the Integrated Approach to ECD

Plans to incorporate behaviour change strategies at program level

Review program objectives and indicators in keeping with MDGs and Global Strategy

Develop/review national programs where necessary

Strengthen information systems on IYCF practices

2. Full Implementation and Active Monitoring of the BFHI

2. Full Implementation and Active Monitoring of the BFHI

Achievements

Barriers Opportunities

Priority Actions

Full implementation and certification of main hospitals in 5 countries

Active promotion of BFHI in 5 other countries

No national policy for BFHI promotion High staff turnover; lack of orientation and ongoing training for new staff

Inadequate monitoring of progress in BFHI

Sensitization of hospital administrative personnel (Cost Benefit Analysis)

Strong antenatal programs exist

Availability of training materials from WHO & UNICEF

Public Communication Strategy to heighten Public Awareness on BFHI

Preparation/review of plans for achieving full BFHI implementation and/or re-assessments of certified hospitals

3. Development /Implement of standards and Guidelines for Mother-Friendly child birth procedures

3. Development /Implement of standards and Guidelines for Mother-Friendly child birth procedures

Achievements

Barriers Opportunities

Priority Actions

Some relevant standards and guidelines are included in Breastfeeding policies

Lack of awareness of medical and nursing staff about relevant procedures

Increased consumer awareness and demand for these procedures

Incorporate standards and guidelines in relevant policies

Monitor adherence of Standards and guidelines

4. Review of IYCF Curricula in Pre-Service Education Programs for Health Care Providers

4. Review of IYCF Curricula in Pre-Service Education Programs for Health Care Providers

Achievements

Barriers Opportunities

Priority Actions

IYCF-related topics are included in pre-service education programs for nursing categories

Insufficient attention to topics related to complementary feeding

Non- participation of MCH or Nutrition personnel in the review process

Resistance to change

Availability of scientific evidence for optimal IYCF practices

Availability of training materials from WHO & UNICEF

Sharing of revised curricula with other countries.

Evaluation of current training curricula

Initiate discussions with relevant training institutions

Review/infuse in the training curricula

5. Review /Strengthening and Organization of In-service Training Programs for health care providers

5. Review /Strengthening and Organization of In-service Training Programs for health care providers

Achievements

Barriers Opportunities

Priority Actions

Ongoing in some countries

BFC & HIV/IFC courses introduced in region

BFC has been conducted in 9 countries; HIV/IFC in 5 countries

No overall in-service training plans

Lack of human & financial resources

Attitudes of some health care workers - do not avail themselves for training

Availability of training courses from WHO/UNICEF

Strengthened IYCF Committees to be proactive – piggy back on ongoing training programs

Development of IYCF training plans

Compile/update data base of trained persons

6. Implementation of Effective Community-based IYCF outreach and support activities

6. Implementation of Effective Community-based IYCF outreach and support activities

Achievements

Barriers Opportunities

Priority Actions

Ongoing to some extent in all countries, mainly through NGO activities

Insufficient support & direction from health system

Lack of consistency in educational messages

NGOs may have access to funds

Free access to media in some countries

Integrate with Health & Family Life Education and Youth-friendly services

Incorporate practical aspects in relevant syllabi of Caribbean Examination Council

Sensitize decision-makers at the community level

Conduct training for community personnel e.g. CBOs; service clubs

Conduct training of Community and Peer counsellors

7. Implementation of Comprehensive IEC Strategy for improving IYCF

7. Implementation of Comprehensive IEC Strategy for improving IYCF

Achievements

Barriers Opportunities

Priority Actions

None of the countries have a comprehensive IEC strategy

Observance of World Breastfeeding Week in 9 countries

May have integration of IYCF theme with other observances eg. World Health Day 2005

Ad hoc IEC programming

Lack of information on local practices, attitudes & perceptions

Possibility of integration with existing health promotion strategies

Create linkages with other programs through integration

Conduct research on IYCF practices & determinants

Development of comprehensive IEC strategy

Strengthen and evaluate strategies

8. Development/Implementation of Standards and Guidelines for Provision of Contraceptive support to BF Women

8. Development/Implementation of Standards and Guidelines for Provision of Contraceptive support to BF Women

Achievements

Barriers Opportunities

Priority Actions

Inclusion in family planning protocols in some countries

Inadequate understanding of conditions for use of LAM

Cultural and religious beliefs

Affordability &availability of preferred types and methods

Religious support for promoting breastfeeding as natural contraceptive

Availability of relevant information from WHO

Review/update/develop standards & guidelines

9. Development/Implementation of Policies forIYCF Counseling & Support to HIV-positive mothers

9. Development/Implementation of Policies forIYCF Counseling & Support to HIV-positive mothers

Achievements

Barriers Opportunities

Priority Actions

Protocol and/or Manual for PMTCT completed in majority of countries but limited provision for infant feeding counseling and support

Lack of integration with breastfeeding or IYCF policies

Counselors not sensitized to HIV/and Infant Feeding recommendations

Integration of PMTCT policies with MCH policies and standards of care

Revision of policies to incorporate new recommendations

Training and sensitization of VCT counselors

Supervision & monitoring of infant feeding counseling & support services

10. Development/Implementation of Policies and Plans related to IYCF in Emergencies

10. Development/Implementation of Policies and Plans related to IYCF in Emergencies

Achievements

Barriers Opportunities Priority Actions

None Lack of awareness of rationale & relevance

Existence of national emergency & disaster plans

Existence of national committees/agencies responsible for emergency preparedness & management

Develop relevant policies & plans; seek approval and inclusion in national emergency plans Training of shelter managers

11. Strengthening of Growth Monitoring/Promotion (GMP) including updating of growth charts

11. Strengthening of Growth Monitoring/Promotion (GMP) including updating of growth charts

Achievements

Barriers Opportunities

Priority Actions

GMP of under-fives ongoing in all countries; in some, limited coverage of older children (24 – 59 months) 15 countries use WHO/NCHS standard

4 countries routinely measure length & height

Inadequate supervision of GMP activities

Lack of attention to maintenance of equipment Poor weighing &measuring techniques

Availability of new growth standards in ‘06

Link to revision of child health records to incorporate new recommendations related to IYCF, immunization schedules etc

Sensitize officials in Ministry of Health to rationale & importance of new growth standardsObtain new standards & support materials from WHO Conduct training to implement the revised growth charts

12. Development of nutrition surveillance system including monitoring of IYCF practices

12. Development of nutrition surveillance system including monitoring of IYCF practices

Achievements

Barriers Opportunities Priority Actions

Surveillance ongoing in 7 countries

Nutrition indicators not included in HIS

Lack of resources for proper data management

Untimely reporting & feedback

Utilization of reports to guide National Plans & programs

In some countries, close collaboration exists between MCH & Nutrition Units

Define key indicators to be monitored

Implement measures for strengthening nutrition surveillance within framework of HIS