Strategy for Promoting Optimal Infant and Young Child Feeding
The IYCF Policy and Strategy is designed to contribute to the objectives of the Afghan National Health and Nutrition Sector Strategy and the overall goal of the Public Nutrition Policy and Strategy by focusing on the following objective:
To increase the percentage of child caregivers adopting appropriate infant and young child feeding and caring practices (by 20% by 2013).
This objective will be achieved through the following three strategy components:
1. Application of IYCF Policy and Strategy supported by advocacy, technical guidance and law enforcement
National IYCF Policy and Strategy
1. Disseminate the National IYCF Policy and Strategy amongst all key stakeholders (MoPH, MAIL, MoJ, MoMI, MoEd, MoRA, MoWA, NGO’s, private sector).
- Preparation of a policy brief/leaflet for key decision makers, civil servants, NGOs and private sector stakeholders on the Government of Afghanistan’s IYCF policy
- Participation in relevant meetings and forums to disseminate information on the IYCF policies.
2. Regular updating of IYCF action plan and preparation of a resource mobilization plan to support the implementation of the IYCF Policy & Strategy
3. Review MoPH related sub-policies, strategies and guidelines and make sure IYCF has been reflected in these documents
The Code of Marketing of Breast-milk Substitutes
4. Establish a National Committee for the Enforcement of the Code
5. Establish enforcement mechanisms for the Code of Marketing of BMS
6. Disseminate information on the Code (including translations) and related legislation to all key stakeholders (Provincial Departments of Health, PRTs, private sector, all health facilities, MOWA, NGOs, etc.) through posters, leaflets, and workshops
7. Training of Code monitors (IBFAN)
8. Establish enforcement mechanisms and develop guidelines for the implementation of the Maternity Protection Act
9. Inform working women of their rights under the Maternity Protection Act (e.g. through leaflets and radio; can be part of IYCF Public Awareness Campaign)
10. Review existing international guidelines and national training packages and develop a comprehensive and coherent set of harmonized guidelines covering IYCF policy and priorities and strategic interventions, namely: IYCF promotion in different health facilities (including BFHI guidelines); IYCF promotion at community level; Infant and Young Child Feeding in Emergencies; Implementation of the Code, etc.
11. Disseminate guidelines to the relevant stakeholders, and conduct trainings on their implementation (c.f. also training activities under outputs 2 and 3)
Infant and Young Child Feeding in Emergencies
12. As part of the Afghan IYCF guidelines, develop a section on IYCF in Emergencies based on the internationally endorsed Operational Guidance for IFE
13. Disseminate the IFE Guidelines to all relevant stakeholders (including the Disaster Management Committee, the PRT, NGOs and Provincial Development Councils) and ensure they are implemented in emergency situations.
2. Caregivers know optimal IYCF practices and are supported in providing optimal care and mobilizing the resources required for IYCF, through IEC/BCC and community support interventions.
Public awareness Raising
- Implement the National Breastfeeding Communication Campaign (to be launched during World Breastfeeding Week 1-7August 2009)
- Celebrate World Breastfeeding Week annually
- Expand the National Breastfeeding Communication Campaign to cover complementary feeding and IYCF as a whole, and conduct regular IYCF awareness activities:
- Identification and mobilization of key partners for public awareness activities, namely MoPH, MAIL, MoWA, MoRA, MoE, MRRD and public media.
- Conduct sample baseline KAP surveys, where possible (referring to formative research conducted in 2002 and 2003)
- Identification and definition of harmonized messages to be used by all stakeholders, under MoPH PND lead.
- Development of adequate materials, including posters, leaflets, radio and TV spots
- Training of relevant stakeholders on the IEC messages (including key health staff -cf link to output 4-, religious leaders, community leaders, journalists, etc.)
- Implementation of Public Awareness Activities through the various media identified
- Post-awareness raising monitoring survey (KAP)
Establishment of community support groups and interventions
- Identification of opportunities for establishing IYCF community support groups, on the basis of existing networks and projects (e.g. health shuras, women’s shuras, Growth Monitoring and Promotion, etc.) and/or integrating IYCF counselling in existing community development activities.
- Mobilization of elders and community leaders to establish support for the community support groups and/or community-based IYCF counselling
- Identify facilitators who can provide counselling at community level, through community support groups and/or other development interventions (e.g. CHW, dahia, literacy teacher, head of women’s shura, etc.) and determine their training needs
- Development of training materials and job aids for community-level IYCF counsellors and support group facilitators
- Training of IYCF counsellors and /or support group facilitators on adequate IYCF counselling and psycho-social support skills
- Provide IYCF counsellors and /or support group facilitators with the resources required to conduct adequate counselling (e.g. BF counselling kit; cooking set;)
- Provide regular assistance and supervision to IYCF support groups and IYCF counsellors operating at community level.
- Monitor the implementation of counselling sessions and participatory cooking sessions
- Establish linkages and partnerships with food security projects aiming to diversify household food production and income generation (if locally in place) or mobilize resources and expertise to implementation food security interventions if they are not in place.
Integration of IYCF in non-health community-level interventions
- Establish pool of IYCF trainers in MAIL and train extension workers (in particular women) on IYCF counselling
- Integration of IYCF messages and participatory cooking sessions in agricultural projects
- Include IYCF in the curricula of literacy training and train literacy teachers on IYCF.
3. IYCF promotion and counselling is effectively implemented as part of the BPHS and EPHS in all health facilities.
Capacity-building of various categories of personnel involved in implementation will be an integrated component of each strategic priority/output. Advocacy and resource mobilization will be essential to enable the implementation of the activities required to achieve these outputs. An advocacy and resource mobilization plan will therefore be developed. The activities to be implemented to achieve these outputs/strategic priorities are described below.
Expansion of Baby-Friendly Hospital Initiative to more hospitals and selected health facilities providing MCH services
1. Review lesson learned from the current BFHI
2. Train pool of BF assessors/advocates at the central and regional level.
3. Develop tools, conduct assessment/re-assessment to certifying health facilities as Baby-friendly
4. Train health facility staff on measures required to comply with BFHI criteria and implement these measures
5. Supervise and monitor facilities and provide certificates for facilities complying with BFHI criteria
Integrationif IYCF counselling in all health gacilities
6. Develop guidelines and establish IYCF corners in health facilities, including breastfeeding counselling and participatory cooking sessions (N.B. can be part of child health corner)
7. Ensure IYCF counselling is part of health education activities, including breastfeeding demonstration and participatory cooking sessions
8. Ensure breastfeeding counselling and re-lactation assistance are part of the management of acute malnutrition (in TFU and CMAM)
9. Identify at least one referral centre in each province for referral of complicated and difficult lactation and IYCF cases.
Training of health staff on IYCF
10. Integrate IYCF into the curricula of all medical and paramedic education institutions including community midwifery school and postgraduate programs (esp. residency training programs in paediatrics, obstetrics and gynaecology).
11. Develop training packages and job aids on IYCF for different health staff categories, including: doctors, nurses, midwives, community midwives, and CHWs
12. Integrate IYCF training modules as part of in-service trainings, in particular for MCH staff, CHWs & midwives (e.g. as part of C-IMCI training)
13. Distribute printed material and job aids to all facilities, including for CHWs and community midwives as part of C-IMCI
15. Train and establish pool of trainers at the national level and in “each region” on MBFI and IYCF, in particular by training Provincial Nutrition Officers on IYCF
16. Train at least 2 MCH staff of each health facility.
17. Train out-reach staff to enable them to integrate IYCF in out-reach services.