INFANT AND YOUNG CHILD FEEDING PROGRAMMING STATUS · INFANT AND YOUNG CHILD FEEDING PROGRAMMING...
Transcript of INFANT AND YOUNG CHILD FEEDING PROGRAMMING STATUS · INFANT AND YOUNG CHILD FEEDING PROGRAMMING...
INFANT AND YOUNG CHILD FEEDING
PROGRAMMING STATUS
Results of 2010 - 2011 assessment of key
actions for comprehensive infant and young child feeding programmes in 65 countries
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© United Nations Children’s Fund (UNICEF) April 2012 Cover photo: Ghana: © UNICEF/HQ02-0570/Pirozzi Permission to reproduce or extract any part of this document is required. Requests may be sent to C. Rudert, Nutrition Section, UNICEF New York, [email protected]
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Acknowledgements
Nutrition staff from UNICEF country offices compiled the information on IYCF programmes in each of the 65 countries which completed the matrices, and in many countries Government staff and partners were also involved in the exercise.
UNICEF consultant Avril Armstrong collected and inputted the data and drafted the report. Adebayo Ogunlade conducted additional analysis and editing of the report and produced country profiles for 22 countries with poor IYCF practices and large burdens of children sub-optimally fed and undernourished. From UNICEF headquarters, Christiane Rudert (Nutrition Specialist Infant Feeding) conceptualized the assessment matrix and prepared the first draft; she was also responsible for overseeing the assessment, managing the consultancies and finalizing the report. Mandana Arabi (formerly Nutrition Specialist Complementary Feeding) oversaw the development of the final version of the matrix and contributed to following up on the conducting of the assessment. The assessment was supported by Nune Mangasaryan (Senior Advisor Infant and Young Child Nutrition).
Any questions or comments should be addressed to Christiane Rudert, [email protected]
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Table of Contents
Acronyms and abbreviations……………………………………………………………………...
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Executive summary………………………………………………………………………………….
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1.0 Introduction…………………………………………………………………………………... 7
1.1 Objectives………………………………………………………….…………………………..
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2.0 Methodology……………………………………………………….…………………………. 7
2.1 Data collection ………………………………..………………………………………………. 7
2.2 Data analysis procedure…………………..………………………………………………….
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3.0 Results………………………………………………………………………………………...... 10
3.1 Response rates……………………………………………………………………………….… 10
3.2 National level IYCF actions…………………………………………………………..……….. 10
3.3 Health service level IYCF actions………………………………………………………..…… 16
3.4 Community-based IYCF actions…………………..……………………………………..…… 23
3.5 Communication on IYCF……………………………………...…………………………..…… 27
3.6 Complementary feeding interventions/components……………………….…………..…… 31
3.7 IYCF in difficult circumstances………………….………………………………………..…… 34
3.7.1 HIV and infant feeding ……….………………….………………………………………..…… 34
3.7.2 Infant feeding in emergencies………………….………………………………………..…… 35
3.8 IYCF monitoring and evaluation…………………………………………………..……..…… 39
3.9 Conclusions and recommendations…….…...……...…………………..……………..……. 41
References………………………………………………………..………………………..…………... 50
Section 4: IYCF profiles: 22 countries with poor IYCF practices and large burdens of
undernutrition among children under five years…………….…………..………………………
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ANGOLA…………………………………………………..……………………………..…..………….. 52
BANGLADESH…………………………………………………..…………………………..………….. 54
BURKINA FASO…………………………………………………..………………..………..…………. 56
COTE D’IVOIRE…………………………………………………..………………...………..………… 58
DEMOCRATIC REPUBLIC OF THE CONGO………………………………..……………..………. 60
ETHIOPIA…………………………………………………..……………………..…………..………… 62
INDIA…………………………………………………..………………………..………………….……. 64
INDONESIA…………………………………………………..………………………..……………….. 66
KENYA…………………………………………………..………………………..……………………... 68
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MALAWI………………………………………………………………………………………………….. 70
MALI………………………………………………………………………………………………………. 72
MOZAMBIQUE…………………………………………………………………………………………... 74
NIGER…………………………………………………..………………………..………………………. 76
NIGERIA…………………………………………………..………………………..……………………. 78
NORTH SUDAN…………………………………………………..………………………..…………… 80
PHILIPPINES…………………………………………………..………………………..………………. 82
SIERRA LEONE…………………………………………………..………………………..…………… 84
SOMALIA…………………………………………………..………………………..………………..….. 86
SOUTH SUDAN…………………………………………………..………………………..………….… 88
UGANDA…………………………………………………..………………………..………………….… 90
UNITED REPUBLIC OF TANZANIA…………………………………………………..……………… 92
YEMEN…………………………………………………..………………………..……………………… 94
ANNEXES………………………………………………………………………..………………………. 96
ANNEX 1: Assessment matrix questionnaire ………………………….……………..……………... 97
ANNEX 2: Completion of assessment matrix and response rate…….……………..…………….. 104
ANNEX 3: Key IYCF interventions and indicators ………….……………..………………………... 105
ANNEX 4: Country descriptions………………………….……………..……………………………... 107
ANNEX 5a: IYCF policy, strategy and plan of actions………………….……………..…………… 111
ANNEX 5b: IYCF legislation and law………………………….……………..……………………….. 114
ANNEX 5c: National level IYCF action score ………………………….……………..……………... 116
ANNEX 5d: IYCF health service training curricula……………………….……………..………….. 118
ANNEX 5e: IYCF health workers capacity development……………….……………..……………. 121
ANNEX 5f: Training of health providers on IYCF counseling…………….……………..………….. 123
ANNEX 5g: IYCF health system counseling………………………….……………..………………. 125
ANNEX 5h: Baby-Friendly Hospital Initiative………………………….……………..………………. 127
ANNEX 5i: Health system level IYCF actions score…………………….……………..……………. 129
ANNEX 5j: Community-based IYCF actions………………………….……………..……………….. 132
ANNEX 5k: Capacity development and coverage of community-based IYCF actions………….. 135
ANNEX 5l: IYCF community activity implementor………..…………….……………..…………….. 137
ANNEX 5m: Communication on IYCF…...……….……………………….……………..………….… 138
ANNEX 5n: Communication on IYCF: Strategy, materials and monitoring/evaluation…………. 141
ANNEX 5o: Communication on IYCF action scores…..……………….……………..……………… 144
ANNEX 5p: Complementary feeding components / interventions….….……………..……………. 147
ANNEX 5q: IYCF in difficult circumstances (HIV and infant feeding)….……………..……………. 149
ANNEX 5r: IYCF in difficult circumstances (Infant feeding in emergencies)……………………….. 152
ANNEX 5s: Overall IYCF in difficult circumstances……….………………………….……………... 155
ANNEX 5t: IYCF monitoring and evaluation……….………………………………..…………………. 157
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Acronyms and abbreviations
ANC ante-natal care
BCC behaviour change communication
BFHI Baby Friendly Hospital Initiative
BMS breast-milk substitutes
CAR Central African Republic
CEE/CIS Central and Eastern Europe/Commonwealth of Independent States
CF complementary feeding
CHW community health worker
Code International Code of Marketing of Breastmilk Substitutes and subsequent relevant
World Health Assembly Resolutions
DRC Democratic Republic of Congo
EAPR East Asia and the Pacific and South Asia Region
ESAR Eastern and Southern Africa Region
GMP growth monitoring and promotion
GSIYCF Global Strategy for Infant and Young Child Feeding
HIV human immunodeficiency virus
HMIS health management information system
HW health worker
IF infant feeding
ILO International Labour Organization
IMCI integrated management of childhood illness
IYCF infant and young child feeding
IYCN infant and young child nutrition
KAP knowledge, attitudes and practices
LAM lactation amenorrhea method
LBW low birth weight
LNS lipid nutrient supplements
LQAS lot quality assurance sampling
MAM moderate acute malnutrition
MICS multiple indicator cluster survey
M&E monitoring and evaluation
PMTCT prevention of mother to child transmission
ROSA Regional Office for South Asia
SOWC State of the World’s Children
TBA traditional birth attendant
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
U5MR under-five mortality rate
WCAR Western and Central African Region
WHO World Health Organization
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Executive summary This comprehensive infant and young child feeding (IYCF) situation assessment was conducted with the primary objective of providing an up-to-date overview of the scope and scale of IYCF programming and implementation status globally, which will enable gaps and constraints as well as areas of achievement to be highlighted and actions to strengthen the programmes identified. Since 2010, the equity-focused approach has emerged as a pivotal priority for UNICEF as an organization [1]. The present report is highly relevant to this effort. It presents the detailed IYCF profile for 22 nutritionally vulnerable countries, “countries with the poorest IYCF practices and largest burden of undernutrition among children less than five years”
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Furthermore, optimal IYCF practices play an important role in reducing early childhood morbidity and mortality, as well as in improving early child growth and development. WHO/UNICEF recommend exclusive breastfeeding from birth to first six months of life, with the introduction of complementary foods thereafter, and continued breastfeeding until two years of age [2].
Guidance on IYCF actions
In support of country-level actions in strengthening IYCF programmes, UNICEF has recently developed a programming guide on IYCF [3] for country level managers and public health/nutrition staff. The programming guide is based on scientific evidence, lessons learned, best practices and presents the “how” of programming at all levels. Key IYCF action areas at the national, health service and community levels for a comprehensive, at-scale IYCF strategy, including the design and implementation steps are outlined.
IYCF assessment matrix
Accompanying the IYCF Programming Guide is an assessment matrix. The matrix is structured around the components of the Guide. This tool is intended for use by UNICEF’s country offices, in close collaboration with governments and other partners involved in IYCF programming, to regularly monitor and assess the scope and scale of recommended IYCF in-country actions and identify areas for improvement. The matrix can be used periodically to assess whether progress is being made to address identified gaps. The aggregated information is also helpful for regional and headquarters staff to prioritize support and additional guidance on the areas most commonly reflected as problematic.
Methodology Between 2010 and 2011, the UNICEF Nutrition Section at HQ requested its country offices to complete the IYCF assessment matrix. In most cases the exercise was undertaken in collaboration with Government counterparts and other partners. The data collected were compiled, analyzed and will be used as baseline data for the scope and scale of IYCF programming globally. This report summarizes the results of the analysis. In total, the assessment matrix was sent to 86 (including 22 designated nutritionally vulnerable countries) country offices in 6 regions [East and South Asia region (ESAR), West and Central African region (WCAR), Region of South Asia (ROSA), Middle East and North African region (MENA) and East Asia and Pacific region (EAPR)] for completion. IYCF action score was calculated for each country on each of the action areas. Scores were then scaled from 0 to 10 and rated based on a colour scale
2. It is emphasized that the results are principally qualitative and
are based on the responses received from the countries. Overall, approximately 65 countries (76%) responded within the stipulated timeframe and returned completed assessment matrices.
1 It is noted that these 22 countres do not represent the entire set of countries with poor nutrition indicators, but a selection.
2 Colour scale interpreted as follows: Red = 0-3 [“Poor” – very low number of key IYCF actions implemented]; Orange = 4-6 [“Fair” – low
number of key IYCF actions implemented; Green = 7-8 [“Good” - average number of key IYCF actions implemented]; Purple = 9-10 [“Very good” – High number of key IYCF actions implemented].
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Key findings National level IYCF actions Overall more countries had IYCF policies than strategies and plans
of actions. Approximately 84% of the countries (n=51) had policies (stand-alone or integrated), 60% (n=38) had strategies and only 48% (n=30) had plans of action.
An estimated 62% of the countries (n=39) had national legal frameworks related to the Code of Marketing of Breastmilk Substitutes in place and only 19 countries (50%) had a Code monitoring or enforcement system in place. Paid maternity leave existed in most of the countries [92% (n=56)] but only about 52% of the countries (n=32) provided paid nursing breaks for mothers after they returned to work.
On average, countries were rated “fair” on their national level IYCF actions, indicating implementation of low number of key IYCF actions at the national level.
Overall, 12% of the countries were rated “Very good”, 28% “Good”, 40% “Fair” and 20% “Poor” on the national IYCF actions.
Health service IYCF actions Pre-service trainings for nurses and other health professionals on
IYCF were more likely to occur than training for medical doctors. Only 51% of the countries (n=33) conducted IYCF-focused pre-service trainings for medical doctors, and about 88% (n=38) conducted pre-service trainings for nurses and other health professionals.
In-service trainings occurred in about 37 countries (60%). About 69% of the countries (n=44) had job aids and counselling cards available for health professionals (medical doctors, nurses and other health professionals).
Although about 43 countries indicated that health workers were trained on IYCF counselling since 2006, none of the countries were able to report on the geographic scale and target population coverage of counselling activities taking place within the maternal and child health centres.
Among the 55 countries that indicated that at least one hospital/maternity facility was ever-certified as “Baby-Friendly”, the average proportion ever-certified was 23% (ranging from 1 to 100%). Among the 22 countries that indicated that at least one hospital/maternity facility was ever re-certified as “Baby-Friendly”, the average proportion ever re-certified is extremely low at 5.6% (ranging from 1 to 76%).
On average, countries were rated “fair” on their health service IYCF actions, indicating the implementation of low number of key IYCF actions at the health service level.
Overall, 12% of the countries were rated “Good”, 57% “Fair” and 31% “Poor” on the health service IYCF actions.
Community level IYCF actions Eighty-four percent of the countries (n=53) had established
community-based IYCF activities either as stand-alone and/or integrated within other programmes.
Only 11 countries reported having stand-alone IYCF activities within the community. Some countries indicated integrating activities within other programmes [such as Integrated Management of Childhood Illnesses (n=12), ante-natal care (n=9), growth monitoring and promotion (n=7)].
About 66% of the countries (n=39) indicated training of community health workers on community IYCF counselling had occurred since
Health service level IYCF action
scores in 65 countries
Community level IYCF action scores in
65 countries
National level IYCF action scores in
65 countries
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2006, while 27 countries (60%) conducted specific capacity building on communication skills for community health workers. The average proportion of community health workers trained on IYCF counselling since 2006 was 26 % (ranging from ≈1 to 73%).
Only 13 countries routinely monitored the counselling skills of the community health workers and very few monitored the counselling quality
On average, countries were rated “Poor” on their community-based IYCF actions, indicating the implementation of very low number of key IYCF actions at the community level.
Overall, only 8% of the countries were rated “Good”, 31% “Fair” and 61% “Poor” on the community-based IYCF actions.
Communication on IYCF Only 36 countries (55%) conducted communication on IYCF
through five or more communication channels. Countries also indicated having communication strategies at the national (n=33), health service (n=54) and community (n=50) levels.
Behavioural change and communication materials were available in most [95% (n=61)] of the countries.
However, few countries had monitoring and evaluation systems for communication on IYCF. Only 16 countries (28%) routinely monitored on-going communication on IYCF activities.
Additionally, about 20% of the countries (n=9) routinely monitored the number of people reached through media messages. As a result, only a few countries were able to report on the coverage of communication on IYCF activities in their country.
On average, countries were rated “Fair” on their communication on IYCF actions, indicating the implementation of low number of key communication on IYCF actions.
Overall, 12% of the countries were rated “Good”, 62% “Fair” and 26% “Poor” on the communication on IYCF actions.
Complementary feeding interventions/components About 60% of the countries (n=37) indicated that
caregivers/mothers were counselled on home preparation of complementary foods for children 6-24 months. Countries d a variety of counselling channels, such as counselling cards (at the health service and community level), cooking classes, published recipe guides for mothers and broadcast food preparation demonstrations on TV.
Micronutrient supplements (multiple/single) were provided to improve complementary feeding for children 6-24 months in about 79% of the countries (n=51). Furthermore, 58% of the countries (n=19) provided fortified industrially blended complementary foods, while only 26% of the countries (n=10) provided fortified local complementary foods.
On average, countries were rated “Fair” on their complementary feeding interventions/components.
Overall, 11% of the countries were rated “Very good”, 4% “Good”, 36% “Fair” and 49% “Poor” on the complementary feeding interventions/components.
IYCF in exceptionally difficult circumstances HIV and infant feeding
HIV and infant feeding policy and guidance were available in about 84% of the countries (n=54).
Approximately 72% of the countries (n=47) d infant feeding counselling for HIV positive mothers, while about 83% countries (n=45) trained health workers on infant feeding and HIV. However, only about 67% (n=38) of the countries provided support on infant feeding for HIV positive mothers.
Communication on IYCF action scores
in 65 countries
Complementary feeding interventions/
components scores in 65 countries
HIV and infant feeding action scores in
65 countries
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Infant feeding and HIV training materials and job aids/counselling cards were updated with the WHO 2010 recommendation in approximately 76% (n=31) and 74% (n=23) of the countries, respectively.
Only 27.4% (n=17) of the countries had a monitoring system on infant feeding practices among HIV positive mothers in place.
On average, the countries were rated “‘fair’” on their actions related to HIV and infant feeding interventions.
Overall, 12% of the countries were rated “Very good”, 38% “Good”, 25% “Fair” and 25% ‘Poor”. Infant feeding in emergencies
Only 41% (n=26) of the countries indicated that their national IYCF policy included infant feeding in emergencies. Similarly, 24 countries (41%) also reported having a national emergency preparedness plan which included IYCF in emergencies.
About 24% (n=14) countries provided training for health providers or IYCF counsellors on infant feeding in emergencies.
Fifteen (15) countries (25%) indicated that they provide breastmilk substitutes in emergencies.
On average the countries are rated “poor” on their actions related to infant feeding in emergencies.
Overall, 4% of the countries were rated “Good”, 17% “Fair” and 78% “Poor”.
IYCF monitoring and evaluation
Routine monitoring and evaluation of ongoing IYCF activities and the monitoring of process indicators took place in about half of the countries
Evaluation or review of the IYCF situation only occurred in about two thirds of the countries. At the same time, monitoring of national IYCF programmes only took place in 39 countries (64%).
Almost none of the countries were able to report on the geographic scale and population coverage of IYCF counselling services, either in the health system or at community level. Coverage of communication activities was also not reported.
On average, countries were rated “Fair” on the IYCF monitoring and evaluation action score.
Overall, 4% of the countries were rated “Very good”, 11% “Good”, 37% “Fair” and 48% “Poor”.
Summary of recommendations These recommendations represent a summary of major lines of action that are suggested by the results of the assessment; they are not meant to be all-encompassing or detailed. For detailed guidance see the UNICEF IYCF Programming Guide, which covers all the steps to design, plan and monitor comprehensive IYCF interventions that will be required to strengthen the various components and address constraints and gaps. National level IYCF actions i. Gaps at the policy level still need to be addressed. Although most countries had some form of
IYCF policy (stand-alone/integrated), very few countries had a combination of policy, strategy and plan of action to operationalize the policy and strategy.
ii. IYCF policy comprehensiveness should be reviewed. National IYCF policies still did not reflect certain key IYCF practices or components.
iii. National IYCF policies should be comprehensive to ensure that all relevant health and community services protect, promote and support breastfeeding and ensure timely, safe and age-appropriate
Infant feeding in emergencies action
scores in 65 countries
IYCF monitoring and evaluation action
scores in 65 countries
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complementary feeding at 6-24 months as well as guidelines on ensuring appropriate IYCF in exceptionally difficult circumstances.
iv. More countries need to establish national legislation on the Code of Marketing of Breast milk Substitutes and continually check the status of their Code.
v. Gaps existed with monitoring and enforcement systems for the Code, even for those countries with a law already in place. Regular independent monitoring is needed, which is free from commercial interests using standard protocols to document violations.
vi. Maternity leave was provided in many countries but a large percentage of countries do not provide nursing breaks for mothers.
Health service level IYCF actions i. In-service training and pre-service education gaps in countries need to be comprehensively
addressed. The standard pre-service and in-service training curricula in countries should be based on the WHO 2009 IYCF model chapter for textbooks for medical students and allied professionals – noting that the HIV and infant feeding chapter needs to be updated in line with the 2010 WHO recommendations on HIV and infant feeding.
ii. It is also vital to ensure that the capacities of health professionals are substantially strengthened in providing recommended IYCF counseling and support.
iii. Appropriate systems and structures to routinely deliver IYCF counselling services within the health system need to be developed as well as supervision and performance monitoring mechanisms need to be in place to ensure sustained implementation and documentation of performance. IYCF indicators need to be integrated within the health management information systems (HMIS), especially in countries where these systems function relatively well. Rapid assessment tools such as lot quality assurance sampling (LQAS), SMART and other nutrition surveys, health facility assessment tools and qualitative assessments can be used to measure coverage and quality of IYCF counseling, and established assessment and survey instruments need to integrate appropriate IYCF indicators.
iv. Given that the Baby-Friendly Hospital Initiative was reported as having extremely low coverage of re-certification of facilities, it must be properly institutionalized within the national health system in order to ensure continuity and sustainability. The Ten Steps and the tools to assess compliance with them need to be fully integrated within the standard operating procedures of health facilities and the supervisory, monitoring, quality assurance, accreditation systems.
Community level IYCF actions i. Community-based initiatives can extend the delivery of interventions, particularly important in
countries that have a weak health infrastructure or low health facility delivery rates. However, current IYCF actions at the community level in most countries appear to be not as well-developed as the health service level.
ii. More effort is required to strengthen and scale up community level IYCF actions and ensure that IYCF is promoted and supported in communities. Community-based IYCF activities and programmes should build upon existing health and nutrition programmes at community level to the extent possible.
iii. Training community health workers in community-based IYCF counseling and communication skills should be intensified in countries and large-scale coverage pursued. The distinction between promotive actions/communication and counselling and skilled support needs to be more clearly made, and the importance and complementarity of both underscored, as many countries do not yet pursue large-scale actions related to counselling and support at the community level.
iv. Monitoring and evaluation of community-based IYCF activities should be strengthened to include supportive supervision and a recognition mechanism for well-performing workers in more countries. Additionally, monitoring systems should be comprehensive enough to be able to provide sufficient detail on the coverage, quality of training and counseling activities among others. A combination of routine data and rapid assessment and survey tools should be used to monitor coverage and quality of community IYCF interventions (see recommendation iii) in the section on the health system above).
Communication on IYCF i. Comprehensive communication strategies on IYCF based on formative research and using
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multiple channels to reach priority participant groups with age and context-specific messages should be an integral part of in-country IYCF intervention.
ii. Gaps exist with respect to routine monitoring of ongoing communication on IYCF activities. Countries need to strengthen or develop appropriate system to monitor and evaluate communication activities, outcomes and impact on behaviour.
Complementary feeding additional interventions/components i. Counseling mothers or caregivers on optimal complementary feeding practices and using multiple
communication channels will be crucial for improving mothers/caregivers knowledge and skills on home preparation of nutrient-rich complementary foods for children 6-24 months.
ii. For some countries provision of complementary food supplements may be needed to fill the nutrient gap when locally available foods alone cannot satisfy nutrition requirements. Appropriate decision-making processes are needed to determine whether, when and for whom supplements are needed, and where implemented, monitoring systems are needed to be able to report on coverage.
IYCF in difficult circumstances HIV and infant feeding i. HIV and infant feeding recommendations, based on the latest 2010 guideline, need to be fully
integrated within all the in-country IYCF guidelines, materials, training sessions and counselling contacts.
ii. These revised materials need to be thoroughly disseminated to all relevant health and community workers across the whole country, and systematic follow up and mentoring on quality and appropriate application is needed
iii. More emphasis on the importance of providing support and follow-up for HIV positive mothers is required.
Infant feeding in emergencies i. National policies should be updated to include infant feeding in emergencies and not wait until after
an emergency strikes before prioritizing infant feeding in emergencies. ii. Capacities for the design, planning, management and monitoring of IYCF interventions in
emergencies need to be strengthened among Governments, partners, NGOs and other institutions.
iii. Free breast milk substitutes were still provided in some of the countries. Actions should be taken to inform governments in advance (as part of emergency preparedness and planning) in these countries about the negative impact of accepting donations of these products on IYCF practices, and to ensure effective systems are in place to prevent, block and handle donations in case an emergency occurs. In situations where breast milk substitutes are necessary for eligible children then close control and monitoring is necessary.
Monitoring and evaluation system for IYCF i. Monitoring and evaluation systems need to be substantially strengthened as evidenced by the low
proportion of countries that were able to report on geographical scale, target population coverage and quality of IYCF interventions in the health services, at community level, on complementary feeding supplements and related to communication currently taking place in their countries. Steps to strengthen this aspect will involve a number of initiatives, for example to include IYCF indicators within HMIS systems where these systems are functioning well; to improve community-based tallying and reporting by CHWs; to integrate IYCF indicators of outcome (IYCF practices) and programme performance (e.g. coverage of counselling and communication, coverage of complementary feeding supplements or social protection schemes; training received, counselling services provided, etc., within rapid assessment tools such as LQAS-based small household surveys, CHW surveys and health facility surveys; and systematically integrating all IYCF indicators within household surveys such as SMART and MICS.
ii. The monitoring and evaluation system needs to be carefully designed from the outset to ensure that it comprehensively captures relevant information for the key IYCF action areas.
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1. INTRODUCTION Supported by unequivocal evidence of its impact on child survival and health, key IYCF actions are an integral part of UNICEF programmes that seek to improve early childhood survival, growth and development. Optimal IYCF entails the initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months of a child’s life and continued breastfeeding up to two years or beyond, together with safe, age-appropriate complementary foods starting at 6 months of age [2].
Several countries, including those with high burden of undernutrition and sub-optimal IYCF practices, are beginning to strengthen and enhance the scope and scale of their programmes. In support of these country-level IYCF actions, UNICEF’s Nutrition Section in New York HQ has recently developed a comprehensive programming guide on IYCF [3] for programme managers and public health/nutrition staff. The programming guide is based on scientific evidence, lessons learned, best practices and presents the “how” of programming at all levels. Key IYCF action areas at the national, health system and community levels for a comprehensive, at-scale IYCF strategy are outlined, including the design and implementation steps. The guide offers a number of benefits, including opportunity to assess the current scale, scope and status of IYCF programmes compared to the recommended approach.
An IYCF assessment matrix is included as an adjunct to the programme guide. This matrix is intended for use by UNICEF country offices, in collaboration with governments and IYCF partners, to regularly monitor and assess the scope and scale of recommended IYCF actions in each country. As country offices engage in the design and implementation of IYCF interventions, this matrix is meant to be applied in assessing the status of in-country existing programmes and ultimately identifying gaps in recommended key IYCF action areas. Between 2010 and 2011, the UNICEF Nutrition Section at HQ requested its country offices to complete the assessment matrix. The data collected were compiled and analysed and will be used as the baseline data of the scope, scale and status of IYCF programming globally. This report summarizes the results of the analysis. Structure of the document This document is divided into five main sections. Sections 1 and 2 contain the background information, objective and the detailed methodology as well as the data analysis procedure employed. Section 3 is the result section which contains the key findings of the 2010 – 2011 assessment of key IYCF actions in 65 countries. Section 4 contains the IYCF profile for 22 selected countries with poor IYCF practices and large burdens of undernutrition among children less than five years. Section 5 of the document contains the annexes with the assessment matrix questionnaire, tables with detailed results for each of the action areas, responses received, contacts etc.
1.1 OBJECTIVE The main objective of this analysis was to provide an overview of the scope, scale and status of comprehensive IYCF programmes, encompassing all of the recommended key IYCF action areas [3] at the country-level. Special emphasis was placed on the 22 nutritionally vulnerable countries.
2. METHODOLOGY
2.1 DATA COLLECTION A version of the 2009 IYCF matrix is included in Annex 1. There are two versions of the IYCF assessment matrix. Annex 2 shows the different completion phases of the matrix and the countries that responded at each phase. Version 1: In 2008, the first version of the assessment matrix was pilot-tested in 10 countries. Version 2: In 2009, the assessment matrix was revised and more detailed questions were added, including detailed questions on the International Code of Marketing of Breast-milk Substitutes, maternity protection laws, IYCF partners, UNICEF and government IYCF specific activity budgets, availability of job aids and counseling cards for health professionals, community and health system level monitoring and evaluation and monitoring and training on IYCF in difficult circumstances. In
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addition, the new matrix was updated in 2009 to reflect current available guidelines and reference documents on IYCF. Twenty-three countries in ROSA, EAPR and CEE/CIS completed this 2009 matrix between 2009 and 2010 (Annex 2). The 2009 matrix was then sent to a new group of countries for completion in January 2011. Between January and April 2011, 33 countries completed the 2009 assessment matrix (Vietnam completed the matrix in 2009 and 2011); only the 2011 responses were included in this analysis. In total between 2009 and 2011 the new 2009 assessment matrix was sent to 86 (including 22 nutritionally vulnerable countries) country offices in six world regions (ESAR, WCAR, ROSA, MENA and EAPR) for completion. All responses were compiled and the data cleaned and managed using File Maker Pro 11, and analyzed using Microsoft Excel. For two countries, Liberia and Cote d’Ivoire, the completed 2008 version of the matrix was used. These countries did not complete the 2009 version of the matrix.
2.2 DATA ANALYSIS PROCEDURE
Country scores and ratings Indicators were developed based on selected key IYCF action areas outlined in the programming guide (Tables 2a – 2m). These indicators were used to guide the analysis procedure and only the questions on the assessment matrix related to these indicators were included in this analysis. From these indicators, an IYCF action score was calculated for each country for each IYCF action area. Each country’s score represented its performance on a particular IYCF action area. Scores at each action level were combined to calculate a total overall score for each country as well. Scores were then scaled from 0 to 10 and rated based on the colour scale as shown in Table 1. Country scores were grouped and analyzed regionally and as a whole. At the end of the analysis each country had a score that represented its performance on each IYCF action level.
Table 1: IYCF action score and rating keys
Score Colour Rating
0 – 3 POOR (very low number of the key IYCF actions or interventions implemented)
4 – 6 FAIR (low number of the key IYCF actions or interventions implemented)
7 – 8 GOOD (average number of the key IYCF actions or interventions implemented)
9 – 10 VERY GOOD (high number or all of the key IYCF actions or interventions implemented
Calculation of country scores and sub scores
The scores are calculated based on the average of the sub-scores for each of the components that are considered to be required for that action area. For example, the national level IYCF action score is calculated by determining the mean between the two sub-scores for i) the national policy, strategy and plan of action sub-score and (ii) national legislation action sub-score, which make up the aggregate score. These sub-scores are derived from country’s responses to the questionnaire (each of the questions that were selected was awarded a score of “1” for positive response and “0” for negative response). The detailed composition of each of the two sub scores are as shown in Annexes 5a to 5c; (i) Policy, strategy and plan of action sub-score is composed and derived based on response on key national IYCF policy actions areas, including key IYCF practices reflected in the national IYCF policy (initiation of breastfeeding within the first hour, exclusive breastfeeding, complementary feeding from 6 to 24 months and beyond); the national IYCF strategy and plan of action, as well as other components (including Baby-Friendly Hospital Initiative (BFHI), international Code for Marketing of
9
Breastmilk Substitutes, behaviour change and communication, IYCF in emergencies and HIV and infant feeding). (ii) The legislation sub-score is composed and derived from the response from key IYCF legislation action areas including the Code law, maternity protection law, maternity leave, paid nursing break. The detailed composition for each of the other IYCF action areas are as shown in the respective tables in annex 5d – 5t, including health service level IYCF actions (Annexes 5d to 5i), community level IYCF actions (Annexes 5j to 5k), communication on IYCF (Annexes 5m to 5o), the complementary feeding components/interventions (Annex 5p), IYCF in exceptionally difficult circumstances (Annexes 5q to 5r) and IYCF monitoring and evaluation action (Annex 5t).
Limitations
The result of the present assessment should be interpreted within the context of a qualitative assessment and its inherent limitations. The results are based on the assessment and judgement of UNICEF country-level representatives (in close collaboration with governments and other partners involved in IYCF programming). However in few instances the results might not reflect an absolute picture of a country’s overall IYCF programme, as there may be some elements of subjectivity inherent with this type of assessment. For example, in some cases a particular component may appear to be scored highly based on the reported status, when in fact the reality may be less positive. In addition, it was apparent that the majority of countries were unable to report on the component of “scale” as information systems do not exist to record the geographic and population coverage of IYCF interventions. Nevertheless, efforts were undertaken to ensure that the assessment results reflect the best possible, up-to-date in-country IYCF programming status.
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3. RESULTS
3.1 RESPONSE RATES The UNICEF nutrition specialists and managers, in many cases in collaboration with country government officials and other partners completed the matrices (See annex 4). Of the 86 countries that received the matrix between 2009 and 2011, 65 responded (22 designated as nutritionally vulnerable countries and 43 others). Pakistan and Cote d’Ivoire were the only two nutritionally vulnerable countries that did not respond during the above timeframe. For Cote d’Ivoire, the 2008 version of the matrix was used. Based on this, the overall response rate was 76% (96% for which profiles were developed) (Annex 2). Responses varied across regions. Response rates regionally were 100% for MENA, 93% for EAPR, 86% for ROSA, 80% for ESAR, 77 % for WCAR, and 42% in CEE/CIS. The majority (79%) were completed by UNICEF country officers (including nutrition and health professionals) alone or in collaboration with the MOH, but with 14% solely by the Ministry of Health (MOH) or other government bodies responsible for nutrition.
3.2 NATIONAL LEVEL IYCF ACTIONS NATIONAL IYCF POLICY, STRATEGY AND PLAN OF ACTION A national IYCF policy is usually a formal document setting out the position of the government on recommended IYCF practices and the principles of action to achieve national goals, such as legislative and systems frameworks, main areas of intervention and accountabilities [4]. The IYCF programming guide highlights what an IYCF should include and emphasizes that it should be up to date and reflect all the key practices and major areas of action. An IYCF strategy involves high-level national strategic thinking that defines why the issue of IYCF is being addressed, the overarching goals and specific objectives, the interventions and major lines of action to achieve the objectives and by whom. The strategy document is a broad outline considering and choosing between possible choices of IYCF interventions and actions, while focusing on the most critical needs [3]. The recommended contents and structure of an IYCF strategy are outlined in the programming guide.
National IYCF policy Approximately 31% of the countries (n=19) had a stand-alone IYCF policy. IYCF was integrated into either a nutrition or health policy in 32 countries (53%) that did not have a stand-alone policy. Botswana and Zimbabwe had draft policies; Somalia’s IYCF policy was included in its nutrition strategy and in Southern Sudan it was mentioned in the draft nutrition and health policy. The key IYCF practices (Table 2) that are reflected in most country’s national IYCF policy were exclusive breastfeeding [85% (n=51)] and complementary feeding of 6-24 month old children [83% (n=48)] while early initiation of breastfeeding appeared in only 68% (n=40) of the countries. In less than half (n=32) countries were all three practices reflected in the national policies. Regionally, in CEE/CIS only Uzbekistan and Turkmenistan had stand-alone IYCF policies (25% of countries). Although these countries had stand-alone IYCF policies, in Turkmenistan, the policy did not reflect key IYCF practices related to complementary feeding for 6-24 month olds, while Uzbekistan’s policy lacked the key practice related to early initiation of breastfeeding. Although Kyrgyzstan and Kazakhstan did not have stand-alone IYCF policies, their policies were integrated into their child health policies and contained all the key practices
3 of a comprehensive IYCF policy as well
as over 6 additional components (Annex 5a).
3 The three key IYCF practices reflected in the national policy as captured by the assessment matrix, included (i) initiation of breastfeeding within
one hour of birth, (ii) exclusive breastfeeding and (iii) appropriate and adequate complementary feeding with continued breastfeeding from 6 to 24 months and beyond
11
Four countries (29%) in EAPR had a stand-alone IYCF policy. These countries were Vanuatu, Cambodia, China and the Philippines. Three countries (Korea, Indonesia and Thailand) were not specific regarding whether IYCF was included in another national policy; however, Thailand’s IYCF policy reflected all the key components (Annex 5a). The other country with a comprehensive national IYCF policy was Vietnam. In the ESAR, (Angola, Burundi, Ethiopia, Kenya, Madagascar, Namibia, Rwanda, Uganda, Zambia, Malawi, Somalia and South Africa] 71% had IYCF policies. Mozambique had no officially approved IYCF policy, only a draft, but had other planning or policy documents where IYCF featured prominently. These were listed on the assessment matrix as: the Communication and Social Mobilization Strategy for Protection, Promotion and Support of Breastfeeding 2009-2013.
Zimbabwe was in the process of drafting an IYCF policy; however, all key practices and components were integrated into its nutrition policy. South Africa planned to update its policy. In the MENA region, only three countries (Yemen, Sudan and South Sudan) were assessed. Yemen and Sudan (67%) indicated having IYCF policy. In South Sudan, IYCF was included in the drafted nutrition and health policy and key practices reflected included exclusive breastfeeding, and complementary feeding. In Sudan, IYCF was integrated in the nutrition policy and it reflected all the key IYCF practices. Five countries (83%) in ROSA reported having a national IYCF policy. Two of the countries (33%), Nepal and Bhutan had stand-alone IYCF policies, while India, Sri Lanka and Afghanistan have their IYCF policies as part of the nutrition/health policies. Bangladesh’s policy reflected all key components with the exception of initiation of breastfeeding, while India had only the initiation of breastfeeding reflected in its national IYCF policy. In WCAR, all the countries had IYCF policies either as a stand-
Table 2a: Key practices and indicators at the national IYCF policy level (all regions)
National level actions
Selected Indicators
Results, n (%)
National IYCF Policy
Countries with national IYCF policy (stand-alone/integrated)
51 (83.6%)
Countries with stand-alone IYCF policy
19 (31.0%)
Countries with integrated IYCF policy
32 (52.5%)
National strategy and plan of action
Countries with national IYCF strategy
38 (60.3%)
Countries with national plan of action
30 (47.6%)
Key IYCF practices* reflected in the national IYCF policy
Countries with all key IYCF practices* reflected in the national IYCF policy
32 (49.2%)
Countries with initiation of breastfeeding in the first hour of birth reflected in the national IYCF policy
40 (67.8%)
Countries with exclusive breastfeeding reflected in the national policy
51 (85.0%)
Countries with appropriate and adequate complementary feeding from 6 to 24 months and beyond reflected in the national IYCF policy
48 (82.8%)
*Key IYCF practices reflected in the policy, (i) included initiation of breastfeeding within one hour of birth, (ii) exclusive breastfeeding and (iii) appropriate and adequate complementary feeding with continued breastfeeding from 6 to 24 months and beyond
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alone [4 countries (24%)] or as part of nutrition/health policies in 13 countries (77%). Data were not available for Liberia regarding the key practices and components of its IYCF policies.
National IYCF Strategy and plan of action About 60% of countries (n=38) that responded had an IYCF national strategy but only 48% (n=30) had a national action plan. Only Uzbekistan in the CEE/CIS region had a strategy and two countries (Uzbekistan and Tajikistan) had a plan of action. Uzbekistan had policy, strategy and plan of action. In the EAPR region, 36% of the countries (n=5) had a strategy and plan of action. Vanuatu, China, Myanmar, Philippines and Thailand had strategies. Countries with plan of action were Korea, Vanuatu, Timor-Leste, Vietnam and Thailand. Only Vanuatu and Thailand had both a strategy and a plan of action. In the ESAR, 65% of the countries (n=11) had a strategy and 47% a plan of action. Half of the countries Madagascar, Zambia, Tanzania, South Africa, Swaziland, Uganda, Kenya and Ethiopia had both a plan of action and strategy. South Africa, Uganda and Kenya had a policy, strategy and plan of action. In the MENA region, 2 (Yemen and North Sudan) of the 3 countries had both an IYCF
strategy and plan of action. Yemen was the only country with all three: policy, strategy and plan of action. In the ROSA region, all countries had a strategy but India and Nepal reported having no plan of action. Afghanistan, Bhutan and Sri Lanka all had policy, strategy and plan of action. In the WCAR region most of the countries that responded [87% (n=13)] had a strategy but only 60% of these countries (n=13) had a plan of action. Mauritania, Nigeria, CAR, Gambia, Ghana, Gabon, Togo and Senegal reported having both a strategy and a plan of action and DRC had neither a strategy nor a plan of action. Gambia, CAR, Gabon, Ghana, Mauritania, Senegal, Togo and Nigeria had policy, strategy and plan of action.
NATIONAL IYCF LEGISLATION The International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly Resolutions need to be translated into national legislation and regulations, integrated into the legislative and regulatory frameworks of the country. The code, adopted by the World Health Assembly in 1981, provides guidelines for the marketing of breast milk substitutes, bottles, and teats [5].
International code of marketing of breast milk substitutes law / regulation About 62% of the countries (n=39) reported having an existing international code of marketing of breast-milk substitutes law or regulation but only 50% (n=19) had systems of Code monitoring or enforcement in place (Table 2b, Annex 5b). The entire CEE/CIS region responded that their country had an existing international code of marketing of breast-milk substitute law. Romania and Kyrgyzstan had a system of Code monitoring and enforcement in place.
Box 1: Summary of national IYCF policies, strategies and plan of actions in the 65 countries assessed
Overall, more countries had IYCF policies than strategies and plan of action. Approximately 84% of the countries had national IYCF policies (stand-alone or integrated), 60% had strategies and 48% had plan of action. Having a stand-alone policy was not a requirement for having a comprehensive IYCF policy. Some stand-alone IYCF policies were not comprehensive and several of the integrated IYCF policies were comprehensive in all key IYCF practices or components.
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In the EAPR, 71% of the countries (n=10) that responded reported having a law or regulation in place; only 5 countries (55.6%) had a system of monitoring or enforcement in place. Korea, Indonesia, Myanmar, Timor-Leste had no laws or regulation. In the ESAR, 41% of the countries (n=7) had laws or regulation in place and these countries are Zimbabwe, Uganda, Tanzania, Botswana, Mozambique, Malawi and Zambia. Almost all of these countries except Mozambique had a system of monitoring and enforcement in place. Only Yemen in the MENA region had a national Code law/regulation but with no system of enforcement. In the ROSA region 83.3% of the countries (n=5) had laws or regulations on the Code (all except Bhutan). India and Sri Lanka were the only two with systems of monitoring or enforcement. In the WCAR region, 9 (60%) of the 15 countries that responded, had a Code related law / regulation. These include Mauritania, Nigeria, Ghana, Burkina Faso, Gambia, Gabon, Benin, Congo and Senegal. Only 4 of these countries had a system of monitoring and enforcement in place (Senegal, Nigeria, Gambia, and Ghana).
Maternity Protection Laws and Nursing breaks Overall, 50 countries (79%) out of those that responded had maternity protection laws, about 92% (n=56) provided paid maternity leave for women and 52% (n=32) provided paid nursing breaks for mothers after they returned to work. In the CEE/CIS region, 50% of the countries (n=4) Bosnia, Turkmenistan and Romania and Kazakhstan had maternity protection laws and all of the countries provided paid maternity leave for mothers but only Romania, Kyrgyzstan and Kazakhstan provided paid nursing breaks for mothers.
In the EAPR region, Timor-Leste and Fiji were the only two countries without maternity protection laws (14%). All EAPR countries except Timor-Leste provided paid maternity leave for mothers and 64% of the countries (n=9) provided paid nursing breaks. Among those who did not provide paid nursing breaks were Timor Leste, Fiji, Korea, Myanmar, Indonesia and Thailand.
About 14 countries (82%) in ESAR regions had a maternity protection law in place. Only Rwanda and Somalia did not provide maternity
Table 2b. Key components and indicators at the national level on IYCF legislation
National action level Indicators Results, n (%)
Development & enforcement of national legislation on the marketing of breast milk substitute
Countries with existing international code of marketing of breast milk substitute law/regulation
39 (61.9%)
Countries with Code monitoring and enforcement system in place
19 (50.0%)
Development & enforcement of national legislation on maternity protection
Countries with maternity protection laws or regulations in place 50 (79.4%)
Countries with paid maternity leave 56 (91.8%)
Countries with paid nursing breaks provided for mothers after they return to work
32 (51.6%)
Box 2. Summary of national IYCF legislations/regulations in the 65 countries assessed
Generally, countries performed slightly better on IYCF legislative actions than on IYCF policy (Annex 5b); however, there were still gaps in the monitoring and enforcement of the International Code of Marketing of Breast-milk Substitutes and the provision of nursing breaks for mothers after they return to work. Thirty-nine countries (62%) had International Code of Marketing of Breast-milk Substitutes laws or regulations in place, 19 countries had code monitoring or enforcement in place. Nevertheless, 56 countries (92%) have paid maternity leave in place but only 32 countries (52%) provided paid nursing breaks for mothers after they returned to work.
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leave for women and 41% of the countries (n=7) provided paid nursing breaks for mothers. All the 6 countries in the ROSA had maternity protection laws. Nepal was the only country without paid maternity leave for mothers and only Bhutan and Afghanistan provided paid nursing breaks for mothers.
Most of the countries [93% (n=14)] in WCAR that responded had maternity protection law in place with the exception on Mali. Furthermore, all the countries [100% (n=15)] that responded had paid maternity leave for women. However, the DRC, Benin, Congo Brazzaville, Sierra Leone and Gambia had no paid nursing breaks for mothers returning to work. North Sudan was the only country in the MENA region with a maternity protection law and this country provided paid maternity leave for women and paid nursing breaks as well as Yemen (although Yemen had no maternity protection law
or regulation).
NATIONAL LEVEL IYCF ACTIONS SCORE The national level IYCF action score was calculated for each country based on performance in the key action areas related to IYCF policy and legislation. National level IYCF action scores and how countries performed are shown in figure 1. The average national IYCF action score was 6 out of 10. MENA had the lowest score (4) and ROSA the highest (7). The other four regions had averages of 5 (ESAR and CEE/CIS) and 6 (WCAR and EAPR). Countries with a score between 0 - 3 ‘poor’ had, at the time of the survey, very few or none of the key national level actions related to IYCF policy, strategy, plan of action and legislation. Twenty per cent of the countries (n=13) fell in this category and had many gaps in their national IYCF policy and legislative actions. Countries with a score between 4 and 6 were still below average and were rated as having a low ‘fair’ national IYCF action level; 26 countries (40%) fell in this category. These countries need to intensify efforts to strengthen their national IYCF actions. Countries with scores between 7 and 8 were categorized as ‘good’ regarding the status of national level IYCF action in their countries. About 28% of the countries (n=18) fell into this category. A score between 9 and10 indicated a high level of actions at the national level. Senegal and Gambia WCAR, Zimbabwe, and Botswana in ESAR, Vietnam and the Philippines in EAPR, Afghanistan and Sri Lanka in ROSA all had scores ≥ 9.
15
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
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CEE/CIS EAPR ESAR MENA ROSA WCAR
Figure 1: National level IYCF actions score*
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
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3.3 HEALTH SERVICE LEVEL IYCF ACTIONS
Health service interventions for IYCF are one of the key pillars of the overall IYCF policy and strategy, and are crucial even if service coverage and utilization are not high for all of the maternal and child health services. Even if the health system is weak or access is poor, IYCF actions should still be an important part of it, for a number of reasons: health professionals are influential; they are often the trainers and supervisors of community cadres; the advice and messages provided at health facility and community level, as well as through communication channels, should be harmonized, and health professionals should be able to deal with problematic cases referred by community health workers or lay counsellors.
IYCF HEALTH SERVICE CURRICULA Incorporating IYCF topics in the basic curriculum of medical and para-medical health professionals is most likely to be the most feasible and sustainable way to address the current knowledge gaps. The standard pre-service curricula should be based on the recent WHO Model Chapter for Medical Textbooks on IYCF [6]. A number of other WHO reference documents on IYCF also inform curricula
4.
Only Mauritania, Sri Lanka and Togo (7% out of the 41 countries that provided a response) used all four references/documents (Table 2c) to update both their pre-service IYCF packages for medical doctors, nurses and health professionals. The reference used by the largest percentage of countries to update pre-service curricula for medical doctors was the revised Baby Friendly Hospital Initiative (BFHI) material 2009 [7] [66% (n= 27)]. The other references, including the Global Strategy on IYCF [2] or the Guiding Principles for Complementary Feeding of the Breastfed Child [8], were the key IYCF documents/references used in 24 countries (59%).
4 The four key IYCF documents/references used in updating/developing health professionals’ pre-/in-service curricula as
captured by the assessment matrix, included (i) Global strategy for IYCF 2003; (ii) Revised BFHI material 2009; (iii) Guiding principles for complementary feeding of breastfed child 2001; and (iv) Guiding principles for feeding non-breastfed children 6 to 24 months WHO 2005
Table 2c. Health service level actions: IYCF training curricula for health professionals
Health system actions Selected indicators
Results, n (%)
Pre
-serv
ice
cu
rric
ulu
m Development/updating of
IYCF integrated curriculum for health providers’ pre-service education (Medical doctors only)
Countries that used the global strategy on IYCF* to develop/update their medical curriculum
24 (58.5%)
Countries that used the revised BFHI material 2009* to develop/update their medical curriculum
27 (65.9%)
Development/updating of IYCF integrated curriculum for health providers’ pre-service education (Nurses and other health professionals only)
Countries that used the global strategy on IYCF* to update/develop the curriculum for nurses and other health professionals
14 (30.4%)
Countries that used the revised BFHI material 2009* to update /develop the curriculum for nurses and other health professionals
18 (39.1%)
In-s
erv
ice
cu
rric
ulu
m Development/updating of
IYCF integrated curriculum for health providers’ in-service training (for all health professionals)
Countries that used the global strategy on IYCF* to update/develop the curriculum for of all health professionals
11 (100%)
Countries that used the revised BFHI material 2009* to update /develop their medical curriculum
3 (27.3)
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The WHO 2005 Guiding Principles for Feeding Non-Breastfed Children 6 to 24 months [9] was used in approximately 56% of the countries (n=23) to update their medical curricula. For nurses and other health professionals, most of the countries [83% (n=38)] used WHO/PAHO 2001 Guiding Principles for Complementary Feeding of the Breastfed Child to update their pre-service training curricula
4.
Furthermore, about 14 countries (30%) used the Global Strategy for IYCF [2] for updating nurses and other health professional curricula. Furthermore, all the countries that responded (11), indicated updating their in-service IYCF training package for their health professionals using the global strategy for IYCF [2] document (Table 2c). “Baby-friendly practices” was the element
5 that was least likely [70% (n=39)] to be included in medical
curricula and “Appropriate breastfeeding practices” was the most likely [84% (n=47)] element to be included in medical training curricula. Similarly, for nurses and other health professionals; pre-service curricula, “Appropriate complementary feeding” was the element least likely [70% (n=38)] and “Appropriate breastfeeding [85% (n=46)] was the most likely to be reflected in the curricula. About 57% of the countries (n=32) had pre-service curricula for medical doctors that were comprehensive, that is, contains all three key IYCF elements and 52% (n=28) had comprehensive curricula for nurses and other health professionals. Regionally for medical curricula, CEE/CIS [71% (n=5)], EAPR [64% (n=7)] and WCAR [67% (n=10)] had the highest percentage of countries reporting that their pre-service medical curricula contained a comprehensive IYCF package. ESAR [(47% (n=8)], MENA [33% (n=)] and ROSA [40.0% (n=2)] were all below 50%. Turkmenistan noted that the elements were only partially developed and Benin that there were no specific IYCF elements but only elements on nutrition. Additionally, the IYCF training packages for nurses and other health professionals were comprehensive among 10 countries (59%) in ESAR; 3 (60%) in ROSA, 4 (67%) in CEE/CIS, 7 (54%) in WCAR and 4 countries (36%) in EAPR. No countries in MENA had a comprehensive IYCF package for their pre-service curricula for nurses and other health professionals.
CAPACITY DEVELOPMENT ON IYCF FOR HEALTH PROVIDERS Building the capacity of health providers whether through in-service training or pre-service education is critical for ensuring optimal IYCF practices. Fewer countries [51% (n=33)] conducted IYCF-focused pre-service trainings for their medical doctors than the IYCF-focused in-service trainings for nurses and other health professionals [88% (n=38)]. This was a similar trend across regions except in MENA where the training conducted was for medical doctors (Annex 5e). Only the countries in MENA and Benin and CAR in WCAR responded that there was no IYCF pre-service training for nurses and other health professionals. Approximately 60% of countries (n=37) indicated that stand-alone IYCF in-service trainings were conducted for health professionals (medical doctors, nurses and other health professionals). The regions with the lowest percentage of countries that had in-service training were ROSA [50% (n=3)] and WCAR [56% (n=9)]. The other regions had between 62% (n=8) [ESAR] and 67% (n=10) [ESAR] of countries conducting in-service IYCF trainings. Sixty-nine per cent of the countries (n=44) indicated having IYCF job aids and counselling cards for health professionals. CEE/CIS (50%) and WCAR (56%) had fewer countries with job aids, compared to MENA (67%), EAPR (71%), ESAR (82%) and ROSA (83%). Training on IYCF counseling took place in 55 countries (85%). Additionally, training of
5 The three key IYCF elements reflected in the training package as captured by the assessment matrix, included (i) the Baby-
Friendly practices to support early initiation of breastfeeding, (ii) appropriate breastfeeding practices and (iii) appropriate complementary feeding practices
Box 3. Summary of training/capacity development on IYCF for health providers in the 65 countries assessed
Pre-service IYCF trainings for nurses and other health professionals were more likely to occur than training for medical doctors. About half of the countries conducted pre-service trainings for medical doctors and a little over four-fifths pre-service IYCF training for nurses. In-service trainings occurred in roughly two-third of the countries (All health professionals).
18
health workers on stand-alone IYCF counseling since 2006 occurred in 94% (n=43) out of the 46 countries that responded. Only 54% of the countries were able to report on the proportion of health workers trained. Where countries were able to estimate this, the average proportion of health workers trained on IYCF counseling since 2006 is 10%, with a range of 0.2% to 82%. Also, most countries were not able to report on the coverage of the training on IYCF counselling by district. Among the few which did report, the average proportion districts in which IYCF training took place was 47 %, ranging from 2% to 100% coverage. Regionally, only Bosnia and Romania in CEE/CIS did not have IYCF training since 2006; however, the other countries in the region (Kosovo, Bosnia, Uzbekistan, Kyrgyzstan, Kazakhstan and Tajikistan) that conducted IYCF training also indicated training of their health workers in standalone IYCF counselling. In EAPR 82% of the countries (n=9) which responded that they had conducted trainings since 2006 indicated training their health workers in stand-alone IYCF counselling. One country, Vanuatu, did not conduct any IYCF trainings since 2006. All of the countries (n=6) in ROSA had some form of training since 2006 and only 4 countries responded that health workers were trained in stand-alone IYCF counselling. For India and Nepal, data were not available. Both ESAR and WCAR had 14 countries in each region that trained health workers in IYCF since 2006. All of those countries in WCAR and only 12 in ESAR indicated training health workers in IYCF counseling.
IYCF COUNSELING AT THE HEALTH SERVICE LEVEL IYCF counseling and support in health services is important for establishment and sustaining of good infant and young child feeding practices, as well as for solving problems at relevant health care contacts. Most countries [91% (n=59)] indicated that IYCF counselling occur at the health service level. Countries that did not have IYCF counselling activities were Romania in CEE/CIS, Mongolia in EAPR, and Somalia in ESAR, South Sudan in MENA and Sierra Leone and Liberia in WCAR. Mongolia reported that the country had just begun the process of training its health workers on IYCF counselling. The assessment aimed to determine the major programmes and services within which IYCF was integrated in countries. Of the countries who reported that IYCF counselling took place in their health system, 56% (n=33) of the counselling took place during ante-natal care (ANC), 76% (n=44) in prevention of mother to child transmission (PMTCT) services, 58% (n=34) in growth monitoring and
Table 2d. Health service level actions: IYCF capacity development
Health system actions Selected indicators Results, n (%)
Pre- and in-service capacity development on IYCF for health providers/lactation counsellors
Countries with IYCF-focused pre-service trainings for health professionals (medical doctors only)
33 (50.8%)
Countries with IYCF-focused pre-service trainings for nurses and other health professionals.
38 (88.4%)
Countries with IYCF-focused in-service trainings for all health professionals (medical doctors, nurses and other health professionals)
37 (59.7%)
Training of health workers on stand-alone IYCF training since 2006
Countries in which health workers are trained on IYCF counseling since 2006
43 (93.5%)
Average proportion of health workers trained on IYCF counseling since 2006
10% [range 0.2% – 82%]
Average proportion of district covered by the training on IYCF counseling
47% [range 2.0% – 100%]
19
promotion (GMP) services, 78% (n=46) in the integrated management of childhood illness (IMCI) programme and only 25% (n=15) of the countries had IYCF counselling taking place through the essential nutrition action (ENA) programme. A few countries mentioned other services such as the Baby-Friendly Hospital Initiative, maternal and child health clinic, expanded programme on immunization (EPI) clinics, child health days and community-based management of acute malnutrition (CMAM), although only 3 countries (Madagascar, Ghana and Mauritania) indicated CMAM. Countries that have IYCF counseling taking place within in the top five maternal and child health contacts
6 (Table 2c) included, Turkmenistan
(CEE/CIS), Mozambique (ESAR), Sudan (MENA), Niger, Senegal and Nigeria (WCAR).
6 The top five maternal and child health programme where counseling on IYCF takes place the most frequently included ante-
natal care, prevention of mother to child transmission of HIV, growth monitoring and promotion, integrated management of childhood illness and essential nutrition action programmes
Table 2e. Health system level action: IYCF health service counseling
Health system actions Selected indicators Results, n (%)
Esta
bli
sh
men
t o
f in
teg
rate
d IY
CF
co
un
selin
g
serv
ice
s w
ith
in h
ealt
h s
yste
m
IYCF counseling activities within the health facilities at relevant maternal and child health contacts
Countries with IYCF counseling currently taking place within the health service level
59 (90.8%)
Countries with IYCF counseling taking place within the top five maternal and child health contacts
#
6 (9.2%)
System integration: IYCF counseling within the top five maternal and child health contacts
Countries in which IYCF counseling is currently taking place within the IMCI
Countries in which IYCF counseling is currently taking place within the PMTCT
Countries in which IYCF counseling is currently taking place within the GMP
Countries in which IYCF counseling is currently taking place within the ANC
Countries in which IYCF counseling is currently taking place within the ENA
46 (78.0%)
44 (75.9%)
34 (57.6%)
33 (55.9%)
15 (25.4%)
Mo
nit
ori
ng
an
d e
valu
ati
on
of
IYC
F
co
un
selin
g s
erv
ice
s w
ith
in t
he
healt
h s
yste
m
Development & implementation of supervision/quality assurance system for IYCF services in the health system
Countries with routine monitoring of health workers skills
18 (34.6%)
Countries with routine monitoring of quality of counselling
10 (19%)
% of countries with regular supportive supervision provided by managers
24 (44.0%)
Countries that routinely monitor the or conducted routine monitoring of other process indicators
20 (35.1%)
# Top five maternal and child health contacts identified included, Antenatal care, Prevention of mother to child transmission of HIV/AIDS,
Growth monitoring and promotion, Integrated management of childhood illnesses and essential nutrition action programmes
20
The assessment included a question on the proportion of the target population reached with IYCF counselling services in the health system, and the proportion of districts where IYCF counseling services are provided, but no countries were able to provide a response. This represents a major gap in programme monitoring, as it is not possible to determine whether IYCF counselling is actually being provided and the scale of services.
BABY-FRIENDLY HOSPITAL INITIATIVE The BFHI was launched by WHO and UNICEF in 1991, following the joint WHO/UNICEF statement on breastfeeding in the maternity services in 1989 and the adoption of the Innocenti Declaration in 1990 [10]. The BFHI promotes the implementation of the “Ten Steps to successful breastfeeding” practices with the primary objective of creating an environment conducive for breastfeeding [11]. Maternal and infant experience in health care services exerts a strong influence on breastfeeding initiation and later infant feeding behaviour.
Based on the responses from 65 countries, 55 countries (85%) had “ever-certified” at least one hospital or maternity facility as baby-friendly, but only 22 countries (34%) had re-certified at least one hospital or maternity facility. The average proportion of hospitals/maternity facilities ever certified was reported to be 22.7%, with a range of 1.0% to 100%. This is in line with the global reported average of around 27% at the time. And the average proportion of hospitals/maternity facilities ever re-certified was extremely low at 5.6%, with a range of 1.0% to 76%. The low rate of certification, in particular re-certification, highlights the difficulty of rapidly scaling up the BFHI in the traditional vertical manner and of sustaining the intervention. At the regional level, all of the countries (n=8) in CEE/CIS had ever-certified at least one hospital/maternity facility, while only 63% of the countries (n=5) had at least one hospital/maternity facility re-certified baby-friendly. Although the average proportion of maternity facilities ever-certified is 49%, with a range of 1% (in Tajikistan) to 100% (in Kosovo). In EAPR region, only Vanuatu had no hospitals ever certified baby-friendly and only 4 countries (29%) [Vietnam, Papua New Guinea, Fiji and Thailand] had re-certified baby-friendly hospitals. Not all countries reported the number of facilities in their countries, however, of
Table 2f. Health system level action: Baby-friendly Hospital Initiative
Health system actions Indicators Results, n (%)
Insti
tuti
on
alizin
g t
he “
Ten
ste
ps t
o
su
cce
ssfu
l b
reastf
eed
ing
" in
all
mate
rnit
y f
acilit
ies/H
osp
itals
Certification of
hospitals/ maternity
facilities “Baby-
Friendly”
Countries with at least one hospital/
maternity facility ever certified as “Baby
Friendly”
55 (84.6%)
Average proportion* of hospitals /
maternity facilities ever certified “Baby-
Friendly”
22.7% (range 1.0% - 100%)
Re-certification of
hospital/ maternity
facilities “Baby-
friendly”
Countries with at least one hospital /
maternity facility ever re-certified as
“Baby-Friendly” since 2006
22 (33.9%)
Average proportion* of hospitals/
maternity facilities ever re-certified “Baby-
Friendly” since 2006
5.6% (range 1.0% - 76%)
Box 6. Summary of BFHI status in the 65
countries assessed
The average proportion of hospitals/maternity facilities ever certified Baby-Friendly was 22.7%, with a range of 1.0% to 100%. And the average proportion of hospitals/maternity facilities ever re-certified Baby-Friendly was 5.6%, with a range of 1.0% to 76%. The low rate of certification, in particular re-certification highlights the difficulty of scaling up rapidly the BFHI in the traditional vertical manner. A sustainable option might be to institutionalize the BFHI principles within the health services.
21
those who did, only Fiji (100%) Philippines (83%) and Thailand (67%) certification rates were above 50%. Over half (52%) of baby-friendly designated hospitals in Fiji were re-certified, about 10% for Thailand and 0% for Philippines. ESAR (16%), ROSA (15%) and WCAR (16%) regions had similar average proportion of hospitals/maternity facilities certified. However, re-certification was only 0% (in ROSA), while ESAR (87.5%) of its countries hospitals/maternity facilities certified baby-friendly. However, recertification rate was even lower, as none of the facilities in ROSA were re-certified, 5.6% in WCAR and 4.3% in ESAR.
MONITORING AND EVALUATION OF IYCF COUNSELING ACTIVITIES As noted above, there is generally a serious problem of low reporting with respect to the coverage of IYCF counseling activities taking place within the maternal and child health contacts. The absence of routine and mandatory monitoring/reporting system on IYCF counselling is a major constraint. Inclusion of questions in household surveys or rapid assessments that would enable coverage to be determined is also generally assumed not to happen. Only 35% (n=18) of countries health system routinely monitored health worker skills. Only 10 (19%) had routine monitoring of the quality of counselling taking place in their health system. Forty-four per cent (n=24) had managers that provided regular supportive supervision. None of the countries in MENA monitored health workers skills or quality of counselling routinely. In CEE/CIS, neither Kazakhstan nor Tajikistan conducted routine monitoring of health worker performance. Only Cambodia in EAPR conducted both performance monitoring activities and was the only country that conducted managerial supportive supervision.
In ESAR, only Malawi and Rwanda conducted regular monitoring of health worker skills. In ROSA only Sri Lanka, Bangladesh and India did and in WCAR six countries (Nigeria, DRC, Togo, Senegal, CAR and Gabon routinely monitored health workers skills. Among these countries only Tajikistan, Rwanda, India, Sri Lanka, Gabon, Togo, DRC and Nigeria carried out regular support supervision. Approximately 35.1% (20) of the countries reported conducting monitoring of other process indicators. Those mentioned included number of health workers trained, number of trainings conducted and
number of facilities carrying out IYCF counselling activities.
HEALTH SERVICE LEVEL IYCF ACTIONS SCORE
The average IYCF health service level IYCF action score was approximately 5 indicating a low level of IYCF action at the health system level for countries as a whole (Figure 2). Regional averages were mostly 5 (CEE/CIS, WCAR, EAPR and ESAR) or 4 (ROSA and MENA) (See Annex 5i). Romania and Bosnia Herzegovina. in CEE/CIS, Myanmar, Indonesia, Korea, Vietnam and Timor-Leste in EAPR, Botswana and Somalia in ESAR, Yemen and South Sudan in MENA, Afghanistan, Nepal and Bangladesh in ROSA and Congo, Cote d’Ivoire, Gabon, Liberia and Sierra Leone in WCAR had very low IYCF health service level activity scores and were rated as having very ‘poor’ IYCF health system actions. Overall, 12% of the countries were rated “Good”, 57% “Fair” and 31% “Poor” on the health service IYCF actions.
Box 5. Summary of IYCF counseling / monitoring within the health service in the 65 countries assessed
Almost all of the countries that responded (43) had an IYCF stand-alone counseling training in-country during 2006-2009. Very few countries monitored health workers skills routinely or monitored the quality of counseling taking place within the health service level.
22
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
7 7 7
6 6
5
3
1
7
6 6 6
5 5
4 4 4
3 3
2 2 2
7 7
6 6 6 6
5 5 5 5
4 4 4 4
3
2 2
6
3
2
6
5 5
3 3 3
7 7
6 6 6 6
5 5 5
4 4 4
3 3
2 2
0
0
1
2
3
4
5
6
7
8
9
10
Kyrg
yzsta
n
Ta
jikis
tan
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rkm
en
ista
n
Kazakhsta
n
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ekis
tan
Kosovo
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Herz
.
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ma
nia
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o P
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inea
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vill
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Sc
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Figure 2: Health service IYCF actions score*
CEE/CIS EAPR ESAR ROSA WCAR CEE/CIS EAPR ESAR MENA WCAR
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
23
3.4 COMMUNITY LEVEL IYCF ACTIONS
Community-based IYCF programmes and activities should build upon existing health and nutrition programmes to the extent possible. Community level breastfeeding and complementary feeding promotion and support can be effective in improving optimal infant and young child feeding, particularly for those disadvantaged and vulnerable groups with low access to health services.
COMMUNITY LEVEL IYCF ACTIVITIES Based on the responses received, established community-based IYCF activities were carried out in 53 countries (84%). Countries without established community-based IYCF activities were Kazakhstan, Romania and Uzbekistan in CEE/CIS; Mongolia and Myanmar in EAPR; Angola, Botswana and Burundi in ESAR, Bhutan in ROSA and Congo in WCAR.
Korea and Thailand in EAPR provided no response. About 20% of the countries (n=11) indicated that the community-based IYCF activities was stand-alone. One country in MENA (Sudan), ROSA (Afghanistan), and WCAR (Niger); two countries in CEE/CIS (Bosnia and Herzegovina and Turkmenistan) and EAPR (China and Vanuatu) and four in ESAR (Madagascar, Mozambique, Somalia and Uganda) had stand-alone IYCF activities. Countries without stand-alone IYCF community-based activities indicated in which package IYCF was included. Some countries had stand-alone community-based IYCF activities; however, they also indicated that IYCF was also included in other community activity packages. Twelve countries (30%) had IYCF within the community IMCI programme, 23% of the countries (n=9) had it included in ANC, 18% (n=7) in GMP, 13% (n=5) in ENA, 13% (n=5) in mother to mother programmes and 3% (n=1) in PMTCT programme. Only one country (Afghanistan) reported that IYCF activities were included within the CMAM programme.
Table 2g. IYCF actions at the community service level: Community-based IYCF activities
Health system actions Selected indicators Results, n (%)
Esta
bli
sh
men
t o
f in
teg
rate
d
IYC
F
Co
un
se
lin
g s
erv
ice
s a
t th
e
co
mm
un
ity
-leve
l
IYCF counseling activities at the community level
Countries with established community-based IYCF counseling activities
53 (84.1%)
Countries with stand-alone community-based IYCF activities
11 (20.3%)
System integration: IYCF counseling taking place within other relevant selected community-based programmes
Countries in which IYCF counseling is currently taking place within C-IMCI
Countries in which IYCF counseling is currently taking place within the ANC
Countries in which IYCF counseling is currently taking place within the GMP
12 (30.0%)
9 (22.5%)
7 (17.5%)
Imp
lem
en
tati
on
of
co
mm
un
ity
-based
IY
CF
co
un
selin
g s
erv
ice
s
Development and implementation of community-based programmes
Countries in which IYCF activities are carried out by multipurpose community health workers
34 (62.9%)
Countries in which IYCF activities are carried out by dedicated community health workers
29 (53.7%)
Countries in which IYCF activities are carried out by mother support groups
26 (47.3%)
24
The majority of IYCF community activities were being carried out by multi-purpose community health workers [63% (n=34)] who conducted group education sessions as a part of child survival packages. Dedicated IYCF community health workers or counsellors who provided group counselling/promotion and individual counselling and support to mothers were reported in about 54% of the countries (n=29), with 47% of the countries (n=26) mentioning mother support groups. Only 17% of the countries’ IYCF community activities were conducted by traditional birth attendants (TBAs) or traditional health practitioners (THPs). Other groups listed as IYCF activity implementers were volunteers; secular and community groups (see Annex 5l for a complete list). About 68% of the countries (n=44) had data available to calculate the coverage of the IYCF
community-based activities. The average coverage was 65.3%, ranging from 3% to 100%. Thirteen countries had less than 25% of their districts covered with IYCF activities. 38 countries (59%) were not able to report the proportion of the population targeted by the IYCF activities. However, the proportion ranges from 7% to 100% among countries that were able to report on the proportion of the population living in the target districts (See Annex 5k which provides the coverage details as provided by the countries).
Capacity development and routine monitoring of community health worker skills Not all countries had information on the community-based IYCF trainings that took place in their
Box 7. Summary of community level IYCF activities in the 65 countries assessed
Almost 84% of the countries (n=53) indicated carrying out community-based IYCF activities, but only 11 countries (20%) indicated had an established stand-alone IYCF activities. Approximately 60% of the countries (n=27) had a community-based IYCF training and specific communication skills capacity building. Of the countries that responded, only 13 routinely monitored their community health workers skills and very few countries [13% (n=6)] monitored the quality of community health workers’ counselling skills. The monitoring systems need to be substantially strengthened. None of the countries responded on the proportion of districts implementing community IYCF interventions.
Table 2h. IYCF at the community system level: Capacity development of community health workers skills Community-based actions
Selected indicators Results, n (%)
Training of community health workers on community-based IYCF counseling
Countries in which community health workers are trained on community-based IYCF counseling since 2006
39 (66.1%)
Countries in which the capacity building on communication skills are conducted for community health workers
27 (60.0%)
Average proportion of community health workers trained on IYCF counseling since 2006
25.6% [<1% - 73%]
Average proportion of district covered by the training on IYCF counseling
No information
Community level monitoring system
Countries in which community IYCF activities are routinely monitored
15.0 (31%)
Countries in which community health workers’ counselling skills are routinely monitored
13 (27.1%)
Countries in which community health workers’ counselling qualities are routinely monitored
6 (13.0%)
Countries with supportive supervision of community health workers
23 (50.0%)
Countries with recognition mechanism for well-performing workers
5 (19.2%)
25
countries since 2006. Approximately 66% of the countries (n=39) had a community-based IYCF training while about 60% (n=27) out of the 45 countries that responded had capacity building on communication skills for community health workers (see Annex 5j). Regionally, WCAR [81% (n=39)], ESAR [77% (n=13)] and EAPR [67% (n=8)] had the most countries that conducted community based IYCF trainings. IYCF Trainings occurred in two countries in MENA (Yemen and Sudan). Only Sri Lanka in ROSA, Turkmenistan and Kyrgyzstan in CEE/CIS had training on IYCF. About 60% of the countries (n=27) acknowledged that community health workers participated in specific communication skill capacity building, with WCAR region having the highest number of countries [86% (n=12)] that had specific skill-building capacity development for their community health workers. Only 17 countries (26%) were able to report on the proportion of community health workers trained since 2006. The average proportion of community health workers trained on community-based IYCF counseling since 2006 is 26%, with a range of <1% (in Indonesia) to 73% (in South Africa) [See Annex 5k]. None of the countries responded on the questions related to the proportion of districts implementing community IYCF interventions. This reveals a major gap in information about geographic coverage – and indeed the question was a very general one, not even about the proportion of the population that has access to IYCF services at community level. The assessment tool did not attempt to assess coverage for the target population of community-based IYCF interventions, as it was assumed that this information would not be available. Neverthess, this represents a key area of work: to develop or strengthen community information systems to be able to measure performance, quality and coverage of IYCF interventions and to explore feasible assessment modalities including small surveys (e.g. through LQAS) and qualitative methods to complement the information systems.
Monitoring community-based IYCF activities
Only 15 countries (31%) indicated that that routine monitoring of IYCF community-based activities was being conducted. Neither of CEE/CIS or MENA regions conducted routine monitoring of IYCF activities in their region. Only Cambodia in EAPR and Somalia, Rwanda, Madagascar, South Africa and Kenya in ESAR; as well as Afghanistan in ROSA and 8 countries in WCAR reportedly conduct routine monitoring of IYCF community activities (based only on countries that responded). Furthermore, only 13 countries (27%) indicated that the counseling skills of community health workers were routinely monitored and only 6 countries (13%) routinely monitored the quality of counselling conducted by Community health workers. However, more countries [23 (50%)] conducted supportive supervision of the community health workers. Only Kyrgyzstan, Fiji, Kenya, CAR and Nigeria indicated that there was a recognition mechanism for well performing community health workers in their countries. Taken together, the monitoring systems of community-based IYCF activities in most countries need to be substantially strengthened.
Community level IYCF actions score The average community-based IYCF actions score was very low: 3 (Annex 5j); all of the regions were either rated very low (CEE/CIS, EAPR, ROSA) or low (ESAR) for their performance on community-based IYCF activities. Eight countries had a score of 0: Romania and Uzbekistan (CEE/CIS); Myanmar, Mongolia, Indonesia, Thailand (EAPR); Angola (ESAR) and Bhutan (ROSA). All of these countries responded that no community-based IYCF activities existed in-country. Four countries (Senegal, Togo, Cote I’voire, Nigeria and CAR), all in the WCAR region had scores of 7 or 8, based on how they completed the assessment matrix. They all received a rating of ‘good’ for their community-based IYCF activity level. However, in some cases this status reported in the matrix may reflect a more positive picture than the actual situation on the ground, based on other sources, reports and experience. All other countries were either "Poor – 1-3” or "Fair 4-6” regarding in-country community-based IYCF actions. Comparatively, WCAR was the only region with a score of 5 (denoting a medium level of community-based IYCF activities). Overall, only 8% of the countries were rated “Good”, 31% ‘Fair” and 61% “Poor” on the community-based IYCF actions.
26
.
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
5
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1
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6
5
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6
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8
7 7 7 7
6 6 6
5
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3
4
5
6
7
8
9
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Figure 3: Community level IYCF actions score*
CEE/CIS EAPR ESAR MENA ROSA WCAR
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
27
3.5 COMMUNICATION ON IYCF Communication broadly encompasses advocacy, social mobilization, social marketing, and behaviour and social change communication. Communication on IYCF is a research-based consultative process of addressing the knowledge, attitudes and practices that are intrinsically linked to programme goals on IYCF. Formative research identifies both positive and problematic behaviours and motivators related to IYCF. It also identifies, analyses, and segments so-called “participant groups” who influence infant and young child feeding behaviours and practices, as well as the communication channels which particular communities and groups are most likely to use to receive information and to dialogue on IYCF. An effective communication strategy uses a wide mix of channels appropriate to the identified participant groups, which may include interpersonal, group and mass media channels, as well as participatory methods and social marketing [3]. It also includes plan to implement communication activities at scale and on a continuous basis, rather than just focusing on a one-off event such as World Breastfeeding Week alone.
National level communication strategy on IYCF About 52% of the countries (n=33) had a stand-alone national IYCF communication strategy, while 47 countries (78%) had elements
7 of communication on IYCF included in the overall national IYCF or
nutrition strategy. The elements included in most strategies were World Breastfeeding Week (WBW) [90% (n=37)], while child health days [63% (n=26)] and national campaigns [54% (n=22)] were present to a lesser extent in countries.
In some instances, countries that indicated that despite not having a national IYCF communication strategy, their country still participated in certain IYCF communication activities. For example, Kosovo did not have an IYCF strategy but celebrated WBW under their national plan of action for nutrition.
7 The key elements of communication on IYCF included in most national level communication strategy as captured by the
assessment matrix, included World Breastfeeding Week, National campaigns and health days
Table 2i. Communication on IYCF
Key actions Selected indicators Results, n (%)
Imp
lem
en
tati
on
of
co
mp
reh
en
siv
e c
om
mu
nic
ati
on
str
ate
gy o
n I
YC
F
National level communication strategy on IYCF
Countries with national level communication strategy on IYCF
33 (52.3%)
Communication on IYCF at the health service level
Countries with on-going health service level behavioural change communication activities
54 (91.5%)
Communication on IYCF at the community level
Countries with on-going community-based behavioural change communication activities
50 (84.7%)
IYCF communication channels*
Countries in which behavioural change and communication activities are implemented through five or more communication channels
36 (55.4%)
Countries in which behavioural change and communication activities are implemented through eight communication channels
5 (7.7%)
Monitoring system for communication on IYCF
Countries that routinely monitor on-going communication on IYCF activities
16 (28.1%)
Countries that routinely monitor the number of people reached through media messages
9 (19.6%)
Countries that routinely monitor the quality of group messages
8 (18.2%)
*The 8 most important IYCF communication channels used among the countries, included national TV, radio, campaigns and poster, interpersonal communication, and mobile phone messages as well as communication through indigenous leaders and community leader
28
Although 23 countries indicated that there was no national coordination mechanism present in-country, almost all (except Angola and Botswana) listed an implementing agency. In 13% of the countries, the national coordination mechanism was implemented by non-governmental organisations and 11% by the government and 76% by both.
Communication on IYCF at the health service level At the health system level, most of the countries [92% (n=54)] that responded had on-going behaviour change and communication activities occurring in their health system. The three behaviour change and communication activities that occurred in most countries were distribution of posters and leaflets on IYCF [83% (n=47)] with coverage rates ranging from 20% to 100% (as reported in only 24 countries); health workers conducting IYCF group sessions [73% (n=44)] with coverage rates ranging from 2% to 100% (as reported in only 10 countries) and videos on IYCF [37% (n=22)] for communication on IYCF with coverage rates ranging from 20% to 100% (as reported in 13 countries).
Communication on IYCF at the community level8 About 85% of the countries (n=50) indicated that there were ongoing behaviour change and communication activities at community level. Countries that did not indicate having ongoing behaviour change and communication activities at community level were Thailand, Papua New Guinea, Vanuatu, Philippines, Zambia, Tanzania, Somalia, Afghanistan and Cote d’Ivoire. Approximately 85% of the countries (n=40) who responded indicated that community-based health workers conducted group sessions to promote IYCF, 80% (n=39) had mother support groups or other group sessions to promote IYCF but only 34% (n=15) were aware of traditional health practitioners conducting sessions on IYCF. Other examples of special groups that conducted IYCF sessions in communities were community volunteers in Uzbekistan, Myanmar, Yemen, Sri Lanka; community resource persons in Mali; community health nurses and dieticians in Fiji and associations and NGOs in Benin.
IYCF communication channels, materials and monitoring and evaluation Behaviour change and communication channels The 8 most important IYCF communication channels used, included National TV, radio, campaigns, and posters, interpersonal communication, mobile phone messages, as well as communication through indigenous leaders and community leader. Only five countries (Cambodia, Senegal, Zambia, Tanzania and Mauritania) out of the ones that that responded indicated implemented behaviour change and communication through 8 or more multiple channels. The average number of channels used was 5 and roughly 60% of the countries used 5 or more communication channels. The messages were most often communicated through national television [88% (n=52)], national campaigns [81% (n=48)], interpersonal communication [81% (n=48)], community leaders [71% (n=42)] and religious leaders [58% (n=34)]. The least used behaviour change and communication methods were mobile phones [12% (n=7)] (Annex 5m). Behaviour change and communication materials Behaviour change and communication materials were available in most [95% (n=61)] of the countries Posters and leaflets on breastfeeding [90% (n=52)] and on complementary feeding [83% (n=48)] were the most common materials used. Participatory materials on IYCF were the least used behaviour change and communication materials [29% (n=17)]. Zimbabwe, Botswana, Gabon and the CAR had
8 The assessment matrix did capture information on the coverage of communication activities at the community level.
Box 8. Summary of IYCF communication channels/ methods in the 65 countries assessed
Roughly two-thirds of the countries conducted behaviour change and communication (BCC) through 5 or more communication channels and at multiple levels in-country: national, health system and community levels. Almost all of the countries had BCC materials available in country. However, only about 30% of the countries conducted regular monitoring of IYCF communication activities.
29
no behaviour change and communication material available and Ethiopia’s only materials were family health cards. Monitoring and evaluation of communication strategy About 16 countries (28%) routine monitored IYCF communication activities. Few countries [20% (n=9)] had system in place for monitoring the number of people reached through media messages as well as to monitor the quality of the group sessions [18% (n=8)]. This represents a significant gap. As described for the monitoring of community based activities, there is a need to develop feasible approaches for monitoring and evaluation of communication strategies to measure whether coverage and quality is being achieved and the activities are appropriate and effective.
Communication on IYCF action scores
This communication score took into account all actions or activity related to IYCF behaviour change and communication including communication on IYCF at the national, health service and community level in each country as well as the communication on IYCF monitoring system. The average Communication on IYCF score was 5 (See annex 5o). The highest scores were in WCAR (Burkina Faso, Mauritania, and Senegal) with a score of 8 (Figure 4). Seventeen countries’ communication on IYCF actions were rated as ‘poor: 0-3”. These countries were Romania and Tajikistan in CEE/CIS; Timor Leste, Philippines and Indonesia in EAPR; Ethiopia, Madagascar, Somalia, South Africa, Zimbabwe and Botswana in ESAR; Nepal in ROSA and DRC, Gabon, Cote d’Ivoire, Liberia and CAR in WCAR. Furthermore, all of these countries except Zimbabwe and Timor Leste scored 0 on BCC monitoring actions. Overall, 12% of the countries were rated “Good”, 62% ‘Fair” and 26% “Poor” on the communication on IYCF actions.
30
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
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Figure 4: Communication on IYCF actions score*
CEE/CIS EAPR ESAR MENA ROSA WCAR
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
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3.6 COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
Quality counseling of mothers/caregivers and appropriate behavioural change and communication are essential for improving complementary feeding practices among children 6 to 24 months and beyond. In addition, provision of complementary food supplements (e.g. industrially and locally produced fortified foods, micronutrient powders or lipid-based nutrient supplements) may be needed to fill nutrient gaps when locally available foods alone cannot satisfy nutritional requirements. Strategies to improve complementary feeding in different contexts may also encompass various social protection measures such as cash transfers or vouchers, and nutrition-sensitive measures in the agriculture sector.
Counseling of mothers/caregivers on home preparation of complementary foods About 59.7% of the countries (n=37) indicated that counseling of caregivers/mothers in home preparation of complementary foods was provided to improve complementary feeding practices of children 6 – 24 months. More countries counsel mothers through food preparation demonstration on TV [60% (n=22)] and health system counseling cards [57% (n=21]. Very few countries provide food preparation demonstrations on TV or radio [8% (n=3)] or cooking classes [15% (n=5)]. Regionally, counseling of mothers/caregivers on home preparation of complementary foods was similar for ESAR [69% (n=11)], ROSA [67% (n=4)], WCAR [65% (n=11)]; but less than two-thirds for EAPR [58% (n=7)] and CEE/CIS [25% (n=2)].
Provision of complementary food supplements It must be noted that the assessment of the use of supplements was intended to be a general overview, and a much more detailed survey was undertaken by UNICEF and CDC on the use of various types of products
9.
9 This section is not intended to be comprehensive. In 2011 CDC and UNICEF conducted a detailed assessment of
programmatic interventions related to home fortification in 162 countries (the survey covers the coverage and scale of use among young children).
Table 2j. Complementary feeding interventions
Key components Selected indicators Results, n (%)
IYCF counseling of mothers/care-givers in relation to home preparation of complementary foods
Countries in with caregivers/mothers are counselled on home preparation of complementary foods
37 (59.7%)
Countries that counsel mothers through counseling cards on food preparation (for health system)
21 (56.8%)
Countries that counsel mothers through counseling cards on food preparation (for community base)
15 (44.1%)
Provision of complementary feeding supplements
Countries providing micronutrient supplements to improve complementary foods of children 6 to 24 months
51 (78.5%)
Countries providing targeted food supplements to improve complementary foods of children 6 to 24 months
40 (61.5%)
32
Fifty-one (79%) countries reported that micronutrient supplements10
were provided to improve complementary feeding of children 6-24 months old. Approximately two-thirds of these countries provided both single micronutrients [68% (n=34)] and multiple micronutrients [62% (n=31)]. Supplements were most often available in non-emergency settings [73% (n=38)] with about 33% of the countries (n=17) provided them during emergencies. Targeted food supplements were provided in 62% (n=40) of the countries to improve the nutritional quality of complementary foods for children 6 to 24 months. Specifically, unfortified and fortified local complementary foods are available in 41% (n=16) and 26% (n=10) of the countries, respectively; while unfortified and fortified industrially-blended complementary foods were provided in 21% (n=7) and 58% (n=19), respectively. In addition, only few countries [19% (n=6)] provided lipid-based nutrient supplements to improve complementary feeding of children 6 to 24 months. The matrix contained questions aiming to assess how targeting of complementary feeding supplements was undertaken and the coverage achieved, but none of the countries responded on these aspects. Regionally, all countries (n=6) in ROSA had some type of micronutrient supplements available followed by CEE/CIS region [88% (n=7)], WCAR [82% (n=14)], EAPR [71% (n=10)], ESAR [71% (n=12)] and MENA (66.7%). Countries that indicated that multiple or single micronutrients were not provided/available for children 6 to 24 months, included Tajikistan in CEE/CIS, Fiji, Papua New Guinea, Timor-Leste and Myanmar in EAPR, Botswana, Ethiopia, Zimbabwe, Angola and Rwanda in ESAR, South Sudan in MENA and Mali, DRC and Sierra Leone in WCAR. Not all countries were aware if social protection programmes with food security component are available in their country; however, 40% (n=22) of those that responded did have such programmes.
Complementary feeding interventions/components score The average complementary feeding component/interventions action score was 4. This score is ranked as ‘fair’ and is indicative that actions to strengthen complementary feeding through counselling to caregivers/mothers as well as provision of complementary food supplements are low across countries (Figure 5 & Annex 5p). One of the regions had an average complementary feeding action score of 6 (EAPR) and ROSA had 4. Three regions (ESAR, MENA and WCAR) had an average of 3 and CEE/CIS average of 2; these regions are ranked as poor. The complementary feeding components/interventions actions score for 36 countries (55%) were ranked as ‘poor’. Overall, 11% of the countries were rated “Very good”, 4% “Good”, 36% “Fair”, and 49% “Poor” on the complementary feeding interventions/components.
10
The limitation of the assessment matrix pertaining to the reported use of micronutrient supplements is that it was difficult to differentiate countries that use micronutrient supplements added to complementary foods from other supplements that are taken directly (e.g. Vitamin A or Zinc supplements) because of the way the assessment matrix questionnaire was framed.
Box 9. Summary of the complementary feeding interventions status in the 65 countries assessed
Only about 60% of the countries counsel mothers/caregivers in home preparation of complementary foods for children 6 to 24 months. 42 countries responded that targeted food supplements were provided. Most countries did not have coverage estimates for supplement distribution in their countries.
33
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
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Figure 5: Complementary feeding components/interventions score*
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
34
3.7 IYCF IN DIFFICULT CIRCUMSTANCES
3.7.1 HIV and infant feeding IYCF in the context of HIV poses significant challenges. Updated HIV and infant feeding guidance was issued by WHO in 2010. These new guidelines fundamentally transforms the landscape in which decisions on infant feeding are made by mothers and caregivers, health providers and national health authorities. The latter establish a single national public health recommendation: either breastfeeding and ARVs or replacement feeding. With the provision of ARVs for HIV-positive mothers and their infants, the standard breastfeeding practices can be recommended for the entire population and different recommendations for HIV-exposed infants are no longer needed. Counseling on individual choice of feeding options is also no longer necessary – unless the mother chooses to opt out of the national policy that has been set. The challenge countries face is to ensure the updated guidelines are widely disseminated and properly understood. Fifty-four (84%) countries had a policy or guidance on HIV and infant feeding and 89% of those countries (n=48) had HIV and infant feeding policy or guidance included in their national IYCF policies (Table 2k & Annex 5q). Almost all of countries [93% (n=53)] had guidance on HIV and infant feeding included in their PMTCT policy but only 74% of the countries (n=42) had their infant feeding policy based on the WHO 2010 recommendation on HIV and infant feeding [12]. Regionally, in the CEE/CIS, Kosovo, Bosnia, Romania, Kazakhstan reported having no policy or guidance on HIV and infant feeding in place. In the other regions, countries without guidance were Korea and Timor Leste in EAPR, Botswana in ESAR, and Yemen in MENA, India in ROSA and DRC and Liberia in WCAR. Counselling of HIV positive mothers on appropriate infant feeding is reported to be in place in 48 countries (72%). All the countries in MENA and one-thirds of the countries (n=4) in the ROSA region (Nepal, Sri Lanka, Afghanistan and Bangladesh) had no infant feeding counselling activities for HIV+ mothers. Approximately 87% (n=40) of the countries that had counseling activities for mothers in place also had IYCF counselling materials that included HIV and IF and only 31 countries (76%) had training materials updated based on the most recent HIV and infant feeding guidance.
Table 2k. IYCF in difficult circumstances: HIV and infant feeding
Action area Selected indicators
Results, n (%)
Infa
nt
feed
ing
pro
gra
mm
ing
wit
hin
th
e c
on
text
of
HIV
Policy on HIV and infant feeding
Countries with policy or guidance on HIV and infant feeding
54 (84.4%)
Countries in which the national IYCF policy include guidance on HIV and infant feeding
47 (88.7%)
Countries in with the prevention of mother to child transmission of HIV policy include guidance on HIV and infant feeding
53 (93.0%)
Capacity development
Countries with established training activities for health workers on HIV and infant feeding
45 (83.3%)
Countries in which health workers are trained on HIV and infant feeding counselling
44 (74.6%)
Counseling activities for HIV+ mothers
Countries with established counseling activities for HIV positive mothers on infant feeding
47 (72.3%)
Countries with follow-up and continuous support for HIV + mothers on infant feeding in place
38 (66.7%)
35
Almost all of the countries [90% (n=55)] that responded had PMTCT training materials that included infant feeding and 76% (n=38) of these were updated. The exceptions were Cote d’Ivoire, South Sudan, Mongolia, Korea, Sierra Leone, Sri Lanka and Indonesia. HIV and infant feeding job aids and counselling cards were available in 63% (n=36) of the countries that responded and 74% (n=23) of these had their materials updated based on the recent HIV and infant feeding guidance. Approximately 83% (n=45) of the countries that responded had training for health workers on HIV and infant feeding and 44 countries (75%) trained health workers on HIV and infant feeding counselling.
Infant feeding counseling was integrated into the PMTCT services in 86% of the countries (n=50). Countries without their infant feeding counselling services integrated within the PMTCT programme were Mongolia, Indonesia and Timor Leste and Philippines in EAPR, Botswana in ESAR, North Sudan and South Sudan in MENA, Sri Lanka and Bangladesh in ROSA. Thirty-eight countries (67%) indicated that they provided support or follow-up for HIV+ mothers. Free infant formula was provided to HIV+ mothers in about 58% (n=35) of the countries that responded to the question. In general, formula was provided by most countries in CEE/CIS [88% (n=7)] except Kazakhstan, 60% of the countries (n=3) in ROSA region, 64% (n=9) in EAPR, 47% (n=7) in ESAR and only Yemen in MENA. Furthermore, based on the countries that responded, 42% (n=14) of the free formula came from the government and 64% (n=21) from non-governmental organizations. Uzbekistan and Vietnam indicated that both entities distributed formula. Overall, only 27% (n=17) of the countries have a system in place for monitoring infant feeding practices among HIV+ mothers.
3.7.2 Infant feeding in emergencies The protection, promotion and support of good IYCF practices is essential in emergencies, when child mortality and malnutrition rates escalate and the risks of sub-optimal IYCF practices are amplified. The response in terms of IYCF in emergencies is often less than adequate, starting from the preparedness, policy and planning aspects to the actual execution of the activities. An important starting point for an effective IYCF response in emergencies is the presence of a strong programme prior to the emergency, with high coverage of services and interventions and good availability of trained and skilled personnel, including those responsible for design, planning, management and decision-making. Approximately 41.3% of the countries (n=26) had a national IYCF policy which includes Infant feeding in emergencies. Additionally, 24 countries (40.7%) had national emergency preparedness plan which includes IYCF in emergencies and only 25.4% (n=15) of these were updated based on the latest edition of the guideline on infant feeding in emergencies [13].
Countries with system in place for monitoring infant feeding practices among HIV+ mothers
17 (27.4%)
Countries that provide free breast-milk substitute to HIV+ mothers
35 (58.3%)
Table 2l. IYCF in difficult circumstances: infant feeding and emergencies
Action area Selected indicators
Results, n (%)
Infa
nt
an
d y
ou
ng
ch
ild
feed
ing
in
em
erg
en
cy c
on
texts
Policy on infant feeding in emergencies
Countries in which the national IYCF policy includes infant feeding in emergencies
26 (41%)
Countries in which the national emergency preparedness plan include IYCF in emergencies
24 (41%)
Capacity Countries in which health providers and IYCF counsellors 14 (24%)
36
Regionally, in the CEE/CIS only Tajikistan has a national IYCF policy which includes IYCF in emergencies. In the other regions, 13 countries (46%) have a national policy in EAPR, 41% (n=7) in ESAR, 83% (n=6) in ROSA and 75% of the countries (n=12) in WCAR. Only few countries [33% (n=9)] indicated that an up-to-date guideline or training materials on IYCF in emergencies are available. Additionally, only 24% of the countries (n=14) indicated that health workers or IYCF counsellors are trained on IYCF in emergencies.
Overall IYCF in difficult circumstances score
Similar to other IYCF action levels, the mean IYCF in difficult circumstances action score was 4 (Figures 6 and 7; Table 10c in Annex 2). This was indicative of a ‘fair’ level of activity occurring in countries in this area. The overall score among all the countries was ‘fair’, only 2 countries (Ghana and Congo) received a rating of (7) ‘good’; the rest have a score of 6 or lower. Regionally, WCAR scored 5; both ESAR and EAPR, scored 4; While CEE/CIS, MENA and ROSA had the lowest score of 3. Overall, about 78% of the countries assessed (n=51) were rated poor on the Infant feeding in emergency action scores. While only few countries were rated fair [17% (n=11) or good [5% (n=3). For IYCF within the context of HIV, 12% of the countries were rated “Very good”, 38% “Good”, 25% fair and 25% “Poor”.
development are trained on infant feeding in emergencies
Countries with up-to-date training material on counseling on IYCF in emergencies
9 (33%)
Provision of breast-milk substitute
Countries in which breast-milk substitutes are provided during emergencies
15 (25%)
Countries in which the national government procures and distribute breast-milk substitutes during emergencies
4 (13.8%)
37
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
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CEE/CIS EAPR ESAR MENA ROSA WCAR
Figure 7a: HIV and Infant Feeding score*
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
38
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
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ia
Buru
ndi
Ang
ola
Som
alia
S. S
uda
n
Yem
en
N.
Su
da
n
Sri L
an
ka
Ne
pa
l
Afg
ha
nis
tan
Ban
gla
de
sh
Bhu
tan
India
Nig
eria
Sen
eg
al
Tog
o
Mali
Co
ng
o B
.
Gh
an
a
Mau
rita
nia
B. F
aso
CA
R
DR
C
Ga
mb
ia
Ga
bo
n
Nig
er
S. L
eo
ne
Ben
in
Co
te D
'Ivo
ire
Lib
eri
a
Sc
ore
CEE/CIS EAPR ESAR MENA ROSA WCAR
Figure 7b: Infant Feeding in emergencies score*
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
39
3.8 IYCF monitoring and evaluation In a broad sense, monitoring is assesses ongoing implementation and evaluation centres on taking stock of a programme or intervention. Quality monitoring is an ongoing programmed activity which helps to orient required adjustments at any stage of the programme cycle, and programme evaluation attempts to determine systematically and objectively (as much as possible) the worth or significance of a policy, strategy or intervention [14].
At the national level, monitoring and evaluation for IYCF was undertaken in about 64% of the countries (n=39). Regionally, countries that do not have a monitoring and evaluation strategy in place included; 5 countries (63%) in CEE/CIS [Bosnia, Romania, Kazakhstan, Turkmenistan and Kosovo]; 3 countries (27%) in EAPR [Fiji, Papua New Guinea Vanuatu]; 4 countries (24%) in ESAR [Angola, Swaziland, Tanzania and Burundi]; Yemen and South Sudan in MENA; 27% of the countries (Gabon, Cote d’Ivoire, Benin and Niger) in WCAR.
Only 31 countries (50%) routinely monitor ongoing IYCF activities and 56% (n=34) reported that there has been an overall evaluation or review of IYCF situation in the countries.
IYCF monitoring and evaluation actions score The average monitoring and evaluation IYCF actions score for countries was low: 4 (Annex 5t). All the regions were either rated very low (0-3) [CEE/CIS, MENA] or low (4-6) [EAPR, ESAR, ROSA, WCAR) on their performance on monitoring and evaluation IYCF activities. In general, most of the countries were rated poor [31 countries (48%)] or fair [24 countries (37%)]. Only few countries were rated good [11% (7)] or very good [4% (3)]. The monitoring and evaluation system of most countries appears to be weak requiring substantial strengthening or reinforcement.
Table 2m: Selected indicators on monitoring and evaluation of IYCF actions
National level action
Selected indicators
Results, n (%)
Monitoring, review and evaluation
Countries with monitoring and evaluation for IYCF actions in place at the national level
39 (63.9%)
Countries that routinely monitor on-going IYCF activities
31 (50.0%)
Countries in which there has been an overall evaluation or review of IYCF situation
34 (55.7%)
40
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
7
5
3 3 3
1 1
0
7 7
5
4 4 4 4
3 3 3 3 3
2
1
9
7
6
5 5 5 5
4
3 3 3 3 3 3 3
2 2
5
2
1
6 6
5
4
3 3
9 9
7 7 7
6 6 6
5 5 5
4
3 3 3
2
0 0
1
2
3
4
5
6
7
8
9
10
Ta
jikis
tan
Kyrg
yzsta
n
Bosnia
& H
erz
.
Tu
rke
mn
ista
n
Uzb
ekis
tan
Kazakhsta
n
Kosovo
Ro
ma
nia
Ca
mb
od
ia
Vie
tna
m
Mo
ngo
lia
Ind
one
sia
Mya
nm
ar
Phill
ipin
es
Tim
or-
Le
ste
Ch
ina
La
o P
DR
Pap
ua
Ne
w G
uin
ea
Th
aila
nd
Van
ua
tu Fiji
Kore
a
Rw
an
da
Som
alia
Ma
law
i
Ken
ya
Ma
dag
asca
r
Mo
za
mb
iqu
e
Za
mb
ia
Sou
th A
fric
a
Bots
wa
na
Buru
nd
i
Eth
iop
ia
Sw
azila
nd
Ta
nza
nia
Ug
and
a
Zim
ba
bw
e
Ang
ola
Na
mib
ia
No
rth
Su
da
n
Sou
th S
ud
an
Yem
en
Ind
ia
Sri L
an
ka
Ban
gla
de
sh
Afg
han
ista
n
Bhu
tan
ne
pa
l
Nig
eria
To
go
DR
C
Gha
na
Ma
urita
nia
G
am
bia
Burk
ina
Fa
so
Sen
eg
al
CA
R
Gab
on
Ma
li
Sie
rra
Le
on
e
Ben
in
Lib
eria
Nig
er
Co
ngo
Bra
za
vill
e
Co
te d
'Ivoire
Sco
re
CEE/CIS EAPR ESAR MENA ROSA WCAR
Figure 8: IYCF monitoring and evaluation actions score*
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
41
3.9. CONCLUSIONS AND RECOMMENDATIONS The purpose of this assessment was to review the current scope, scale and status of IYCF key actions in 65 countries (Table 3; figure 9); with special focus on some 22 nutritionally vulnerable countries (see pages 48 to 92).
As a whole, countries were rated “Fair” on average, indicating low implementation of comprehensive IYCF packages (Table 3). Individual countries performed strongly in some areas while they also had gaps in some other key action areas.
In order to achieve the goal of having a comprehensive IYCF strategy at scale, countries will have to act in synergy by building upon or maintaining progress in areas where IYCF actions are already established while at the same time working to strengthen areas where actions are weak or non-existent.
National level IYCF actions Conclusions On average, countries were rated “fair” on their national level IYCF actions, indicating
implementation of low number of key IYCF actions at the national level.
Overall, 12% of the countries were rated “Very good”, 28% “Good”, 40% “Fair” and 20% “Poor” on the national IYCF actions.
On the whole, more countries had IYCF policies than strategies and plan of action.
An estimated 62% of the countries had national laws or regulations in place related to the International Code of Marketing of Breastmilk Substitutes and only 19 countries had the code monitoring or enforcement in place. Paid maternity leave existed in most of the countries (92%), but only about 52% of the countries provided paid nursing breaks for mothers after they returned to work.
Recommendations Gaps at the policy level still need to be addressed. Although most countries had some form of IYCF
policy (stand-alone/integrated), very few countries had a combination of policy, strategy and plan of action.
IYCF policy comprehensiveness should be reviewed. National IYCF policies still did not reflect certain key IYCF practices or components.
National IYCF policies should be comprehensive to ensure that all relevant health and community services protect, promote and support breastfeeding and ensure timely, safe and age-appropriate complementary feeding at 6-24 months as well as include guideline on ensuring appropriate IYCF in exceptionally difficult circumstances.
More countries need to establish national legislation on the Code of Marketing of Breast milk Substitutes.
Gaps existed with monitoring and enforcement systems for the Code, even for those countries with a law already in place. Regular independent monitoring is needed, which is free from commercial interests using standard protocols to document violations. Effective regulations and systems for enforcement are also needed.
Maternity leave was provided in many countries but a large percentage of countries do not provide nursing breaks for mothers.
Health service level IYCF actions Conclusions On average, countries were rated “fair” on their health service IYCF actions, indicating the
implementation of low number of key IYCF actions at the health service level.
Overall, 12% of the countries were rated “Good”, 57% “Fair” and 31% “Poor” on the health service IYCF actions.
Pre-service trainings for nurses and other health professionals on IYCF were more likely to occur than training for medical doctors. Only 51% of the countries conducted IYCF-focused pre-service
42
trainings for medical doctors, and about 88% conducted pre-service trainings for nurses and other health professionals.
In-service trainings occurred in about 60% of the countries. Further, an estimated 69% had job aids and counselling cards available for health professionals (medical doctors, nurses and other health professionals).
Although 43 countries indicated that health workers were trained on IYCF counselling since 2006, only a few countries were able to report on the scale and coverage of counselling activities taking place within the maternal and child health centres.
Among the 55 countries that indicated that at least one hospital/maternity facility ever certified as “Baby-Friendly”, the average proportion ever-certified is 23% (ranging from 1 to 100%). Among the 22 countries that indicated that at least one hospital/maternity facility ever re-certified as “Baby-Friendly”, the average proportion ever re-certified is very low at 5.6% (ranging from 1 to 76%).
Recommendations In-service training and pre-service education gaps in countries need to be comprehensively
addressed. The standard pre-service and in-service training curricula in countries should be based on the WHO 2009 IYCF model chapter for textbooks for medical students and allied professionals – noting that the HIV and infant feeding chapter needs to be updated in line with the 2010 WHO recommendations on HIV and infant feeding.
It is also vital to ensure that the capacities of health professionals are substantially strengthened in providing recommended IYCF counseling and support.
Appropriate systems and structures to routinely deliver IYCF counselling services within the health system need to be developed. Supervision and performance monitoring mechanisms need to be in place to ensure sustained implementation, quality delivery and documentation of performance
Given that the Baby-Friendly Hospital Initiative was reported as having extremely low coverage of re-certification of facilities, it must be properly institutionalized within the national health system in order to ensure continuity and sustainability. The Ten Steps and the tools to assess compliance with them need to be fully integrated within the standard operating procedures of health facilities and the supervisory, monitoring, quality assurance, accreditation systems.
Monitoring of IYCF activities and outcomes in the health system needs to be substantially strengthened, based on the principle that “what is monitored is more likely to be done”. IYCF indicators need to be integrated within the health management information systems (HMIS), especially in countries where these systems function relatively well. Rapid assessment tools such as lot quality assurance sampling (LQAS), SMART and other nutrition surveys, health facility assessment tools and qualitative assessments can be used to measure coverage and quality of IYCF counseling, and established assessment and survey instruments need to integrate appropriate IYCF indicators.
Community level IYCF actions Conclusions On average, countries were rated “Poor” on their community-based IYCF actions, indicating the
implementation of very low number of key IYCF actions at the community level.
Overall, only 8% of the countries were rated “Good”, 31% “Fair” and 61% “Poor” on the community-based IYCF actions.
Eighty-four per cent of the countries (n=53) had established community-based IYCF activities either as standalone and/or integrated within other programmes.
Only 11 countries reported having stand-alone IYCF activities within the community. Some countries indicated integrating activities within other programmes [such as Integrated management of childhood illnesses (n=12), ante natal care (n=9), growth monitoring and promotion (n=7)].
About 66% of the countries indicated training community health workers on community IYCF counselling since 2006 and only 27 countries conducted specific capacity building on communication skills for community health workers. The average proportion of community health workers trained on IYCF counselling since 2006 is 26 % (ranging from ≈1 to 73%).
Only 13 countries routinely monitored the counselling skills of the community health workers and very few monitored the counselling quality.
43
Recommendations Community-based initiatives can extend the delivery of interventions, particularly important in
countries that have a weak health infrastructure or low health facility delivery rates. However, current IYCF actions at the community level in most countries appear to be not as well-developed as the health service level.
More effort is required to strengthen and scale up community level IYCF actions and ensure that IYCF is promoted and supported in communities. Community-based IYCF activities and programmes should build upon existing health and nutrition programmes at community level to the extent possible.
Training community health workers in community-based IYCF counseling and communication skills should be intensified in countries and large-scale coverage pursued. The distinction between promotive actions/communication and counselling and skilled support needs to be more clearly made, and the importance and complementarity of both underscored, as many countries do not yet pursue large-scale actions related to counselling and support at the community level.
Monitoring and evaluation of community-based IYCF activities should be strengthened to include supportive supervision and a recognition mechanism for well-performing workers in more countries. Additionally, monitoring systems should be comprehensive enough to be able to provide sufficient detail on the coverage, quality of training and counseling activities among others. A combination of routine data and rapid assessment and survey tools should be used to monitor coverage and quality of community IYCF interventions.
Communication on IYCF Conclusions On average, countries were rated “Fair” on their communication on IYCF actions, indicating the
implementation of low number of key communication on IYCF actions.
Overall, 12% of the countries were rated “Good”, 62% “Fair” and 26% “Poor” on the communication on IYCF actions.
Only 36 countries (55%) conducted communication on IYCF through five or more communication channels. Countries also indicated having communication strategies at the National (n=33), health service (n=54) and community (n=50) levels.
Behavioural change and communication materials were available in most [95% (n=61)] of the countries. However, few countries have monitoring and evaluation system for communication on IYCF in place.
Recommendations A comprehensive communication strategy on IYCF using multiple channels to reach priority
audience with age and context-specific messages should an integral part of any IYCF intervention.
Gaps exist with respect to routine monitoring of ongoing communication on IYCF activities. Countries need to strengthen or develop appropriate system to monitor and evaluate communication activities, outcomes and impact on behaviour.
Complementary feeding interventions/components Conclusions On average, countries were rated “Fair” on their complementary feeding interventions/components.
Overall, 11% of the countries were rated “Very good”, 4% “Good”, 36% “Fair” and 49% “Poor” on the complementary feeding interventions/components.
About 60% of the countries (n=37) indicated that caregivers/mothers were counselled on home preparation of complementary foods for children 6-24 months. Countries use varieties of counselling channels, such as counselling cards (at the health service and community level), cooking classes, published recipe guides for mothers and food preparation demonstration on TV.
Micronutrient supplements (multiple/single) were provided to improve complementary feeding for children 6-24 months in about 79% of the countries (n=51). Furthermore, 58% of the countries (n=19) provided fortified industrially blended complementary foods, while only 26% of the countries (n=10) provided fortified local complementary foods.
44
Recommendations Counseling mothers or caregivers on optimal complementary feeding practices and using multiple
communication channels will be crucial for improving mothers/caregivers knowledge and skills on home preparation of complementary foods for children 6-24 months.
For some countries provision of complementary food supplements may be needed to fill the nutrient gap when locally available foods alone cannot satisfy nutrition requirement. Appropriate decision-making processes are needed to determine whether, when and for whom supplements are needed. Countries need to establish effective monitoring systems so the coverage and programmatic aspects of these products and the outcomes can be measured.
The use of nutrition-sensitive social protection schemes needs to be more widely tested and applied, as well as strengthened linkages with agriculture for the implementation of nutrition-sensitive interventions to increase the availability of locally produced nutrient dense quality foods.
IYCF in difficult circumstances HIV and infant feeding
Conclusions On average, the countries were rated “‘fair’” on their actions related to HIV and infant feeding
interventions.
Overall, 12% of the countries were rated “Very good”, 38% “Good”, 25% “Fair” and 25% ‘Poor”.
HIV and infant feeding policy and guidance was available in about 84% of the countries (n=54).
Approximately, 72% of the countries (n=47) provide infant feeding counselling for HIV positive mothers, while about 83% countries (n=45) train health workers on infant feeding and HIV. However, only about 67% (n=38) of the countries provided support on infant feeding for HIV positive mothers.
Infant feeding and HIV training materials and job aids or counselling cards were updated with the WHO 2010 recommendations in approximately 76% (n=31), and 74% (n=23) of the countries, respectively.
Only 27% (n=17) of the countries have a monitoring system on infant feeding practices among HIV positive mothers in place.
Recommendations HIV and infant feeding recommendations, based on the latest 2010 guideline, need to be fully
integrated within all the in-country IYCF guidelines, materials, training sessions and counselling contacts.
These revised materials need to be thoroughly disseminated to all relevant health and community workers across the whole country, and systematic follow up and mentoring on quality and appropriate application is needed.
More emphasis on the importance of providing support and follow-up for HIV positive mothers is required.
Infant feeding in emergencies Conclusions On average the countries are rated “poor” on their actions related to infant feeding in emergencies.
Overall, 4% of the countries were rated “Good”, 17% “Fair” and 78% “Poor”.
Only 41% (n=26) of the countries indicated that their National IYCF policy includes infant feeding in emergencies. Similarly, just 24 countries (41%) also reported having a national emergency preparedness plan which includes IYCF in emergencies.
About 24% of the countries (n=14) provide training for health providers or IYCF counsellors on infant feeding in emergency.
Fifteen countries (25%) indicated that they provide breast-milk substitutes in emergencies.
45
Recommendations National policies should be updated to include infant feeding in emergencies and not wait until after
emergency strikes before prioritizing infant feeding in emergencies in the national IYCF strategies.
Capacities for the design, planning, management and monitoring of IYCF interventions in emergencies need to be strengthened among Governments, partners, NGOs and other institutions.
Free breast milk substitutes were still provided in some of the countries. Actions should be taken to inform governments in advance (as part of emergency preparedness and planning) in these countries about the negative impact of accepting donations of these products on IYCF practices, and to ensure effective systems are in place to prevent, block and handle donations in case an emergency occurs. In situations where breast milk substitutes are necessary for eligible children then close control and monitoring is necessary.
IYCF Monitoring and evaluation Conclusions On average, countries were rated “Fair” on the IYCF monitoring and evaluation action score.
Overall, 4% of the countries were rated “Very good”, 11% “Good”, 37% “Fair” and 48% “Poor”.
Evaluation or review of the IYCF situation only occurred in about two thirds of the countries. At the same time, monitoring and evaluation of national IYCF only occur in 39 countries (64%).
Recommendations Routine monitoring and evaluation of ongoing IYCF activities and the monitoring of process
indicators took place in about half of the countries. However, none of the countries were able to report on coverage of the health services, community-based interventions and communication currently taking place in their countries.
Monitoring and evaluation systems need to be substantially strengthened as evidenced by the low proportion of countries that were able to report on geographical scale, target population coverage and quality of IYCF interventions in the health services, at community level, on complementary feeding supplements and related to communication currently taking place in their countries. Steps to strengthen this aspect will involve a number of initiatives, for example to include IYCF indicators within HMIS systems where these systems are functioning well; to improve community-based tallying and reporting by CHWs; to integrate IYCF indicators of outcome (IYCF practices) and programme performance (e.g. coverage of counselling and communication, coverage of complementary feeding supplements or social protection schemes; training received, counselling services provided, etc., within rapid assessment tools such as LQAS-based small household surveys, CHW surveys and health facility surveys; and systematically integrating all IYCF indicators within household surveys such as SMART and MICS.
The monitoring and evaluation system needs to be carefully designed from the on-set to ensure that it comprehensively captures relevant information at key IYCF action areas.
46
Table 3: IYCF comprehensive action score (All countries)
Region Country National level
IYCF score Health
services score
Community-based system
score
Communication on IYCF score
IYCF in Difficult
circumstances score
CF Component SCORE
Monitoring & evaluation
score
Overall IYCF Comprehensive actions score
CEE/CIS Romania 5 3 0 3 3 2 0 2
CEE/CIS Kosovo 2 5 0 4 2 4 1 3
CEE/CIS Uzbekistan 3 7 0 5 5 1 3 3
CEE/CIS Bosnia and Herz. 5 4 3 4 2 4 3 4
CEE/CIS Kazakhstan 7 8 1 6 1 3 1 4
CEE/CIS Turkmenistan 5 7 2 4 4 4 3 4
CEE/CIS Tajikistan 5 8 3 3 4 0 7 4
CEE/CIS Kyrgyzstan 8 8 5 5 4 2 5 5
MEAN 5 6 2 4 3 2 3 4
EAPR Timor-Leste 0 3 1 3 2 1 4 2
EAPR Indonesia 2 4 0 3 3 4 4 3
EAPR Myanmar 4 3 0 4 4 3 4 3
EAPR Korea 5 5 2 7 1 3 1 3
EAPR Fiji 3 8 4 4 4 1 2 4
EAPR Thailand 8 7 0 4 5 1 3 4
EAPR Vanuatu 8 4 1 6 5 1 3 4
EAPR China 5 5 4 4 6 4 3 4
EAPR Lao D. Rep. 8 6 3 6 4 1 3 4
EAPR Mongolia 6 7 0 6 1 7 5 5
EAPR P. New Guinea 6 8 4 5 4 3 3 5
EAPR Philippines 9 4 3 3 6 4 4 5
EAPR Cambodia 8 6 6 6 5 5 7 6
EAPR Vietnam 9 6 5 5 5 6 7 6
MEAN 6 5 2 5 4 3 4 4
ESAR Angola 4 5 0 4 1 0 2 2
ESAR Burundi 2 6 1 4 1 1 3 3
ESAR Ethiopia 2 5 2 3 3 0 3 3
ESAR Botswana 9 2 1 1 2 2 3 3
ESAR Namibia 4 4 2 5 3 3 2 3
ESAR Swaziland 3 6 2 4 5 3 3 4
ESAR Somalia 3 3 5 3 3 3 7 4
ESAR Zambia 5 7 3 4 4 3 5 4
ESAR Mozambique 4 5 3 7 4 4 5 5
ESAR Madagascar 7 5 5 3 4 4 5 5
ESAR South Africa 5 9 3 3 4 5 4 5
ESAR Uganda 7 6 3 5 5 4 3 5
ESAR Zimbabwe 9 9 3 2 5 4 3 5
ESAR Rwanda 4 8 6 5 5 0 9 5
ESAR Tanzania 6 9 4 6 5 4 3 5
ESAR Kenya 6 8 5 7 4 3 5 5
ESAR Malawi 8 8 3 5 4 5 6 6
MEAN 5 6 3 4 4 3 4 4
MENA South Sudan 1 2 2 4 3 2 2 2
MENA Yemen 5 3 3 4 3 2 1 3
MENA North Sudan 6 8 3 5 3 4 5 5
MEAN 4 4 3 4 3 3 3 4
ROSA Nepal 6 4 1 3 3 3 3 3
ROSA Bhutan 7 6 0 4 4 3 3 4
ROSA Bangladesh 7 3 3 5 3 4 5 4
ROSA Afghanistan 9 3 5 4 4 3 4 5
ROSA India 5 6 1 6 1 7 6 5
ROSA Sri Lanka 9 7 5 6 4 6 6 6
MEAN 7 5 3 5 3 4 5 5
WCAR Liberia 0 0 6 2 2 4 3 2
WCAR D. Rep. Congo 4 8 3 2 4 0 0 3
WCAR Cote d'Ivoire 2 4 7 2 4 4 2 4
WCAR Gabon 8 4 1 2 3 1 7 4
WCAR Congo Brazzaville 5 4 2 6 7 2 5 4
WCAR Sierra Leone 6 2 6 6 5 2 4 4
WCAR Benin 4 6 4 4 5 4 6 5
WCAR Mali 3 8 1 5 6 5 5 5
WCAR Niger 6 7 5 6 3 3 3 5
WCAR Cen.Afr.Rep. 7 5 7 2 5 2 6 5
WCAR Gambia 9 4 4 5 5 3 5 5
WCAR Burkina Faso 7 6 4 8 4 6 3 5
WCAR Ghana 8 8 1 7 7 4 7 6
WCAR Mauritania 8 8 6 8 5 3 7 6
WCAR Senegal 10 7 7 8 2 8 6 7
WCAR Togo 8 8 7 6 5 5 9 7
WCAR Nigeria 8 8 8 7 6 5 9 7
MEAN 6 6 5 5 5 3 5 5
Colour key
High / Very good
Medium / Good
Low / Fair
Very Low / Poor
47
*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)
2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3 3 3
4 4 4 4 4 4 4 4 4 4 4 4 4
5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
6 6 6 6 6 6 6 6
7 7 7
0 1 2 3 4 5 6 7 8
South Sudan
Burundi
Angola
Liberia
Timor-Liste
Kosovo
Romania
Bosnia and Herz.
Botswana
Cote d'Ivoire
D. Rep. Congo
Ethiopia
Fiji
Indonesia
Kazakhstan
Korea
Myanmar
Namibia
Nepal
Swaziland
Yemen
Bhutan
Cen.Afr.Rep.
China
Gabon
Lao D. Rep.
Madagascar
P. New Guinea
Sierra Leone
Somalia
Thailand
Turkmenistan
Uzbekistan
Vanuatu
Afghanistan
Bangladesh
Benin
Burkina Faso
Congo Brazzaville
Gambia
India
Kenya
Mali
Mongolia
Mozambique
Niger
North Sudan
Rwanda
South Africa
Tajikistan
Tanzania
Uganda
Zambia
Zimbabwe
Cambodia
Ghana
Kyrgyzstan
Malawi
Mauritania
Philippines
Sri Lanka
Vietnam
Togo
Nigeria
Senegal
Figure 9: Overall IYCF Comprehensive actions score
COLOUR KEY
VERY GOOD High number of key IYCF actions or intervention implemented
GOOD Medium number of key IYCF actions or intervention implemented
FAIR Low number of key IYCF actions or intervention implemented
POOR Very Low number of key IYCF actions or intervention implemented
48
Table 4b: Nutritionally vulnerable country statistics
Table 4b: Under-five mortality rankings in nutritionally vulnerable countries
Country Under-5 mortality rate
(2009)
Value Rank
Democratic Republic of the Congo 199 2
Sierra Leone 192 5
Mali 191 6
Somalia 180 7
Burkina Faso 166 9
Angola 161 11
Niger 160 12
Mozambique 142 15
Nigeria 138 18
Uganda 128 19
Côte d'Ivoire 119 21
Liberia 112 24
Malawi 110 26
Sudan 108 27
United Republic of Tanzania 108 27
Ethiopia 104 29
Kenya 84 39
India 66 48
Yemen 66 48
Bangladesh 52 57
Indonesia 39 66
Philippines 33 77
The above list ranks countries and territories in descending order of their estimated 2009 under-five mortality rate (U5MR), a critical indicator of the well-being of children. Source: UNICEF, Progress for Children: Achieving the MDGs with Equity, No, 9 New York, 2010.
49
Table 4c: Nutrition statistics: Nutritionally vulnerable countries
Countries and
territories
Early initiation of
breastfeeding (%)
% of children (2005–2009*) who are: % of under–fives (2003 –2009*) suffering from:
exclusively breastfed
breastfed with complementary
food
still breastfeeding
underweight (NCHS/WHO)
underweight (WHO) wasting (WHO)
stunting (WHO)
moderate & severe
moderate & severe
severe moderate & severe
moderate & severe 2005–2009* (<6 months) (6–9 months)
(20–23 months)
Angola 55 11 x 77 x 37 x – 16 y 7 y 8 y 29 y
Bangladesh 43 43 74 91 46 41 12 17 43 Burkina Faso
20 16 – – 31 26 7 11 35
Côte d'Ivoire 25 4 54 37 20 16 5 8 40 Democratic Republic of the Congo
48 36 82 64 31 25 8 10 46
Ethiopia 69 49 54 88 y 38 33 11 12 51
India 41 46 57 77 48 43 16 20 48
Indonesia 44 32 75 50 – 18 5 14 37
Kenya 58 32 83 54 20 16 4 7 35
Malawi 58 57 89 72 21 15 3 4 53
Mali 46 38 30 56 32 27 10 15 38
Mozambique 63 37 84 54 18 18 5 4 44
Niger 40 10 52 – 41 y 34 y 11 y 12 y 46 y
Nigeria 38 13 75 32 29 24 9 11 43
Philippines 54 34 58 34 26 22 – 7 32
Sierra Leone 51 11 73 50 25 21 7 10 36
Somalia 26 9 15 35 36 32 12 13 42
Sudan – 34 56 35 31 27 10 16 40
Thailand 50 5 43 19 9 7 1 5 16
Uganda 42 60 80 54 20 16 4 6 38 United Republic of Tanzania
67 41 x 91 x 55 x 22 17 4 4 44
Yemen 30 12 x 76 x – 46 43 19 15 58
Average
45.9
30 66.7 54.2 30.6 25.0 8.5 10.7 41.8
SUMMARY INDICATORS BY REGION/GLOBAL
Africa# 49 34 69 49 24 20 6 9 40 Sub-Saharan Africa#
49 33 70 51 27 22 7 9 42
Eastern and Southern Africa
61 47 72 64 25 21 6 7 44
West and Central Africa
39 23 70 43 28 23 8 10 40
Middle East and North Africa
47 32 57 35 14 14 5 10 31
Asia# 41 38 54 68 31 27 13 17 35
South Asia 39 45 56 75 47 42 15 19 48 East Asia and Pacific
44 28 52 – 11 11 – – 22
Developing countries§
44 36 59 56 26 22 9 12 34
Least developed countries§
50 42 69 68 33 28 9 11 44
World 44 36 59 56 26 22 9 12 34
Source: UNICEF, Progress for Children: Achieving the MDGs with Equity, No, 9 New York, 2010.
50
References
1. UNICEF, 2010. Achieving the MDGs with equity: Progress for children, challenges and disparities. UNICEF: New York.
2. WHO/UNICEF, 2003. Global strategy for IYCF 2003 WHO/UNICEF Global Strategy for Infant and Young Child Feeding. World Health Organization: Switzerland, Geneva.
3. UNICEF, 2011. Programming guide: Infant and young child feeding. UNICEF: New York.
4. WHO & UNICEF. 2007. Planning guide for national implementation of the global strategy for infant and young child feeding. World Health Organization: Switzerland, Geneva.
5. WHO. 1981. International Code of Marketing of Breast-Milk Substitutes. World Health Organization: Switzerland, Geneva.
6. WHO 2009. Infant and young child feeding: Model chapter for textbooks for medical students and allied professionals.
7. UNICEF. 2009. Revised BFHI material
8. WHO/PAHO. 2001. Guiding principles for complementary feeding of breastfeed child.
9. WHO. 2005. Guiding principles for feeding non-breastfed children 6 to 24 months.
10. WHO & UNICEF 1990. Innocenti declaration on the Protection, Promotion and Support for
Breastfeeding. Online at: http://www.unicef.org/programme/breastfeeding/innocenti.htm.
11. WHO & UNICEF, 1991. The Baby-Friendly Hospital Initiative. Online at: http://www.unicef.org/programme/breastfeeding/baby.htm#10.
12. WHO, UNICEF, UNAIDS, UNFPA. 2010. Guidelines on HIV and infant feeding 2010. Principles and recommendation for infant feeding in the context of HIV and a summary of evidence.
13. IFE Core Group 2007. Infant and young child feeding in emergencies: Operational guidance.
14. UNICEF. 2007. Programme policy and procedure manual: Programme operations
51
Section 4: IYCF PROFILES 22 countries*, with poor infant and young child feeding practices and large burdens
of undernutrition among children less than five years, designated nutritionally
vulnerable countries
* IYCF and nutrition data reflects countries’ status for the year 2010. Source: UNICEF, Progress for Children:
Achieving the MDGs with Equity, No, 9 New York, 2010.
52
ANGOLA Angola has a stunting prevalence rate of 29% among children under 5 years of age;
while 16% and 8% are underweight and wasted, respectively. Recent reports on
IYCF status indicate that the rate of early initiation of breastfeeding is currently at
55%, exclusive breastfeeding (< 6 months) at 11% and continued breastfeeding (20
- 23 months) at 37%. About 77% of children 6 to 9 months are breastfed with
complementary food; the nutritional quality of complementary foods from most
developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Angola’s overall national policy, strategy
and plan of actions status appears to be
“poor”. The country has very few of the
building blocks for a comprehensive
IYCF strategy and continued work on
IYCF is required. At present the policy
on IYCF reflected none of the key
practices and only few of the key
components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the key
components, including maternity protection law, maternity leave and paid nursing leave.
However, more work is needed with respect to the CODE law, its monitoring and
enforcement.
HEALTH SYSTEM LEVEL ACTIONS
The health system level actions appear to be “fair”. Although, the country seems
to have adequate IYCF health service counseling, several other key components,
including the BFHI, the pre- and in-service training curricula and health workers
capacity development activities need to be reinforced.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Key components, such as
community system integration,
community capacity development
and training, as well as monitoring
and evaluation require extensive
attention.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy Status
Overall national IYCF policy, strategy and plan of actions
Poor
Key practices reflected in the policy
Early initiation of breastfeeding
× Exclusive breastfeeding
× Continued breastfeeding
× Complementary feeding ×
Selected key components reflected in the national IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding
IYCF in emergency × National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Fair
Key action areas
CODE law × CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Fair
IYCF health workers capacity development Fair
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): < 2
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional delivery in the country (%) 42
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 0
Coverage of the training on IYCF counseling among health workers (%) 0
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Poor
Community monitoring and evaluation
Poor
Selected key components of the IYCF community
system level actions
Status
Community capacity development
Training on community IYCF counseling since 2006
× Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
0
Coverage of community health workers providing IYCF counseling activities as part of other community-based programme (%)
10
Proportion of the population living in the target area
26%
53
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems to
“fair”. Several other key components are judged to be
weak and may require extensive work, including the
national IYCF behaviour change and communication
strategy and the monitoring and evaluation of the effect of
communication on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “poor” and may require extensive attention. Additionally, more
work is needed to strengthen the broader monitoring and
evaluation system within the national legislation, community and
health system levels as well as communication on IYCF and IYCF
in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication strategy Poor
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Selected key interventions in relation to provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months
×
Micronutrients supplements (single/multiple) provided in emergencies
-
Micronutrients supplements provided in non- emergencies
-
Targeted food supplements are provided to improve CF for children 6-24 months
×
Fortified local complementary foods are provided -
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided -
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
×
Provision of complementary food supplements score
×
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
×
Infant feeding counseling for HIV+ mothers ×
IYCF training materials include HIV and infant feeding -
IYCF counseling materials which include HIV and infant feeding are updated
- Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on HIV and infant feeding Poor
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
×
HIV and infant feeding in PMTCT policy
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency ×
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes ×
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF
×
Routine monitoring of ongoing IYCF ×
Overall evaluation/review of IYCF situation ×
54
BANGLADESH Bangladesh has a stunting prevalence rate of 43% among children under 5 years
of age; while 41% and 17% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 43%, exclusive breastfeeding (< 6 months) at 43% and continued
breastfeeding (20 - 23 months) at 91%. About 74% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Bangladesh’s overall national policy,
strategy and plan of actions status
appears to be “good”. The country
seems to have adequate number of the
building blocks for a comprehensive
IYCF strategy. However, more work
may be required to ensure that early
initiation of breastfeeding is reflected in
the national policy.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including CODE law, maternity protection law, and maternity leave.
However, more work may be needed with respect to the CODE monitoring and
enforcement and provision paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Several key components,
including the BFHI, health workers capacity development and the IYCF health
service counseling activities may require strengthening.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
seem “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Key components, such as IYCF
community system integration,
community health workers capacity
development, as well as monitoring
and evaluation may require
extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Good
Key practices reflected in the policy
Early initiation of breastfeeding
× Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication HIV and infant feeding
IYCF in emergency
National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Fair Key action areas
CODE law
CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Poor
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula
-
IYCF health workers capacity development Fair
IYCF health service counseling Poor
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 50
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional delivery in the country (%) 18
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%)
< 1
Coverage of the training on IYCF counseling among health workers (%)
3
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration
Poor
IYCF community health workers capacity development Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
× Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities
×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) 3
Coverage of community health workers providing IYCF counseling activities as part of other community-based programme (%) 25
Proportion of the population living in the target area 7%
55
COMMUNICATION ON IYCF Overall national level communication on IYCF seems
“fair”. Some key components are judged to be weak and
may require extensive work, including the IYCF
behaviour change and communication channels and the
monitoring and evaluation of the effect of communication
on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “fair” and may require additional attention. Weaker aspects of
the comprehensive IYCF monitoring and evaluation system
should be strengthened, particularly at the national legislation,
community and health system levels as well as communication on
IYCF and IYCF in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication Good
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months
Micronutrients supplements provided in emergencies
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months
Fortified local complementary foods are provided ×
Fortified industrially-blended complementary foods are provided
×
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers ×
IYCF training materials include HIV and infant feeding -
IYCF counseling materials which include HIV and infant feeding are updated regularly
- Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency
Government procures/distribute breast milk substitutes ×
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
×
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation
56
BURKINA FASO Burkina Faso has a stunting prevalence rate of 35% among children under 5 years of age; while 26% and 11% are underweight and wasted, respectively. Recent reports on IYCF status indicate that the rate of early initiation of breastfeeding is currently at 20% and exclusive breastfeeding (< 6 months) at 16%. The nutritional quality of complementary foods from most developing countries is usually poor or inadequate. Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Burkina Faso’s overall national policy,
strategy and plan of actions status
appears to be “good”. The country
seems to have most of the building
blocks for a comprehensive IYCF
strategy. At present some of the key
components are not reflected in the
national IYCF policy and thus may
require continued work in this area.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has some of the
key components, including CODE law, maternity protection law, maternity leave and
paid nursing leave. However, more work is needed with respect to the CODE
monitoring and enforcement.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country
seems to have adequate IYCF health workers capacity development
component, several other key components, including the BFHI, the pre- and in-
service training curricula and the IYCF health service counseling activities may
need strengthening.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “fair”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Key components, such as
community system integration,
community capacity development
and training, as well as monitoring
and evaluation require extensive
attention
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Good
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the national IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication HIV and infant feeding - IYCF in emergency × National IYCF strategy × National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Good Key action areas
CODE law
CODE monitoring and enforcement
×
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Fair
IYCF health workers capacity development Good
IYCF health service counseling Fair
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): < 2
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 76
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 10
Coverage of the training on IYCF counseling among health workers (%) 100
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Fair
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Fair
Selected key components of the IYCF community
system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities
Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
66
Coverage of community health workers providing IYCF counseling activities as part of other community-based programme (%)
100
Proportion of the population living in the target area (%)
100
57
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“good”, However, to take advantage of the adequate
communication on IYCF, other weaker aspects of the
comprehensive IYCF programming should be reinforced,
particularly at the health system and community levels, as
well as IYCF monitoring and evaluation.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation
appears to be “fair” and may require extensive attention.
Additionally, more work is needed to strengthen the broader
monitoring and evaluation system within the national
legislation, community and health system levels as well as
communication on IYCF and IYCF in exceptionally difficult
circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Good
Key action areas or component
National IYCF behaviour change and communication Good
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Very Good
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements
Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months
Micronutrients supplements (single/multiple) provided in emergencies
×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months
Fortified local complementary foods are provided
Fortified industrially-blended complementary foods are provided
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency ×
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency -
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF ×
Overall evaluation/review of IYCF situation ×
58
COTE D’IVOIRE Cote d’Ivoire has a stunting prevalence rate of 40% among children under 5 years
of age; while 16% and 8% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 25%, exclusive breastfeeding (< 6 months) at 4% and continued
breastfeeding (20 - 23 months) at 37%. About 54% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Cote d’Ivoire’s overall national policy,
strategy and plan of actions status
appears to be “fair”. The country has
some of the building blocks for a
comprehensive IYCF strategy and
continued work on IYCF is required. At
present, there is no information on
some of the key components as
reflected in the national IYCF policy.
IYCF LEGISLATION AND LAW There is no information on the current status of the overall national IYCF legislation
and law status. Additionally, there is no information on the current status of the key
action areas or components including, CODE law, CODE monitoring and enforcement,
maternity protection law, maternity leave and paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country
seems to have adequate IYCF counseling service at the health system level,
several other key components, including the BFHI, the pre- and in-service
training curricula and health workers capacity development activities may need
to be reinforced.
\
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “good”. Key components,
such as community system
integration as well as, monitoring
and evaluation may require further
strengthening. The community
health workers capacity
development and training activities
may be adequate.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication - HIV and infant feeding
IYCF in emergency
National IYCF strategy - National IYCF plan of action - Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation - Key action areas
CODE law -
CODE monitoring and enforcement
-
Maternity protection law -Maternity leave -
Paid nursing breaks -
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Poor
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Poor
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 9
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country -
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) -
Coverage of the training on IYCF counseling among health workers (%) -
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Good
Key action areas or components
IYCF community system integration
Fair
IYCF community health workers capacity development
Very Good
Community monitoring and evaluation
Fair
Selected key components of the IYCF community
system level actions
Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities
Routine monitoring of skills of community health workers
Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
-
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
-
Proportion of the population living in the target area
35%
59
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“poor”. Several other key components are judged to be
weak and may require extensive work, including the
national IYCF behaviour change and communication
strategy and channels, as well as the monitoring and
evaluation of the effect of communication on IYCF
behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION Overall national level IYCF monitoring and evaluation
appears to be “poor” and may require extensive attention.
Additionally, more work is needed to strengthen the broader
monitoring and evaluation system within the national
legislation, community and health system levels as well as
communication on IYCF and IYCF in exceptionally difficult
circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Poor
Key action areas or component
National IYCF behaviour change and communication strategy Poor
IYCF behaviour change and communication channels Poor
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements
Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies
Micronutrients supplements provided in non- emergencies
-
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided -
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
×
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
-
Status
Overall national standing on Infant feeding in emergencies
- Selected key action areas
National IYCF policy include IYCF in emergency -
National emergency preparedness plan includes IYCF in emergency
-
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
-
Breast milk substitutes are provided during emergency -
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF
×
Routine monitoring of ongoing IYCF ×
Overall evaluation/review of IYCF situation -
60
DEMOCRATIC REPUBLIC OF THE CONGO The Democratic Republic of the Congo (DRC) has a stunting prevalence rate of
46% among children under 5 years of age; while 25% and 10% are underweight
and wasted, respectively. Recent reports on IYCF status indicate that the rate of
early initiation of breastfeeding is currently at 48%, exclusive breastfeeding (< 6
months) at 36% and continued breastfeeding (20 - 23 months) at 64%. About
82% of children 6 to 9 months are breastfed with complementary food; the
nutritional quality of complementary foods from most developing countries is
usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS The DRC’s overall national policy,
strategy and plan of actions status
appears to be “very good”. The
country seems to have most of the
building blocks for a comprehensive
IYCF strategy in place. Nevertheless,
more work may be needed in
developing a comprehensive national
IYCF strategy and plan of actions.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including CODE law, maternity protection law, and maternity leave.
However, there are still gaps with respect to provision of paid nursing breaks and the
CODE monitoring and enforcement.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Several key components,
including the pre- and in-service training curricula and health workers capacity
development and health service counseling activities may be adequate.
However, the BFHI need to be reinforced to take advantage of the good health
system, particularly important with the percentage of institutional births currently
at 64%.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
are judged to be “poor”.
Strengthening IYCF activities within
the communities should be a high
priority action area. Key
components, such as community
system integration, capacity
development, as well as monitoring
and evaluation require extensive
attention.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Very Good
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the national IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication HIV and infant feeding
IYCF in emergency
National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Fair Key action areas
CODE law
CODE monitoring and enforcement
×
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Very Good
IYCF health workers capacity development Very Good
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 4
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 75
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) -
Coverage of the training on IYCF counseling among health workers (%) 5
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) < 1
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 5
Proportion of the population living in the target area 8%
61
COMMUNICATION ON IYCF Overall national level communication on IYCF may be
“poor”. All the key components are judged to be weak
and may require extensive work, including the national
IYCF behaviour change and communication strategy,
channels and materials, as well as the monitoring and
evaluation of the effect of communication on IYCF
behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “good”. However, to take advantage of the current adequate
IYCF monitoring and evaluation, other weaker aspects of the
comprehensive IYCF monitoring and evaluation system should be
strengthened, particularly at the national legislation, community
and health system levels as well as communication on IYCF and
IYCF in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Poor
Key action areas or component
National IYCF behaviour change and communication strategy Poor
IYCF behaviour change and communication channels Poor
Behaviour change and communication materials on IYCF Fair
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months
×
Micronutrients supplements (single/multiple) provided in emergencies
-
Micronutrients supplements provided in non- emergencies
-
Targeted food supplements are provided to improve CF for children 6-24 months
×
Fortified local complementary foods are provided -
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding ×
National IYCF policy include guidance on HIV and infant feeding
-
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
-
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
×
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency
Government procures/distribute breast milk substitutes ×
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation
Status
Overall IYCF monitoring and evaluation score Good
Selected key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation
62
ETHIOPIA Ethiopia has a stunting prevalence rate of 51% among children under 5 years of
age; while 33% and 12% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 69%, exclusive breastfeeding (< 6 months) at 49% and continued
breastfeeding (20 - 23 months) at 88%. About 54% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Ethiopia’s overall national policy,
strategy and plan of actions status
appears to be “poor”. The country has
very few of the building blocks for a
comprehensive IYCF strategy and
continued work on IYCF is needed. At
present the policy on IYCF reflected
none of the key practices and there is
no information on the status of most of
the key components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including maternity protection law, maternity leave. However, more
work is needed with respect to the CODE law, its monitoring and enforcement and
provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. The country seems to be
adequate in some of its key IYCF components. However, it may be essential to
reinforce it weak BFHI.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Key components, such as
community system integration,
community capacity development
and training, as well as monitoring
and evaluation require extensive
attention.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Poor
Key practices reflected in the policy
Early initiation of breastfeeding
× Exclusive breastfeeding
×
Continued breastfeeding
× Complementary feeding ×
Selected key components reflected in the national IYCF policy
Status
Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Fair Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Good
IYCF health workers capacity development Good
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 0
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 18
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 15
Coverage of the training on IYCF counseling among health workers (%) 21
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community
system level actions
Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
53
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
21
Proportion of the population living in the target area
25,500,000
63
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“poor”. Several key action areas are judged to be weak
and may require extensive work, including the IYCF
behaviour change and communication channels and
materials, as well as the monitoring and evaluation of the
effect of communication on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “poor” and may require extensive attention. Additionally,
more work is needed to strengthen the broader monitoring and
evaluation system within the national legislation, community and
health system levels as well as communication on IYCF and IYCF
in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Poor
Key action areas or component
National IYCF behaviour change and communication strategy Good
IYCF behaviour change and communication channels Poor
Behaviour change and communication materials on IYCF Poor
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months
×
Micronutrients supplements (single/multiple) provided in emergencies
-
Micronutrients supplements provided in non- emergencies
-
Targeted food supplements are provided to improve CF for children 6-24 months
×
Fortified local complementary foods are provided -
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
×
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
×Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF ×
Overall evaluation/review of IYCF situation ×
64
INDIA India has a stunting prevalence rate of 48% among children under 5 years of age;
while 43% and 20% are underweight and wasted, respectively. Recent reports on
IYCF status indicate that the rate of early initiation of breastfeeding is currently at
41%, exclusive breastfeeding (< 6 months) at 46% and continued breastfeeding
(20 - 23 months) at 77%. About 57% of children 6 to 9 months are breastfed with
complementary food; the nutritional quality of complementary foods from most
developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS India’s overall national policy, strategy
and plan of actions status appears to be
“poor”. The country has very few of the
building blocks for a comprehensive
IYCF strategy and continued work on
IYCF is required. At present the policy
on IYCF did not reflect most of the key
practices and components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has most of the
key components, including the CODE law, its monitoring and enforcement, maternity
protection law, maternity leave. However, more work is needed with respect to the
provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country
seems to have adequate IYCF counseling service and capacity development
components at the health system level, other key components, including the
BFHI, may need to be reinforced with institutional births currently at 41%.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
seem “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Currently, it seems that all the key
components require extensive
attention.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions Poor
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
×
Continued breastfeeding
×
Complementary feeding ×
Selected key components reflected in the national IYCF policy
Status
Baby-friendly hospital initiative ×International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy
National IYCF plan of action ×
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Good Key action areas
CODE law
CODE monitoring and enforcement
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Good
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 10
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 41
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 12
Coverage of the training on IYCF counseling among health workers (%) -
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Poor
Community monitoring and evaluation
Poor
Selected key components of the IYCF community
system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
- Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) 39
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 100
Proportion of the population living in the target area 100%
65
COMMUNICATION ON IYCF Overall national level communication on IYCF is “fair”,
While some key action areas may be adequate including
the national IYCF behaviour change and communication
strategy and channels, other important key action areas
need to be strengthened, including the behaviour change
and communication materials, as well as the monitoring
and evaluation of the effect of communication on IYCF
behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears
to be “fair” and may require additional attention. Weaker
aspects of the comprehensive IYCF monitoring and
evaluation system should be strengthened, particularly the
routine monitoring of on-going community IYCF activities
within the community, skills of community health workers or
the quality of their skills.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication strategy Very Good
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Fair
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Good
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding Poor
Selected key action areas
Policy on HIV and infant feeding ×
National IYCF policy include guidance on HIV and infant feeding
-
HIV and infant feeding in PMTCT policy -
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
-
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding ×
IYCF counseling materials which include HIV and infant feeding are updated regularly
- Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency ×
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components
Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation
66
INDONESIA Indonesia has a stunting prevalence rate of 37% among children under 5 years of
age; while 18% and 14% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 44%, exclusive breastfeeding (< 6 months) at 32% and continued
breastfeeding (20 - 23 months) at 50%. About 75% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Indonesia’s overall national policy,
strategy and plan of actions status
appears to be “poor”. The country may
have none of the building blocks for a
comprehensive IYCF strategy and
continued work in developing a
comprehensive IYCF policy and plan of
actions may be required.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including maternity protection law, maternity leave. However, more
work is needed with respect to the CODE law, its monitoring and enforcement as well
as provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. All the key components,
including the BFHI, health workers capacity development, the IYCF health
services counseling and the IYCF pre and in service training curricula may need
strengthening.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
seem “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Although, there are no information
on some of the key action areas;
however, all the key components
may require extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Poor
Key practices reflected in the policy
Early initiation of breastfeeding
× Exclusive breastfeeding
×
Continued breastfeeding
× Complementary feeding ×
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy × National IYCF plan of action ×
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Fair Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Poor
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Poor
IYCF health service counseling Fair
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): < 1
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 46
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) < 1
Coverage of the training on IYCF counseling among health workers (%) 2
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
-
Community monitoring and evaluation
-
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
- Capacity building on communication skills for community health workers
- Monitoring and evaluation
Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers
- Routine monitoring of the quality of IYCF counseling
-
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
< 1
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
3
Proportion of the population living in the target area
< 5
67
COMMUNICATION ON IYCF Overall national level communication on IYCF seems
“poor”. All the key components are judged to be weak
and may require extensive work, including the national
IYCF behaviour change and communication strategy,
channels and materials, as well as the monitoring and
evaluation of the effect of communication on IYCF
behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “fair” and may require additional attention. Weaker aspects of
the comprehensive IYCF monitoring and evaluation system
should be strengthened, particularly at the national legislation,
community and health system levels as well as communication on
IYCF and IYCF in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Poor
Key action areas or component
National IYCF behaviour change and communication strategy Poor
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Fair
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Good
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies ×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Poor
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
×
Infant feeding training/counseling for HIV+ mothers ×
IYCF training materials include HIV and infant feeding -
IYCF counseling materials which include HIV and infant feeding are updated regularly
- Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Fair Selected key action areas
National IYCF policy include IYCF in emergency ×
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
Breast milk substitutes are provided during emergency
Government procures/distribute breast milk substitutes ×
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF activities
Routine monitoring of ongoing IYCF activities
Overall evaluation/review of IYCF situation ×
68
KENYA Kenya has a stunting prevalence rate of 35% among children under 5 years of
age; while 16% and 7% are underweight and wasted, respectively. Recent reports
on IYCF status indicate that the rate of early initiation of breastfeeding is currently
at 58%, exclusive breastfeeding (< 6 months) at 32% and continued
breastfeeding (20 - 23 months) at 54%. About 83% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Kenya’s overall national policy, strategy
and plan of actions status appears to be
“very good”. The country seems to
have adequate number of the building
blocks for a comprehensive IYCF
strategy. However, more work may be
required to ensure that early initiation of
breastfeeding is reflected in the national
policy.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has few of the key
components, including maternity protection law and maternity leave. However, more
work is needed with respect to the CODE law, it monitoring and enforcement and
provision of paid nursing leave.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. The country seems to
have adequate IYCF health system level components. The country can take
advantage of its strong health system level actions to further strengthen other
weak action areas, such as the complementary feeding intervention.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “fair”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Important components, such as
community system integration may
require extensive action.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy Status
Overall national IYCF policy, strategy and plan of actions
Very Good
Key practices reflected in the policy
Early initiation of breastfeeding
× Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication HIV and infant feeding
IYCF in emergency
National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Fair Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Good
Key action areas or components Baby-friendly hospital initiative - IYCF health pre- and in-service
training curricula Good
IYCF health workers capacity development Very Good
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): -
Hospitals / maternity facilities re-certified Baby-friendly (%): -
Percentage of institutional birth in the country (%) 44
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) -
Coverage of the training on IYCF counseling among health workers (%) 75
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Fair
Key action areas or components
IYCF community system
integration
Poor
IYCF community health workers capacity development
Very Good
Community monitoring and evaluation
Good
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities
Routine monitoring of skills of community health workers
Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
9
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
100
Proportion of the population living in the target area
15%
69
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“good”. While most of the key action areas may be
adequate, including the national IYCF behaviour change
and communication strategy, channels and materials on
IYCF; the monitoring and evaluation of the effect of
communication on IYCF behaviour needs to be
strengthened.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “fair” and may require additional attention. Weaker aspects of
the comprehensive IYCF monitoring and evaluation system
should be strengthened, particularly at the national legislation,
community and health system levels as well as communication on
IYCF and IYCF in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Good
Key action areas or component
National IYCF behaviour change and communication strategy Very Good
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies
Micronutrients supplements provided in non- emergencies
×
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided
Fortified industrially-blended complementary foods are provided
×
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding
Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding counseling for HIV+ mothers
IYCF counseling materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
×Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes ×
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF activities ×
Overall evaluation/review of IYCF situation
70
MALAWI Malawi has a stunting prevalence rate of 53% among children under 5 years of
age; while 15% and 4% are underweight and wasted, respectively. Recent reports
on IYCF status indicate that the rate of early initiation of breastfeeding is currently
at 58%, exclusive breastfeeding (< 6 months) at 57% and continued
breastfeeding (20 - 23 months) at 72%. About 89% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Malawi’s overall national policy, strategy
and plan of actions status appears to be
“very good”. The country seems to
have adequate number of the building
blocks for a comprehensive IYCF
strategy. However, more work may be
required in terms of developing a
national IYCF plan of actions.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has most of the
key components, including the CODE law, its monitoring and enforcement, as well as
the maternity protection law and maternity leave. However, more work is needed with
respect to the provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country
seems to have adequate IYCF health service counseling activities; effort should
be centred on reinforcing other weak key components within the health system
level.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
All the key components within the
community level may require
extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions or practices implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy Status
Overall national IYCF policy, strategy and plan of actions
Very Good
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication HIV and infant feeding
IYCF in emergency
National IYCF strategy
National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Good Key action areas
CODE law
CODE monitoring and enforcement
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components
Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Very Good
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 5
Hospitals / maternity facilities re-certified Baby-Friendly (%): < 2
Percentage of institutional birth in the country 72
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 [total number (%)] 6
Coverage of the training on IYCF counseling among health workers [total number (%)] 43
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
- Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
-
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
8
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
100
Proportion of the population living in the target area
100%
71
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“fair”. Several important key components are judged to
be weak and may require extensive work, including the
IYCF behaviour change and communication channels
and materials, as well as the monitoring and evaluation of
the effect of communication on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation
appears to be “fair” and may require additional attention.
Weaker aspects of the comprehensive IYCF monitoring and
evaluation system should be strengthened, particularly the
routine monitoring of counseling skills at community and
health system levels.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication strategy Good
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Fair
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Good
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies ×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding counseling for HIV+ mothers
IYCF counseling materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
×Monitoring system on infant feeding practices among HIV+ mothers
-
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF activities
Overall evaluation/review of IYCF situation
72
MALI Mali has a stunting prevalence rate of 38% among children under 5 years of age;
while 27% and 15% are underweight and wasted, respectively. Recent reports on
IYCF status indicate that the rate of early initiation of breastfeeding is currently at
46%, exclusive breastfeeding (< 6 months) at 38% and continued breastfeeding
(20 - 23 months) at 56%. About 30% of children 6 to 9 months are breastfed with
complementary food; the nutritional quality of complementary foods from most
developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Mali’s overall national policy, strategy
and plan of actions status appears to be
“fair”. The country seems to have few
of the building blocks for a
comprehensive IYCF strategy and
continued work on IYCF is required.
The policy on IYCF reflected all the key
practices, but very few of the key
components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “poor”; it has only one of
the key components, the maternity leave. However, extensive work may be required
with respect to the CODE law, its monitoring and enforcement, as well as maternity
protection law and the provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. The country may take
advantage of some of its adequate IYCF health system level actions to reinforce
other IYCF action areas, including BFHI, community system level actions,
communication on IYCF.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
All key components require
extensive attention and actions.
There is no information on the
status of some of the key action
areas.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a
comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy
National IYCF plan of action ×
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Poor Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law × Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Good
IYCF health workers capacity development Good
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 5
Hospitals / maternity facilities re-certified Baby-friendly (%): 3
Percentage of institutional births in the country (%) 57
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) < 1
Coverage of the training on IYCF counseling among health workers (%) 79
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Poor
Community monitoring and evaluation
-
Selected key components of the IYCF community
system level actions
Status
Community capacity development
Training on community IYCF counseling since 2006
× Capacity building on communication skills for community health workers
- Monitoring and evaluation
Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers
- Routine monitoring of the quality of IYCF counseling
-
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
0
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
-
Proportion of the population living in the target area
-
73
COMMUNICATION ON IYCF Overall national level communication on IYCF seems
“fair”. Several important key components are judged to
be weak and may require extensive work, including IYCF
behaviour change and communication channels and
materials, as well as the monitoring and evaluation of the
effect of communication on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “good” and may require additional attention. Weaker aspects
of the comprehensive IYCF monitoring and evaluation system
should be strengthened, particularly at the national legislation,
community and health system levels, as well as communication
on IYCF and in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication strategy Very Good
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Poor
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months × Micronutrients supplements (single/multiple) provided
in emergencies -
Micronutrients supplements provided in non- emergencies
-
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided
Fortified industrially-blended complementary foods are provided
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
×
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding ×
IYCF counseling materials which include HIV and infant feeding are updated regularly
- Monitoring system on infant feeding practices among HIV+ mothers
Status
Overall national standing on Infant feeding in emergencies Fair Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
Breast milk substitutes are provided during emergency
Government procures/distribute breast milk substitutes ×
Government accept donations of infant food
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation ×
74
MOZAMBIQUE Mozambique has a stunting prevalence rate of 44% among children under 5
years of age; while 18% and 4% are underweight and wasted, respectively.
Recent reports on IYCF status indicate that the rate of early initiation of
breastfeeding is currently at 63%, exclusive breastfeeding (< 6 months) at 37%
and continued breastfeeding (20 - 23 months) at 54%. About 84% of children 6 to
9 months are breastfed with complementary food; the nutritional quality of
complementary foods from most developing countries is usually poor or
inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Mozambique’s overall national policy,
strategy and plan of actions status
appears to be “poor”. The country may
have none of the building blocks for a
comprehensive IYCF strategy and
continued work in developing a
comprehensive IYCF policy and plan of
actions may be required.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has most of the
key components, including the CODE, maternity protection law, maternity leave and
the provision paid nursing breaks. However, more work is needed with respect to the
CODE monitoring and enforcement.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country
seems to have adequate IYCF counseling service and capacity development at
the health system level; several other key components, including the BFHI, the
pre- and in-service training curricula and health workers capacity development
activities need to be improved upon.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Key components, such as
community system integration,
community capacity development
and training, as well as monitoring
and evaluation require extensive
attention.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Poor
Key practices reflected in the policy
Early initiation of breastfeeding
× Exclusive breastfeeding
×
Continued breastfeeding
× Complementary feeding ×
Selected key components reflected in the national IYCF policy
Status
Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Good Key action areas
CODE law
CODE monitoring and enforcement
×
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Good
IYCF health service counseling Very Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 0
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 50
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 19
Coverage of the training on IYCF counseling among health workers (%) 100
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) 0
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) -
Proportion of the population living in the target area -
75
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“good”. While most of the key action areas may be
adequate, including the national IYCF behaviour change
and communication strategy, channels, as well as the
monitoring and evaluation; the behaviour change and
communication materials on IYCF needs extensive
attention.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation
appears to be “Fair”. Weaker aspects of the comprehensive
IYCF monitoring and evaluation system should be
strengthened, particularly at the national legislation,
community and health system levels. For instance, routine
monitoring of the quality of IYCF counseling at the
community level need to be strengthened.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Good
Key action areas or component
National IYCF behaviour change and communication Good
IYCF behaviour change and communication channels Very Good
Behaviour change and communication materials on IYCF Poor
Monitoring and evaluating the effect of communication on behaviour Very Good
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided
Lipid-based nutrient supplements are provided
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding -
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency ×
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
×
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation ×
76
NIGER Niger has a stunting prevalence rate of 46% among children under 5 years of
age; while 34% and 12% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 40%, exclusive breastfeeding (< 6 months) at 10%. About 52% of
children 6 to 9 months are breastfed with complementary food; the nutritional
quality of complementary foods from most developing countries is usually poor or
inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Niger’s overall national policy, strategy
and plan of actions status appears to be
“fair”. The country has few of the
building blocks for a comprehensive
IYCF strategy and continued work on
IYCF is required. At present the policy
on IYCF reflected most of the key
practices, but very little number of the
key components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including maternity protection law, maternity leave and provision of
paid nursing leave. However, more work is needed with respect to the CODE law, as
well as its monitoring and enforcement.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. Although, the country
seems to have adequate health workers capacity development activities, IYCF
counseling service and BFHI; several other key components, including the BFHI,
the pre- and in-service training curricula and need to be reinforced.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “fair”. Strengthening
IYCF activities within the
communities should be a high
priority action area. Key
components, such as community
system integration as well as
monitoring and evaluation require
extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the national IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy
National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Fair Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Fair
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Good
IYCF health service counseling Very Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-Friendly (%): 11
Hospitals / maternity facilities re-certified Baby-Friendly (%): 4
Percentage of institutional birth in the country 30
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) < 2
Coverage of the training on IYCF counseling among health workers (%) 12
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Fair
Key action areas or components
IYCF community system integration Fair
IYCF community health workers capacity development
Very Good
Community monitoring and evaluation Poor
Selected key components of the IYCF community
system level actions
Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
51
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
12
Proportion of the population living in the target area
15
77
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“fair”. While some of the key action areas may be
adequate, including the national IYCF behaviour change
and communication strategy and channels, other
important key components including behaviour change
and communication materials on IYCF and the
monitoring and evaluation of the effect of communication
on IYCF behaviour needs to be strengthened.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “poor” and may require extensive attention. Additionally,
more work is needed to strengthen the broader monitoring and
evaluation system within the national legislation, community and
health system levels as well as communication on IYCF and IYCF
in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication Good
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Fair
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies -
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided
Lipid-based nutrient supplements are provided
Status
Overall national standing on HIV and infant feeding Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
-Monitoring system on infant feeding practices among HIV+ mothers
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF - Overall evaluation/review of IYCF situation ×
78
NIGERIA Nigeria has a stunting prevalence rate of 43% among children under 5 years of
age; while 24% and 11% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 38%, exclusive breastfeeding (< 6 months) at 13% and continued
breastfeeding (20 - 23 months) at 32%. About 75% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Nigeria’s overall national policy, strategy
and plan of actions status appears to be
“fair”. The country seems to have
some of the building blocks for a
comprehensive IYCF strategy and
continued work on IYCF is required. At
present the policy on IYCF reflected
most of the key practices, but very little
number of the key components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “very good”; it is judged to
have all the key components. However, to take advantage of the current adequate
IYCF legislation and law; key components not reflected in the national IYCF policy may
be strengthened, including the international code of marketing of breast-milk substitute,
BCC, IYCF in emergency and infant feeding and IYCF.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. Although, most of the key
components seem to the adequate with the exception of the BFHI which needs
more work. Further, there is need to strengthen the capacity of more health
workers on IYCF counseling.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “good”. Seem adequate,
however strengthening the
community system integration may
be needed. Additionally, routine
monitoring and evaluation of
community health workers trained
on IYCF counseling should be part
of the routine monitoring of IYCF
activities.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Very Good Key action areas
CODE law
CODE monitoring and enforcement
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Good
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Very Good
IYCF health workers capacity development Good
IYCF health service counseling Very Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 8
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 39
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) < 1
Coverage of the training on IYCF counseling among health workers (%) -
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Good
Key action areas or components
IYCF community system integration Fair
IYCF community health workers capacity development
Very Good
Community monitoring and evaluation
Very Good
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities
Routine monitoring of skills of community health workers
Routine monitoring of the quality of IYCF counseling
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) -
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 100
Proportion of the population living in the target area 100%
79
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“good”. While most of the key action areas may be
adequate, including the national IYCF behaviour change
and communication strategy, channels and materials; the
monitoring and evaluation of the effect of communication
in IYCF behaviour needs extensive attention.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation
appears to be “Very good”. However, monitoring and
evaluation of national IYCF actions at the national level
need to be strengthened. For instance, proportion and
coverage of community health workers trained on IYCF
counseling skills need to be routinely monitored.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Good
Key action areas or component
National IYCF behaviour change and communication Very Good
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies ×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
×Monitoring system on infant feeding practices among HIV+ mothers
Status
Overall national standing on Infant feeding in emergencies Good Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes ×
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Very good
Key action areas or components Monitoring and evaluation for national IYCF
×
Routine monitoring of ongoing IYCF activities
Overall evaluation/review of IYCF situation
80
PHILIPPINES Philippines has a stunting prevalence rate of 32% among children under 5 years
of age; while 22% and 7% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 54%, exclusive breastfeeding (< 6 months) at 34% and continued
breastfeeding (20 - 23 months) at 34%. About 58% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Philippines’ overall national policy,
strategy and plan of actions status
appears to be “good”. The country has
adequate number of the building blocks
for a comprehensive IYCF strategy. At
present the policy on IYCF reflected
some of the key IYCF components,
while more work is needed with some
others.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “very good”. However, to
take advantage of the current adequate IYCF legislation and law; key components not
reflected in the national IYCF policy may be strengthened, including the international
code of marketing of breast milk substitutes, BCC as well as the national plan of
actions on IYCF.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country
seems to have adequate IYCF health worker capacity development, several
other key components, including the BFHI, the pre- and in-service training
curricula and IYCF health service counseling activities need to be reinforced.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Key components, such as
community integration, community
capacity development and training,
as well as monitoring and evaluation
require extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy Status
Overall national IYCF policy, strategy and plan of actions
Good
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding
IYCF in emergency
National IYCF strategy
National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Very Good Key action areas
CODE law
CODE monitoring and enforcement
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Fair
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Good
IYCF health service counseling Poor
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 83
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 40
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 82
Coverage of the training on IYCF counseling among health workers (%) 100
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community
system level actions
Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
- Monitoring and evaluation
Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) 13
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 100
Proportion of the population living in the target area -
81
COMMUNICATION ON IYCF Overall national level communication on IYCF seems
“poor”. Several important key components are judged to
be weak and may require extensive work, including IYCF
behaviour change and communication channels and
materials, as well as the monitoring and evaluation of the
effect of communication on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears
to be “fair” and may require additional attention. Weaker
aspects of the comprehensive IYCF monitoring and evaluation
system should be strengthened, particularly at the community
and health system levels as well as communication on IYCF
and IYCF in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Poor
Key action areas or component
National IYCF behaviour change and communication Good
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Poor
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies ×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Fair Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
-
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
Breast milk substitutes are provided during emergency
Government procures/distribute breast milk substitutes
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF activities
Overall evaluation/review of IYCF situation
82
SIERRA LEONE Sierra Leone has a stunting prevalence rate of 36% among children under 5
years of age; while 21% and 10% are underweight and wasted, respectively.
Recent reports on IYCF status indicate that the rate of early initiation of
breastfeeding is currently at 51%, exclusive breastfeeding (< 6 months) at 11%
and continued breastfeeding (20 - 23 months) at 50%. About 73% of children 6 to
9 months are breastfed with complementary food; the nutritional quality of
complementary foods from most developing countries is usually poor or
inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Sierra Leone’s overall national policy,
strategy and plan of actions status
appears to be “very good”. The
country has most of the building blocks
for a comprehensive IYCF strategy, but
continued work on IYCF is required. In
particular, more work may be needed
with respect to IYCF in emergency and
national IYCF plan of action.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including maternity protection law, maternity leave. However, more
work is needed with respect to the CODE law, its monitoring and enforcement as well
as the provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. All the key components
may require extensive actions. In particular, BFHI, pre- and in-service training
curricula and IYCF health service counseling activities.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “fair”. Strengthening
IYCF activities within the
communities should be a high
priority action area. Key
components, such as community
system integration, as well as
monitoring and evaluation require
extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Very Good
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication HIV and infant feeding
IYCF in emergency × National IYCF strategy
National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Fair Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Poor
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Fair
IYCF health service counseling Poor
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 0
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 25
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 0
Coverage of the training on IYCF counseling among health workers (%) -
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Fair
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Very Good
Community monitoring and evaluation
Fair
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities
Routine monitoring of skills of community health workers
Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%)
-
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)
100
Proportion of the population living in the target area
100%
83
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“fair”. While most of the key action areas may be
adequate, the national IYCF behaviour change and
communication strategy may need extensive attention.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “fair” and may require extensive attention. Additionally, more
work may be needed to strengthen the broader monitoring and
evaluation system within the national legislation, community and
health system levels as well as IYCF in exceptionally difficult
circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication strategy Poor
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Good
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months × Micronutrients supplements (single/multiple) provided
in emergencies -
Micronutrients supplements provided in non- emergencies
-
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided ×
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Fair
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency ×
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
×
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation ×
84
SOMALIA Somalia has a stunting prevalence rate of 42% among children under 5 years of
age; while 32% and 13% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 26%, exclusive breastfeeding (< 6 months) at 9% and continued
breastfeeding (20 - 23 months) at 35%. About 15% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Somalia’s overall national policy,
strategy and plan of actions status
appears to be “fair”. The country has
few of the building blocks for a
comprehensive IYCF strategy and
continued work on IYCF is required. At
present the policy on IYCF reflected
most of the key practices, but only one
of the key components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “poor” and may require
extensive work. It has none of the key components or action areas, including the
CODE law, it monitoring and enforcement as well as the maternity protection law,
maternity leave and the provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country
seems to have adequate health workers capacity development activities at the
health system level; other key components, including the BFHI, the pre- and in-
service training curricula and counseling activities’ need to be strengthened.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “fair”. Strengthening
IYCF activities within the
communities should be a high
priority action area. Key
components, such as community
system integration, as well as
monitoring and evaluation require
extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative ×International code of marketing of breast milk substitute ×Behavioural change and communication HIV and infant feeding × IYCF in emergency × National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Poor Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law ×Maternity leave ×
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Poor
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Good
IYCF health service counseling Poor
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): < 1
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 9
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 [total number (%)] -
Coverage of the training on IYCF counseling among health workers [total number (%)] 2
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Fair
Key action areas or components
IYCF community system integration Fair
IYCF community health workers capacity development
Very Good
Community monitoring and evaluation
Fair
Selected key components of the IYCF community
system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities
Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) - Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 16
Proportion of the population living in the target area -
85
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“poor”. Several important key components are judged to
be weak and may require extensive work, including
National IYCF behaviour change and communication
strategy, channels, materials and , as well as the
monitoring and evaluation of the effect of communication
on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “good” and may require additional attention. Weaker aspects
of the comprehensive IYCF monitoring and evaluation system
should be strengthened, particularly at the national legislation,
community and health system levels as well as communication on
IYCF and IYCF in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Poor
Key action areas or component
National IYCF behaviour change and communication Poor
IYCF behaviour change and communication channels Poor
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies ×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months × Fortified local complementary foods are provided -
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency ×
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Good
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation
86
SOUTH SUDAN South Sudan has a stunting prevalence rate of 31% among children under 5
years of age; while 28% and 23% are underweight and wasted, respectively.
Recent reports11
on IYCF status indicate that the rate of exclusive breastfeeding
(< 6 months) is currently at 45% and about 21% of children 6 to 8 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS South Sudan’s overall national policy,
strategy and plan of actions status
appears to be “poor”. The country has
very few of the building blocks for a
comprehensive IYCF strategy and
continued work on IYCF is required. At
present it had none of the key
components and very few of the IYCF
practices are reflected in the policy.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “poor”; and may require
extensive work. It has none of the key components or action areas, including the
CODE law, it monitoring and enforcement as well as the maternity protection law,
maternity leave and the provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country
seems to have adequate IYCF counseling service at the health system level;
several other key components, including the BFHI, the pre- and in-service
training curricula and health workers capacity development activities need to be
reinforced.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
The community system integration
component may require extensive
attention. There is no information on
most of the other key components.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or
intervention implemented”
- No information
Poor Very low number of key IYCF actions or
intervention implemented
Fair Low number of the key IYCF actions or
interventions implemented
Good Average number of key IYCF actions or
intervention implemented
Very Good High number or all of the key IYCF actions
or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy Status
Overall national IYCF policy, strategy and plan of actions
Poor
Key practices reflected in the policy
Early initiation of breastfeeding
× Exclusive breastfeeding
Continued breastfeeding
× Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative ×International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and
law
Status
Overall national IYCF legislation Poor Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law ×Maternity leave -
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Poor
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Poor
IYCF health service counseling Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 0
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 12
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 0
Coverage of the training on IYCF counseling among health workers (%) -
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
-
Community monitoring and evaluation
-
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
- Capacity building on communication skills for community health workers
- Monitoring and evaluation
Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers
- Routine monitoring of the quality of IYCF counseling
- Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) 0
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) -
Proportion of the population living in the target area -
87
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“fair”. Several key components are judged to be weak
and may require extensive work, including the national
IYCF behaviour change and communication strategy
and channels, as well as monitoring and evaluation of
the effects of communication on behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “poor” and may require extensive attention. Additionally,
more work is needed to strengthen the broader monitoring and
evaluation system within the national legislation, community and
health system levels as well as communication on IYCF and IYCF
in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication strategy Poor
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements
Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months × Micronutrients supplements (single/multiple) provided
in emergencies -
Micronutrients supplements provided in non- emergencies
-
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Poor
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
×
Infant feeding training/counseling for HIV+ mothers ×
IYCF training materials include HIV and infant feeding -
IYCF counseling materials which include HIV and infant feeding are updated regularly
- Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency -
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
×
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF
×
Routine monitoring of ongoing IYCF ×
Overall evaluation/review of IYCF situation ×
88
SUDAN North Sudan has a stunting prevalence rate of 35% among children under 5 years
of age; while 32% and 16% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 73%, exclusive breastfeeding (< 6 months) at 41%. About 53% of
children 6 to 23 months are breastfed with complementary food; the nutritional
quality of complementary foods from most developing countries is usually poor or
inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS North Sudan’s overall national policy,
strategy and plan of actions status
appears to be “fair”. The country
seems to have most of the building
blocks for a comprehensive IYCF
strategy. However, more work is
required in strengthening its BFHI and
IYCF in emergency.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including maternity protection law, maternity leave and provision of
paid nursing leave. However, more work is needed with respect to the CODE law, its
monitoring and enforcement.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country
seems to be adequate in some of the key components; however, there is need
to further strengthen its BFHI and training curricula.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
All the key components may require
extensive attention.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a
comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative ×International code of marketing of breast milk substitute
Behavioural change and communication HIV and infant feeding
IYCF in emergency × National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Fair Key action areas
CODE law ×
CODE monitoring and enforcement
-
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Fair
IYCF health workers capacity development Good
IYCF health service counseling Very Good
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): 12
Hospitals / maternity facilities re-certified Baby-friendly (%): 12
Percentage of institutional birth in the country 19
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) -
Coverage of the training on IYCF counseling among health workers (%) 62
Summary of IYCF community system level actions
Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Fair
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community
system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) -
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 60
Proportion of the population living in the target area -
89
COMMUNICATION ON IYCF
Overall national level communication on IYCF is “fair”.
Some key components are judged to be weak and may
require extensive work, including behaviour change and
communication materials on IYCF, as well as the
monitoring and evaluation of the effect of communication
on IYCF behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “fair” and may require additional attention. Weaker aspects of
the comprehensive IYCF monitoring and evaluation system
should be strengthened, particularly at the national legislation,
community and health system levels as well as communication on
IYCF and IYCF in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication Good
IYCF behaviour change and communication channels Good
Behaviour change and communication materials on IYCF Fair
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding
interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of
complementary food supplements
Status
Micronutrient supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies ×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided ×
Fortified industrially-blended complementary foods are provided
Lipid-based nutrient supplements are provided
Status
Overall national standing on HIV and infant feeding Poor
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
×
Infant feeding training/counseling for HIV+ mothers ×
IYCF training materials include HIV and infant feeding -
IYCF counseling materials which include HIV and infant feeding are updated regularly
- Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Fair
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF
Overall evaluation/review of IYCF situation ×
90
UGANDA
Uganda has a stunting prevalence rate of 38% among children under 5 years of
age; while 16% and 6% are underweight and wasted, respectively. Recent reports
on IYCF status indicate that the rate of early initiation of breastfeeding is currently
at 42%, exclusive breastfeeding (< 6 months) at 60% and continued
breastfeeding (20 - 23 months) at 54%. About 80% of children 6 to 9 months are
breastfed with complementary food; the nutritional quality of complementary foods
from most developing countries is usually poor or inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country
actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Uganda’s overall national policy,
strategy and plan of actions status
appears to be “fair”. The country has
very few of the building blocks for a
comprehensive IYCF strategy and
continued work on IYCF is required. At
present very few of the key IYCF
components are reflected in the national
policy.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has some of the
key components, including the CODE, its monitoring and enforcement, as well as
maternity protection law and maternity leave. Nevertheless, more work is needed with
respect to the provision of paid nursing breaks.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country
seems to have adequate IYCF training curricula and health workers capacity
development counseling service at the health system level, several other key
components, including the BFHI and IYCF health service counseling may
require to be reinforced.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
All the key components are weak
and may require extensive
reinforcement.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative
International code of marketing of breast milk substitute
Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Good Key action areas
CODE law
CODE monitoring and enforcement
Maternity protection law
Maternity leave
Paid nursing breaks ×
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Fair
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Good
IYCF health workers capacity development Good
IYCF health service counseling Fair
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%): < 1
Hospitals / maternity facilities re-certified Baby-friendly (%): 0
Percentage of institutional birth in the country 41
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 9
Coverage of the training on IYCF counseling among health workers (%) 36
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Poor
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) -
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 21
Proportion of the population living in the target area -
91
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“fair”. Several key components are judged to be weak
and may require extensive work, including the national
IYCF behaviour change and communication strategy and
channels, as well as monitoring and evaluation of the
effects of communication on behaviour.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level IYCF monitoring and evaluation appears to
be “poor” and may require extensive attention. Additionally,
more work is needed to strengthen the broader monitoring and
evaluation system within the national legislation, community and
health system levels as well as communication on IYCF and IYCF
in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication Poor
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Very Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Fair
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months
Micronutrients supplements (single/multiple) provided in emergencies
×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months
×
Fortified local complementary foods are provided -
Fortified industrially-blended complementary foods are provided
-
Lipid-based nutrient supplements are provided -
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
×
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency ×
Government procures/distribute breast milk substitutes -Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF
Routine monitoring of ongoing IYCF ×
Overall evaluation/review of IYCF situation
92
UNITED REPUBLIC OF TANZANIA The United Republic of Tanzania has a stunting prevalence rate of 44% among
children under 5 years of age; while 17% and 4% are underweight and wasted,
respectively. Recent reports on IYCF status indicate that the rate of early initiation
of breastfeeding is currently at 67%, exclusive breastfeeding (< 6 months) at 41%
and continued breastfeeding (20 - 23 months) at 55%. About 91% of children 6 to
9 months are breastfed with complementary food; the nutritional quality of
complementary foods from most developing countries is usually poor or
inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS United Republic of Tanzania’s overall
national policy, strategy and plan of
actions status appears to be “poor”.
The country has very few of the building
blocks for a comprehensive IYCF
strategy and continued work on IYCF is
required. At present there is no
information on the status of most of the
key IYCF components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “very good”. However, to
take advantage of the current adequate IYCF legislation and law; key components not
reflected in the national IYCF policy may need strengthening.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. The country may need to
take advantage of its adequate IYCF actions at the health system level to further
strengthen other IYCF action areas, several other key components, including the
BFHI and health workers capacity development activities in delivering IYCF
counseling need to be reinforced.
COMMUNITY SYSTEM LEVEL ACTIONS
The IYCF community level actions
may be “fair”. Strengthening IYCF
activities within the communities
should be a high priority action
area. More work is required with
respect to reinforcing the IYCF
community system integration as
well as monitoring and evaluation
activities.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or intervention implemented”
- No information
Poor Very low number of key IYCF actions or intervention implemented
Fair Low number of the key IYCF actions or interventions implemented
Good Average number of key IYCF actions or intervention implemented
Very Good High number or all of the key IYCF actions or interventions implemented
National policy, strategy and plan of action for a comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Poor
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
× Complementary feeding ×
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Very Good Key action areas
CODE law
CODE monitoring and enforcement
Maternity protection law
Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Good
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Very Good
IYCF health workers capacity development Very Good
IYCF health service counseling Good
National status of the Baby-Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%) < 2
Hospitals / maternity facilities re-certified Baby-friendly (%) < 1
Percentage of institutional birth in the country 50
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 (%) 6
Coverage of the training on IYCF counseling among health workers (%) 8
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Fair
Key action areas or components
IYCF community system integration Fair
IYCF community health workers capacity development
Very Good
Community monitoring and evaluation
Poor
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) 0
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 42
Proportion of the population living in the target area 41
93
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“fair”. While some of the key action areas may be
adequate, other aspects including the IYCF behaviour
change and communication channels as well as the
monitoring and evaluation of the effect of communication
on behaviour may need strengthening.
ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION
Overall national level communication on IYCF appears to be
“poor” and may require extensive attention. Additionally, more
work is needed to strengthen the broader monitoring and
evaluation system within the national legislation, community and
health system levels as well as communication on IYCF and IYCF
in exceptionally difficult circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication Very Good
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions/components
Status
Overall complementary feeding interventions / components score
Fair
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Fair
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided
in emergencies ×
Micronutrients supplements provided in non- emergencies
Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are
provided
Lipid-based nutrient supplements are provided
Status
Overall national standing on HIV and infant feeding Good
Selected key action areas
Policy on HIV and infant feeding
National IYCF policy include guidance on HIV and infant feeding
HIV and infant feeding in PMTCT policy
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
Infant feeding training/counseling for HIV+ mothers
IYCF training materials include HIV and infant feeding
IYCF counseling materials which include HIV and infant feeding are updated regularly
Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
-
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
×
Breast milk substitutes are provided during emergency
×
Government procures/distribute breast milk substitutes
-Government accept donations of infant food -
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF activities
×
Routine monitoring of ongoing IYCF activities
Overall evaluation/review of IYCF situation
×
94
YEMEN Yemen has a stunting prevalence rate of 58% among children under 5 years of
age; while 43% and 15% are underweight and wasted, respectively. Recent
reports on IYCF status indicate that the rate of early initiation of breastfeeding is
currently at 30% and exclusive breastfeeding (< 6 months) at 12%. About 76% of
children 6 to 9 months are breastfed with complementary food; the nutritional
quality of complementary foods from most developing countries is usually poor or
inadequate.
Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:
NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Yemen’s overall national policy, strategy
and plan of actions status appears to be
“fair”. The country has very few of the
building blocks for a comprehensive
IYCF strategy and continued work on
IYCF is required. At present it had some
of the key components, but more work
is required in terms of the BFHI and HIV
and infant feeding components.
IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the
key components, including the CODE law, maternity leave and provision of paid
nursing breaks. However, more work is needed with respect to the CODE monitoring
and enforcement as well as maternity protection law.
HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country
seems to have adequate IYCF capacity development at the health system level,
other key components, including the BFHI, the pre- and in-service training
curricula and IYCF health service counseling activities may need to be
reinforced.
COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions
may be “poor”. Strengthening IYCF
activities within the communities
should be a high priority action area.
Extensive work is required to
strengthen its weak IYCF
community system integration,
community capacity development
and training, as well as monitoring
and evaluation require extensive
attention.
KEYS
Yes “Part of the key IYCF actions/ interventions implemented”
× No “ Not part of the key IYCF actions or
intervention implemented”
- No information
Poor Very low number of key IYCF actions or
intervention implemented
Fair Low number of the key IYCF actions or
interventions implemented
Good Average number of key IYCF actions or
intervention implemented
Very Good High number or all of the key IYCF actions
or interventions implemented
National policy, strategy and plan of action for a
comprehensive IYCF strategy
Status
Overall national IYCF policy, strategy and plan of actions
Fair
Key practices reflected in the policy
Early initiation of breastfeeding
Exclusive breastfeeding
Continued breastfeeding
Complementary feeding -
Selected key components reflected in the National IYCF policy
Status
Baby-friendly hospital initiative ×International code of marketing of breast milk substitute
Behavioural change and communication × HIV and infant feeding × IYCF in emergency
National IYCF strategy
National IYCF plan of action
Summary of national IYCF legislation and law
Status
Overall national IYCF legislation Fair Key action areas
CODE law
CODE monitoring and enforcement
×
Maternity protection law ×Maternity leave
Paid nursing breaks
Summary of IYCF health system level actions
Status
Overall IYCF health system level actions score Poor
Key action areas or components Baby-friendly hospital initiative Poor
IYCF health pre- and in-service training curricula Poor
IYCF health workers capacity development Good
IYCF health service counseling Fair
National status of the Baby Friendly Hospital Initiative (estimated)
Hospitals / maternity facilities ever certified Baby-friendly (%) 0
Hospitals / maternity facilities re-certified Baby-friendly (%) 0
Percentage of institutional birth in the country 20
Capacity building of health workers in delivering IYCF counseling (estimated)
Health workers trained on IYCF counseling since 2006 [total number (%)] -
Coverage of the training on IYCF counseling among health workers [total number (%)] 0
Summary of IYCF community system level actions Status
Overall IYCF community system level actions score Poor
Key action areas or components
IYCF community system integration Fair
IYCF community health workers capacity development
Fair
Community monitoring and evaluation
Poor
Selected key components of the IYCF community system level actions Status
Community capacity development
Training on community IYCF counseling since 2006
Capacity building on communication skills for community health workers
×
Monitoring and evaluation
Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers
× Routine monitoring of the quality of IYCF counseling
×
Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)
Community health workers trained on community IYCF counseling since 2006 (%) -
Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) -
Proportion of the population living in the target area -
95
COMMUNICATION ON IYCF
Overall national level communication on IYCF seems
“fair”. Several key components may need to be
strengthened, including the national IYCF behaviour
change and communication strategy and channels, as
well as monitoring and evaluation of the effects of
communication on behaviour.
COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS
IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING
INFANT FEEDING IN EMERGENCIES
IYCF MONITORING AND EVALUATION Overall national level IYCF monitoring and evaluation
appears to be “poor” and may require extensive attention.
Additionally, more work is needed to strengthen the broader
monitoring and evaluation system within the national
legislation, community and health system levels as well as
communication on IYCF and IYCF in exceptionally difficult
circumstances.
Summary of national level communication on IYCF
Status
Overall national level communication on IYCF Fair
Key action areas or component
National IYCF behaviour change and communication Fair
IYCF behaviour change and communication channels Fair
Behaviour change and communication materials on IYCF Good
Monitoring and evaluating the effect of communication on behaviour Poor
Summary of additional complementary feeding interventions / components
Status
Overall complementary feeding interventions / components score
Poor
Selected key strategies
IYCF counseling of care-givers in relation to home preparation of complementary foods
Poor
Provision of complementary food supplements Poor
Selected key interventions in relation to the provision of complementary food supplements
Status
Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months
Micronutrients supplements (single/multiple) provided in emergencies
Micronutrients supplements provided in non- emergencies
×
Targeted CF supplements are provided to improve CF for children 6-24 months
Fortified local complementary foods are provided ×
Fortified industrially-blended complementary foods are provided
×
Lipid-based nutrient supplements are provided ×
Status
Overall national standing on HIV and infant feeding Poor
Selected key action areas
Policy on HIV and infant feeding ×
National IYCF policy include guidance on HIV and infant feeding
-
HIV and infant feeding in PMTCT policy -
Status
Other selected key action areas
Infant feeding policy updated based on 2010 WHO rapid advice
-
Infant feeding training/counseling for HIV+ mothers -
IYCF training materials include HIV and infant feeding
-
IYCF counseling materials which include HIV and infant feeding are updated regularly
- Monitoring system on infant feeding practices among HIV+ mothers
×
Status
Overall national standing on Infant feeding in emergencies Poor Selected key action areas
National IYCF policy include IYCF in emergency
National emergency preparedness plan includes IYCF in emergency
National emergency preparedness plan updated based on the latest edition of IYCF in emergency
×
Status
Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency
Breast milk substitutes are provided during emergency
×
Government procures/distribute breast milk substitutes
×
Government accept donations of infant food ×
Summary of IYCF monitoring and evaluation score
Status
Overall IYCF monitoring and evaluation score Poor
Key action areas or components Monitoring and evaluation for national IYCF
×
Routine monitoring of ongoing IYCF ×
Overall evaluation/review of IYCF situation ×
96
Section 5: ANNEXES
97
ANNEX 1:
Assessment Matrix Questionnaire
98
99
100
101
102
103
104
ANNEX 2:
Completion of Assessment Matrix Region Version I Matrix Completed
in 2008 Version II Completed in
2010 Version II Matrix Completed
2010-2011 Matrix Not Completed
WCAR Mauritania, Liberia, Cote d'Ivoire, Burkina Faso, Ghana, Togo, Benin, Nigeria, Niger, Congo Brazzaville
Mali, Senegal, Gambia, Sierra Leone, Congo Brazzaville, Gabon, D. Rep. Congo
Guinea (Conakry), Guinea Bissau, Chad, Cameroon, Equatorial Guinea, Central African Rep.
ROSA Sri Lanka, India, Nepal Afghanistan, Bhutan, Bangladesh Pakistan
MENA North Sudan, South Sudan, Yemen
ESAR Angola, Namibia, Botswana, South Africa, Malawi, Zambia, Zimbabwe, Mozambique, Madagascar, Tanzania, Burundi, Uganda, Kenya, Ethiopia, Somalia, Swaziland, Rwanda
Lesotho, Comoros, Eritrea
EAPR Thailand, Lao People's Dem. Rep., Cambodia, China, Korea, Indonesia, Timor-Leste, Papua New Guinea, Fiji, Myanmar, Vanuatu, Mongolia
Philippines, Vietnam, Malaysia
CEE/CIS Bosnia and Herzegovina, Kazakhstan, Kosovo, Romania, Tajikistan, Turkmenistan, Uzbekistan
Kyrgyzstan
Albania, Armenia, Azerbaijan, Belarus, Croatia, Georgia, Moldova, Montenegro, Serbia, Turkey, Ukraine
Nutritionally vulnerable countries are shown in red
TOTALS
10
23
33
22
Response rate
Result WCAR ESAR ROSA EAPR CEE/CIS MENA TOTAL
Number of countries (#received by countries matrix) 22 20 7 15 19 3 86
Number of matrices Completed (Other Countries) 10 9 4 12 8 na 43
Number of Matrices completed (Nutritionally vulnerable Countries)
7 8 2 2 na 3 22
Total number of matrices completed (All countries) 17 17 6 14 8 3 65
Response Rate for other countries (%) 53.3 66.7 100 92.3 42.1 na 69.3
Response Rate for the Countries designated Nutritionally Vulnerable y (%)
100 100 66.7 100 na 100 95.6
Total Response Rate (%) 77.3 80 85.7 93 42.1 100 75.6
Na= not applicable i.e. no country in the region fell in this category.
105
ANNEX 3:
Key IYCF interventions and indicators
Components and Interventions for a comprehensive IYCF strategy
Indicators
National action level
Policy/Advocacy % of countries with national stand-alone IYCF policy, strategy and plan of action
% of countries with all key IYCF elements in National IYCF Policy
Development & enforcement of national legislation on the marketing of BMS
% of countries with existing ICMBS law or regulation
% of countries with system of monitoring and enforcement of ICMBS law in place
Development & enforcement of national legislation on maternity protection
% of countries with maternity protection laws or regulations in place
% of countries with paid maternity leave
% of countries with paid nursing breaks provided for mothers after return to work
Health system action level
Development/updating of IYCF integrated curriculum for health provider pre-service and in-service education
% of countries with updated pre-service and in-service curricula
% of countries with all 3 elements of a comprehensive IYCF package in pre-service curricula for health professionals
Capacity development on IYCF for health providers/lactation counsellors
% of countries with pre-service and in-service training
% of countries with IYCF job aids and counseling cards for health professionals
% of countries with health workers trained in stand-alone IYCF counseling course 2006-2009
% of countries with routine performance monitoring
Establishment of integrated IYCF counseling services in health facilities at relevant MCH contacts in primary health care services
% of countries with IYCF counseling taking place in the health system
% of countries with caregivers helped or trained in home-preparation of CF
Development & implementation of supervision/quality assurance system for IYCF services in the health system
% of countries with routine monitoring on skills of HW % of countries with routine monitoring of quality of counseling %of countries with regular supportive supervision provided by managers
Institutionalization of the Ten Steps to Successful Breastfeeding in all maternities (BFHI)
% of countries with ever- certified BF facilities
% of countries with BF facilities re-certified since 2006
Community action level
Establishment of community based integrated IYCF counseling services at community level
% of countries with established community-based activities in country
% of countries with stand alone community-based IYCF activities
Capacity development of CHW and IYCF counseling services at community level
% of countries with CHW trained with a stand-alone IYCF counseling
% of countries with specific capacity building on communication skills for HWs.
% of countries with routine monitoring of community health worker skills
% of countries with supportive supervision of CHW
% of countries monitoring quality of counseling skills of CHW
% of countries with recognition mechanism for well-performing workers
Creation of mother support groups for IYCF in the community
% of countries with mother support groups (or other groups) conducting sessions to promote IYCF
Communication
Implementation of communication for behaviour and social change through multiple channels
% of countries with 8 multiple communication channels
% of countries with communication at multiple channels ( national, health system, community levels )
% of countries with BCC materials available
% of countries with national level communication Strategy
% of countries with national coordination mechanism
% of countries with IYCF communication elements in IYCF/national strategy
% of countries with routine monitoring of IYCF communication activities
Additional Complementary feeding Components
Improving the quality of complementary foods through locally available ingredients
% of countries providing micronutrient supplements for CF (6-24 months) % of countries providing local CF (unfortified) % of countries providing fortified local CF
Provision of nutrition supplements and foods for complementary feeding (MNPs, LNS, fortified complementary foods) in food-insecure populations
% of countries providing targeted food supplements % of countries providing industrially-blended CF (unfortified) % of countries with providing fortified industrially-blended CF % of countries with providing lipid based supplements
Social protection schemes with nutrition component - complementary feeding. (e.g. in kind complementary foods, vouchers, cash transfers)
% of countries with social protection program available with food security component
106
IYCF in difficult circumstances
HIV and infant feeding % of countries with IF and PMTCT addressed in IYCF national policy
% of countries with complete, adequate training and counseling on IF and HIV
% of countries with adequately trained HW on HIV and IF
% of countries with follow-up and continuous support for HIV + mothers
IYCF in emergencies
% of countries with IYCF policy whcich includes infant feeding in emergencies
% of countries with complete, adequate training and counseling on infant feeding in emergencies
% of countries with BMS provided during emergencies
Monitoring and Evaluation
Monitoring, review and evaluation % of countries with overall evaluation or review of IYCF situation in the country
% of countries with monitoring of process indicators
107
ANNEX 4:
Country Descriptions
Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses
CEE/CIS Kosovo 09/24/2010 Agron Gashi Health And Nutrition Officer
UNICEF [email protected]
Tajikistan 11/15/2010 Mutrib Bakhruddinov Nutrition Officer UNICEF [email protected]
Bosnia And Herzegovina
10/18/2010 Selena Bajraktarevic Health Nutrition Ecd Officer
UNICEF [email protected]
Uzbekistan 09/30/2010 Bakhodir Rahimov Nutrition Officer UNICEF [email protected]
Turkmenistan 09/30/2010 Shafag Rahimova Health And Nutrition Specialist
UNICEF Srahimova@Univef. Org
Romania 10/12/2010 Anemona Munteanu Health And Nutrition Consultant
UNICEF [email protected]
Kyrgyzstan 03/15/2011 Damira Abakirova Health And Nutrition Officer
UNICEF [email protected]
Kazakhstan 11/26/2009 Aigul Nurgabilova Nutrition Officer UNICEF [email protected]
EAPR Korea NA Sawasan Rawas Nutrition Specialist UNICEF [email protected]
Vanuatu 03/19/2010 Jennifer Timothy Nutrition And Dietetics Coordinator.
Ministry Of Health [email protected]
Cambodia 03/16/2010 Multiple Na Na [email protected]
China 03/18/2010 Lilian Selenje And Chang Suying
Nutrition Specialist UNICEF [email protected]
Indonesia 03/16/2010 Sonia Blaney Nutrition Manager UNICEF [email protected]
Mongolia 03/22/2010 Batjargal Jamiyan Director Of Nutrition Research Center
Nutrition Research Center Of Public Health Institute
Myanmar 03/18/2010 Dr. Kyaw Win Sein Nutrition Specialist UNICEF [email protected]
Papua New Guinea
03/18/2010 Lazarus Dawa And Clementine Yaman
Nutrition Project Officer And Nutrition Officer
Department Of Health And UNICEF
Lazarus Dawa <[email protected]> And [email protected]
Timor-Leste 03/09/2010 Dirce M. Soares/ Faraja Chiwile
Head Of Nutrition Department/ Nutrition Specialist
Ministry Of Health/UNICEF
[email protected], [email protected]
Thailand 03/19/2010 Pornthida Padthong Communication Officer
UNICEF Thailand [email protected]
108
Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses
Vietnam 03/01/2011 Roger Mathisen, Do Hong Phuong
Nutrition Specialist / Health And Nutrition Policy Officer
UNICEF [email protected], [email protected]
Philippines 03/15/2011 Vicenta E. Borja Supervising Health Program Officer
Department Of Health
Fiji 03/18/2010 Ms Jimaima Schultz Manager National Food And Nutrition Centre, Ministry Of Health, Fiji
Lao People's Democratic Republic
03/19/2011 Dr Khamseng Philavong Senior Officer, MCH Center
ESAR Madagascar
01/20/2011 Amal Bennaim Nutrition Specialist UNICEF [email protected]
Burundi 01/20/2011 Hedy Ip Nutrition Specialist UNICEF [email protected]
Zambia 01/31/2011 Ruth Siyandi Nutrition Officer UNICEF [email protected]
Angola 01/02/2011 Vandana Agarwal Nutrition Specialist UNICEF [email protected]
Somalia 02/03/2011 Erin McCloskey Nutrition Specialist-IYCF & Micronutrients
UNICEF Somalia [email protected]
Mozambique
03/01/2011 Maaike Arts Nutrition Specialist UNICEF [email protected]
Botswana 02/04/2011 Patrick Codjia Nutrition Specialist UNICEF [email protected]
Ethiopia 02/21/2011 Abebe Hailemariam Nutrition Specialist UNICEF [email protected]
Tanzania 01/20/2011 Elizabeth Macha Ecd/Nutrition Specialist
UNICEF [email protected]
Rwanda 03/18/2010 Deborah Kortso Collison UNICEF Nutrition Officer
UNICEF [email protected]
South Africa
02/02/2011 Joan Majti Senior Nutrition And Child Survival Specialist
UNICEF [email protected]
Swaziland 06/06/2009 Makhosini Mamba Health Specialist UNICEF [email protected]
Uganda 02/17/2011 Dr. Mbonye Andrew Commissioner Community Health
Ministry Of Health [email protected],
109
Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses
Namibia 01/28/2011 Steve Okokwu Health Specialist UNICEF [email protected]
Zimbabwe 03/22/2011 Fitsum Assefa Nutrition Manager UNICEF [email protected]
Malawi 04/14/2011 Benson M. Kazembe Micronutrient Officer UNICEF Benson M. Kazembe
Kenya 05/06/2011 Linda Beyer Nutrition Specialist, IYCN And HIV
UNICEF [email protected]
Mena Yemen 01/25/2011 Rajia Sharahan, Nagib Abdulbaqi
Nutrition Officer UNICEF [email protected], [email protected]
South Sudan
02/16/2011 Bertha Jackson Nutrition Specialist UNICEF [email protected]
North Sudan
03/08/2011 Mara Nyawo Nutrition Surveillance UNICEF [email protected]
Rosa Bangladesh 03/18/2010 Dr. Mohsin Ali Nutrition Specialist UNICEF [email protected]
India 03/03/2010 Dr. Kajali Paintal Nutrition Specialist UNICEF [email protected]
Nepal 03/17/2010 Pragya Mathema Nutrition Specialist UNICEF [email protected]
Sri Lanka 03/15/2010 Dr. (Ms) H. S. Jayawickrama
Programme Manager, Child Health
Family Health Bureau, Ministry Of Healthcare & Nutrition
Afghanistan
03/07/2011 Zakia Maroof Nutrition Officer UNICEF [email protected]
Bhutan 04/01/2011 Chandralal Mongar And Ugyen Zangmo
Health And Nutrition Officer And Nutrition Programme Officer Respectively
UNICEF And Ministry Of Health Respectively
[email protected] And [email protected]
WCAR Congo Brazzaville
02/02/2011 Isabelle Mouyokani Nutrition Officer UNICEF [email protected]
Mauritania 02/04/2011 Mohamed Ag Bendech/ Ines Lezama
Nutrition Specialist UNICEF [email protected], [email protected]
C. African Rep.
02/04/2011 Benedict Mbeng Nutrition Consultant UNICEF [email protected]
Gambia 02/08/2011 Mathew Baldeh/Bakary Jallow
EPI Specialist/Principal Programme Officer
UNICEF/National Nutrition Agency (Nana)
110
Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses
WCAR Senegal 02/03/2011 Acajou Doom Et Dr. Mama Madame Dionne
Nutrition Specialist UNICEF/MOH [email protected]
Ghana 02/02/2011 Ernestina Agyepong Nutrition Specialist UNICEF [email protected]
Gabon 02/09/2011 Ayang Ebang Michel Nutritionist Centre National De Nutrition
Togo 02/11/2011 Amina Bangana (En Collaboration Avec Le Service National De Nutrition/Ministère De La Santé)
Nutritionist/Nutrition Officer
UNICEF [email protected]
Benin 03/01/2011 Anne-Sophie Le Dain Nutrition Specialist UNICEF [email protected]
Niger 11/04/2009 Gwénola Desplats Nutrition Specialist UNICEF [email protected]
Sierra Leone
02/20/2011 Rashid Abdulai Nutrition Officer UNICEF [email protected]
D. Rep. Congo
03/21/2011 Moïse Kabongo (Nutrition Officer), Simeon Nanama (Nutrition Manager), Kamanda Augustin (National Nutrition Program)
Nutrition Officer, Nutrition Manager, Pronanut Rdc
UNICEF And Pronanut
[email protected], [email protected], [email protected]
Mali 03/24/2011 Anne Marie Dembele Nutrition Officer UNICEF [email protected]
Nigeria 04/11/2011 Stanley Citekwe OIC Chief Of Nutrition UNICEF [email protected]
Burkina Faso
04/21/2011 Fatoumata Lankoande Specialiste En Nutrition UNICEF [email protected]
Liberia Na Na Na Na Na
Cote d'Ivoire
Na Na Na Na Na
111
ANNEX 5a:
IYCF Policy, Strategy and Plan of actions
COUNTRY Stand alone/Not stand alone
policy
Initiation BF
EBF Continued BF
CF Initiation of CF
BFHI 10 Steps
Community
Actions
ICMBS Maternal
Nutrition
Mother Support Groups
BCC HIV/ IF IYCF in Emerge
ncies
Strategy POA Policy, Strategy, POA Sub-Score
CEE/CIS
Bosnia and Herz.
d 0 1 0 1 1 0 1 1 0 1 0 0 0 0 0 0 4
Kosovo na na na na na na na na na na na na na na na 0 0 0
Romania 0 na na na na na na na na na na na na na na 0 0 0
Turkmenistan 1 1 1 1 0 0 0 1 1 0 na na 0 0 1 0 0 4
Uzbekistan 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 5
Tajikistan d 1 1 1 0 1 1 1 1 1 1 0 0 0 0 0 1 6
Kazakhstan d 1 1 1 1 1 1 1 0 1 1 1 0 1 0 0 0 7
Kyrgyzstan d 1 1 1 1 1 0 1 1 1 1 1 1 1 0 0 0 8
n 6 4 6 5 4 4 3 6 4 3 4 2 1 2 1 1 2 M
N 7 6 6 6 6 6 6 6 6 6 5 5 6 6 6 8 8 4
% 85.7 66.7 100 83.3 66.7 66.7 50 100 66.7 50 80 40 16.7 33.3 16.7 12.5 25
EAPR
Cambodia 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 0 8
China 1 0 1 0 1 0 0 1 1 0 0 0 0 0 1 0 3
Fiji c 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 2
Indonesia na 0 0 0 0 0 na na na na na na na na na 0 0 0
Korea na 0 1 1 1 1 1 1 1 0 0 0 0 0 0 0 1 5
Lao D.Rep. 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 8
Mongolia c 0 0 0 1 1 na na na na na na na na na 0 0 2
Myanmar c 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 0 5
P. New Guinea c na 0 na na na 1 0 1 1 0 0 1 1 0 0 0 3
Philippines 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 0 8
Thailand na 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9
Timor-Leste c na na na na na na na na na na na na na na 0 1 1
Vanuatu 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9
Vietnam c 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 9
n 10 6 9 8 11 10 9 9 10 6 6 6 5 7 4 5 5 M
N 11 12 13 12 12 12 11 11 11 11 11 11 11 11 10 14 14 5
% 90.9 50.0 69.2 66.7 91.7 83.3 81.8 81.8 90.9 54.5 54.5 54.5 45.5 63.6 40.0 35.7 35.7
ESAR
Angola d 0 0 0 0 0 1 1 1 0 1 0 0 1 0 0 0 3
Botswana a 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 8
Burundi c 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
Ethiopia c 0 0 0 0 0 na na na na na na na na na 1 1 1
Kenya 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9
112
COUNTRY Stand alone policy
Initiation BF
EBF Continued
BF
CF Initiation of
CF
BFHI 10 Steps
Community
Actions
ICMBS
Maternal
Nutrition
Mother
Support
Groups
BCC HIV/ IF IYCF in Emerge
ncies
Strategy POA Policy, Strategy, POA
Sub-Score
Madagascar c 1 1 1 1 1 1 0 1 0 1 1 1 1 0 1 1 8
Malawi 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 9
Mozambique 0 0 0 0 0 0 na na na na na na na na na 0 0 0
Namibia 1 1 1 1 1 1 0 1 1 0 0 1 1 0 0 1 0 6
Rwanda c 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 8
Somalia e 1 1 1 1 1 0 0 1 1 1 1 1 0 0 0 0 6
South Africa 1 0 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 6
Swaziland 0 na na na na na na na na na na na na na na 1 1 1
Tanzania 0 1 1 0 0 0 na na na na na na na na na 1 1 2
Uganda 1 1 1 1 1 1 1 0 1 1 0 0 0 0 0 1 1 6
Zambia 1,c 1 0 0 1 0 0 0 1 0 0 0 0 0 0 1 1 3
Zimbabwe a 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 8
n 12 9 12 10 11 10 9 8 12 8 7 7 8 7 5 11 8 M
N 17 16 16 16 16 16 13 13 13 13 13 13 13 13 13 17 17 5
% 70.6 56.3 75.0 62.5 68.8 62.5 69.2 61.5 92.3 61.5 53.8 53.8 61.5 53.8 38.5 64.7 47.1
MENA
North Sudan c 1 1 1 1 1 0 0 0 1 0 0 1 1 0 1 1 6
South Sudan f 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 3
Yemen 1 1 1 1 na na 0 0 1 1 0 0 0 0 1 1 1 5
n 2 2 3 2 2 2 0 1 2 2 0 0 1 1 1 2 2 M
N 3 3 3 3 2 2 3 3 3 3 3 3 3 3 3 3 3 5
% 66.7 67 100 67 100 100 0 33 67 67 0 0 33 33 33 67 67
ROSA
Afghanistan c 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10
Bangladesh 0 0 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 8
Bhutan 1 1 1 1 1 1 1 0 1 0 1 0 0 1 1 1 1 8
India c 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 2
Nepal 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 8
Sri Lanka c,d 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10
n 5 5 5 5 5 5 4 4 5 4 5 2 4 5 5 6 4 M
N 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 8
% 83.3 83.3 83.3 83.3 83.3 83.3 66.7 66.7 83.3 66.7 83.3 33.3 66.7 83.3 83.3 100 66.7
WCAR
Gambia c 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10
Benin d 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 3
113
COUNTRY Stand alone policy
Initiation BF
EBF Continued
BF
CF Initiation of
CF
BFHI 10 Steps
Community
Actions
ICMBS
Maternal
Nutrition
Mother
Support
Groups
BCC HIV/ IF IYCF in Emerge
ncies
Strategy POA Policy, Strategy, POA
Sub-Score
Burkina Faso c,d 1 1 1 1 1 1 0 1 1 0 1 1 0 0 1 7
Cen.Afr.Rep. d 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 9
Congo Brazzaville
c 1 1 1 1 1 1 1 1 0 0 0 1 1 0 1 0 7
Cote d'Ivoire c 1 1 1 1 0 1 na na 1 na na na 1 1 na na 5
D. Rep. Congo d 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 9
Gabon d 1 1 1 1 1 1 0 1 1 1 0 0 1 0 1 1 8
Ghana d 0 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 6
Liberia c,d na na na na na na na na na na na na na na na na 1
Mali 1,c 1 1 1 1 0 1 0 1 0 0 0 0 0 0 1 0 5
Mauritania c 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 9
Niger c 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1 0 6
Nigeria 1 1 1 1 1 1 1 0 1 0 0 0 0 0 0 1 1 6
Senegal 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10
Sierra Leone c 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 9
Togo 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10
n 17 14 16 15 15 13 15 9 14 13 7 8 9 11 7 13 9 M
N 17 16 16 16 16 16 16 15 15 16 15 15 15 15 16 15 15 7
% 100 87.5 100 93.8 93.8 81.3 93.8 60.0 93.3 81.3 46.7 53.3 60.0 73.3 43.8 86.7 60.0
COUNTRY TOTAL
n 51 40 51 45 48 44 40 37 47 36 29 25 28 33 23 38 30 M
N 61 59 60 59 58 58 55 54 54 55 53 53 54 54 54 63 63 6
% 83.6 67.8 85.0 76.3 82.8 75.9 72.7 68.5 87.0 65.5 54.7 47.2 51.9 61.1 42.6 60.3 47.6
na= no response/ data not available/ not applicable a= BEING DRAFTED , b= PLANNED, c= PART OF NUTRITION POLICY, d=PART OF HEALTH POLICY, e=PART OF THE NUTRITION STRATEGY, f= MENTIONED IN DRAFTED NUTRITION HEALTH POLICY; M-=mean 1= Yes , 0=No Nutritionally vulnerable countries are highlighted in yellow
114
ANNEX 5b:
IYCF Legislation and law
Region COUNTRY
CODE LAW
CODE Monitoring & Enforcement
Maternity Protection Law Maternity Leave
Paid Nursing Breaks
LEGISLATION SUB-SCORE
CEE/CIS Romania
1 1 1 1 1 10
CEE/CIS Kazakhstan 1 0 1 1 1 8
CEE/CIS Kyrgyzstan 1 1 0 1 1 8
CEE/CIS Bosnia and Herz.
1 0 1 1 0 6
CEE/CIS Turkmenistan 1 0 1 1 0 6
CEE/CIS Kosovo
1 0 0 1 0 4
CEE/CIS Tajikistan
1 0 0 1 0 4
CEE/CIS Uzbekistan a na 0 1 0 2
n 7 2 4 8 3
N 8 7 8 8 8 M
% 87.5 28.6 50.0 100.0 37.5 6
EAPR P. N.Guinea
1 1 1 1 1 10
EAPR Vietnam
1 1 1 1 1 10
EAPR Philippines 1 1 1 1 1 10
EAPR Mongolia 1 1 1 1 1 10
EAPR Vanuatu
1 0 1 1 1 8
EAPR Lao PDR
1 0 1 1 1 8
EAPR China
1 0 1 1 1 8
EAPR Cambodia 1 na 1 1 1 8
EAPR Thailand
1 1 1 1 0 8
EAPR Korea
0 na 1 1 1 6
EAPR Myanmar
0 na 1 1 0 4
EAPR Indonesia 0 na 1 1 0 4
EAPR Fiji
1 0 0 1 0 4
EAPR Timor-Leste 0 na 0 0 0 0
n 10 5 12 13 9 M
N 14 9 14 14 14 7
% 71.4 55.6 85.7 92.9 64.3
ESAR Zimbabwe 1 1 1 1 1 10
ESAR Tanzania 1 1 1 1 1 10
ESAR Botswana 1 1 1 1 1 10
ESAR Zambia
1 1 1 1 0 8
ESAR Uganda 1 1 1 1 0 8
ESAR Mozambique 1 0 1 1 1 8
ESAR Malawi 1 1 1 1 0 8
ESAR Swaziland 0 0 1 1 1 6
ESAR Madagascar 0 na 1 1 1 6
ESAR Angola 0 na 1 1 1 6
ESAR South Africa 0 na 1 1 0 4
ESAR Kenya 0 na 1 1 0 4
ESAR Ethiopia 0 na 1 1 0 4
ESAR Burundi
0 na 1 1 0 4
ESAR Namibia
0 na 0 1 0 2
ESAR Somalia 0 na 0 0 0 0
ESAR Rwanda
0 na 0 0 0 0
n 7 6 14 15 7 M
N 17 8 17 17 17 6
% 41.2 75.0 82.4 88.2 41.2
MENA North Sudan 0 na 1 1 1 6
MENA Yemen 1 0 0 1 1 6
MENA South Sudan 0 na 0 na 0 0
n 1 0 1 2 2 M
N 3 1 3 2 3 4
% 33.3 0.0 33.3 100.0 66.7
ROSA Afghanistan 1 0 1 1 1 8
ROSA India 1 1 1 1 0 8
ROSA Sri Lanka
1 1 1 1 0 8
ROSA Bhutan
0 na 1 1 1 6
Region COUNTRY CODE CODE Monitoring & Maternity Protection Maternity Leave Paid Nursing LEGISLATION
115
law Enforcement Law Breaks SUB-SCORE
ROSA Bangladesh 1 na 1 1 0 6
ROSA Nepal
1 0 1 0 0 4
n 5.0 2.0 6.0 5.0 2.0 M
N 6.0 4.0 6.0 6.0 6.0 7
% 83.3 50.0 100.0 83.3 33.3
WCAR Ghana
1 1 1 1 1 10
WCAR Nigeria 1 1 1 1 1 10
WCAR Senegal
1 1 1 1 1 10
WCAR Burkina Faso 1 0 1 1 1 8
WCAR Gabon
1 0 1 1 1 8
WCAR Mauritania 1 0 1 1 1 8
WCAR Gambia
1 1 1 1 0 8
WCAR Niger 0 na 1 1 1 6
WCAR Togo
0 na 1 1 1 6
WCAR Cen.Afr.Rep. 0 na 1 1 1 6
WCAR Benin
1 0 1 1 0 6
WCAR Sierra Leone 0 na 1 1 0 4
WCAR
Congo Brazzaville
0 na 1 1 0 4
WCAR Mali 0 na 0 1 0 2
WCAR D. Rep. Congo 1 0 1 1 0 6
WCAR Cote d'Ivoire na na na na na NI
WCAR Liberia
na na na na na NI
n 9 4 14 15 9 M
N 15 9 15 15 15 7
% 60.0 44.4 93.3 100 60.0
COUNTRY TOTAL
n 39 19 50 56 32 M
N 63 38 63 61 62 6
% 61.9 50.0 79.4 91.8 51.6
na= no response, not available, not applicable. M= mean. NI= No Information. Nutritionally vulnerable countries are highlighted in yellow
116
ANNEX 5c: National level IYCF action score
Region COUNTRY Policy, Strategy, Plan of actions
SUB-SCORE LEGISLATION SUB-SCORE
NATIONAL level actions SCORE
CEE/CIS Bosnia and Herz. 4 6 5 CEE/CIS Kazakhstan 7 8 7 CEE/CIS Kosovo 0 4 2 CEE/CIS Kyrgyzstan 8 8 8 CEE/CIS Romania 0 10 5 CEE/CIS Tajikistan 6 4 5 CEE/CIS Turkmenistan 4 6 5
CEE/CIS Uzbekistan 5 2 3
Mean 4 6 5
EAPR Cambodia 8 8 8 EAPR China 3 8 5 EAPR Fiji 2 4 3 EAPR Indonesia 0 4 2 EAPR Korea 5 6 5 EAPR Lao D. Rep. 8 8 8 EAPR Mongolia 2 10 6 EAPR Myanmar 5 4 4 EAPR P. New Guinea 3 10 6
EAPR Philippines 8 10 9
EAPR Thailand 9 8 8 EAPR Timor-Leste 1 0 0 EAPR Vanuatu 9 8 8 EAPR Vietnam 9 10 9
Mean 5 7 6
ESAR Angola 3 6 4 ESAR Botswana 8 10 9 ESAR Burundi 1 4 2 ESAR Ethiopia 1 4 2
ESAR Kenya 9 4 6
ESAR Madagascar 8 6 7 ESAR Malawi 9 8 8 ESAR Mozambique 0 8 4 ESAR Namibia 6 2 4 ESAR Rwanda 8 0 4
ESAR Somalia 6 0 3
ESAR South Africa 6 4 5 ESAR Swaziland 1 6 3 ESAR Tanzania 2 10 6 ESAR Uganda 6 8 7 ESAR Zambia 3 8 5 ESAR Zimbabwe 8 10 9
Mean 5 6 5
MENA North Sudan 6 6 6 MENA South Sudan 3 0 1 MENA Yemen 5 6 5
Mean 5 4 4
ROSA Afghanistan 10 8 9 ROSA Bangladesh 8 6 7 ROSA Bhutan 8 6 7 ROSA India 2 8 5 ROSA Nepal 8 4 6 ROSA Sri Lanka 10 8 9
Mean 8 7 7
WCAR Togo 10 6 8 WCAR Sierra Leone 9 4 6 WCAR Senegal 10 10 10 WCAR Nigeria 6 10 8 WCAR Niger 6 6 6 WCAR Mauritania 9 8 8 WCAR Mali 5 2 3 WCAR Liberia 1 NI 0 WCAR Ghana 6 10 8 WCAR Gambia 10 8 9 WCAR Gabon 8 8 8
117
Region COUNTRY Policy, Strategy, Plan of actions
SUB-SCORE LEGISLATION SUB-SCORE
NATIONAL level actions SCORE
WCAR D. Rep. Congo 9 0 4
WCAR Cote d'Ivoire 5 NI 2
WCAR Congo Brazzaville
7 4 5
WCAR Cen.Afr.Rep. 9 6 7 WCAR Burkina Faso 7 8 7 WCAR Benin 3 6 4
Mean 7 6 6
Total Mean 5 6 6
NI= No information. . Nutritionally vulnerable countries are highlighted in yellow
118
ANNEX 5d:
IYCF health service pre- and in-service training curricula
IYCF ELEMENTS MEDICAL TRAINING PACKGE
IYCF ELEMENTS NURSES/ OTHER HEALTH PROFESSIONALS
TRAINING PACKAGE REFERENCES MEDICAL DOCTORS REFERENCES HEALTH PROFESSIONALS INSERVICE REFS.
COUNTRY
Baby Friendly Practice
s Appropri
ate BF Appropriate CF
Baby Friendly Practice
s nurses/
HP
Appropriate BF nurses/
HP
Appropriate CF nurses/
HP
Global Strategy
DOCS Revised BHI
DOCS
Guiding Principles Breastfed
DOCS
Guiding Principles
for Feeding
Non-Breastfed
DOCS
Global Strategy (Nurses)
Revised BHI
(Nurses)
Guiding Principles Breastfed (Nurses)
Guiding Principles
Non-Breastfed (Nurses)
Global Strategy In-servic
e
Revised BHI
In-servic
e
Guiding Principles BF
In-service
Guiding Principles
for Feeding Non-BF
In-service
CURRICULA
SUBSCORE
CEE/CIS Kosovo na na na na na na na na na na na na na na 1 0 0 0 1
Romania 0 0 1 na na na na na na na na na na na na na na na 1
Bosnia Herz. 0 1 0 0 1 0 0 0 1 0 0 0 1 0 1 0 1 0 3
Uzbekistan 1 1 1 1 1 1 0 1 0 0 0 1 1 1 1 1 1 1 8
Kyrgyzstan 1 1 1 1 1 1 1 0 1 0 0 0 1 1 1 0 1 1 7
Kazakhstan 1 1 1 1 1 1 0 0 1 1 0 0 1 0 1 0 1 1 7
Turkmenistan 1 1 1 1 1 0 1 0 1 1 0 0 1 1 1 0 1 0 7
Tajikistan 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9
n 5 6 6 5 6 4 3 2 5 3 0 2 6 4 7 2 6 4 M
N 7 7 7 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 5
% 71.4 85.7 85.7 83.3 100 66.7 50.0 33.3 83.3 50.0 0.0 33.3 100 66.7 100 28.6 85.7 57.1 EAPR Cambodia 0 0 0 0 1 0 na na na na na na na na 1 1 1 1 3
China 0 1 1 0 1 1 na na na na na na na na 1 1 1 1 4
Myanmar na na na na na na na na na na na na na na 1 0 0 0 1
Timor-Leste na na na na na na na na na na na na na na na na na na 0
Philippines na na na na na na na na na na na na na na 1 0 1 0 1
Lao P.Dem. Rep.
1 1 1 1 0 0 na na na na 1 0 1 1 1 0 1 1 6
Korea 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 0 4
Indonesia 1 0 1 0 1 1 0 0 1 0 na na na na na na na na 3
Thailand 1 1 1 1 1 1 0 1 0 0 1 1 1 1 1 1 1 1 8
Vietnam 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 0 4
Fiji 1 1 1 1 1 1 1 0 0 0 1 0 0 0 1 1 1 1 7
P.N.Guinea 1 1 1 1 1 1 1 0 1 1 1 0 1 0 1 0 1 0 7
Vanuatu 1 1 1 1 1 1 1 1 1 1 0 1 1 1 na na na na 7
Mongolia 0 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 8
n 8 9 10 7 8 7 4 5 4 3 4 3 7 4 11 5 10 6 M
N 11 11 11 11 11 11 8 8 8 8 8 8 8 8 11 11 11 11 4
% 72.7 81.8 90.9 63.6 72.7 63.6 50.0 62.5 50.0 37.5 50.0 37.5 87.5 50.0 100.0
45.5 90.9 54.5
ESAR Somalia 1 0 0 0 1 0 na na na na na na na na na na na na 1
Mozambique 1 0 1 1 1 1 na na na na 0 0 1 0 na na na na 3
Botswana na na na 1 1 1 na na na na na na na na na na na na 2
119
IYCF ELEMENTS MEDICAL TRAINING PACKGE
IYCF ELEMENTS NURSES/ OTHER HEALTH PROFESSIONALS
TRAINING PACKAGE REFERENCES MEDICAL DOCTORS REFERENCES HEALTH PROFESSIONALS INSERVICE REFS.
COUNTRY
Baby Friendly Practice
s Appropri
ate BF Appropriate CF
Baby Friendly Practice
s nurses/
HP
Appropriate BF nurses/
HP
Appropriate CF nurses/
HP
Global Strategy
DOCS Revised BHI
DOCS
Guiding Principles Breastfed
DOCS
Guiding Principles
for Feeding
Non-Breastfed
DOCS
Global Strategy (Nurses)
Revised BHI
(Nurses)
Guiding Principles Breastfed (Nurses)
Guiding Principles
Non-Breastfed (Nurses)
Global Strategy In-servic
e
Revised BHI
In-servic
e
Guiding Principles BF
In-service
Guiding Principles
for Feeding Non-BF
In-service
CURRICULA
SUBSCORE
Namibia na na na 1 1 1 na na na na 1 0 1 0 1 0 1 0 4
Malawi 0 1 0 0 1 0 na na na na na na na na 1 0 1 1 3
Madagascar 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 1 5
South Africa 1 1 1 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 8
Swaziland 0 1 0 1 0 0 0 1 0 0 0 0 1 0 1 1 0 1 4
Burundi 1 1 1 0 1 1 0 0 1 1 0 0 1 1 1 0 1 0 6
Angola 1 1 1 0 1 1 0 1 0 1 0 0 0 1 na na na na 4
Kenya 0 1 1 1 1 1 1 1 0 0 1 1 0 0 1 1 1 1 7
Zambia 0 1 1 0 1 1 1 1 0 1 0 0 1 1 1 1 1 1 7
Tanzania 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 9
Ethiopia 0 1 1 1 1 1 1 0 1 1 0 0 1 1 1 0 1 1 7
Uganda 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 8
Rwanda 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9
Zimbabwe 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9
n 9 13 12 12 15 13 7 9 6 8 2 6 12 9 12 8 12 11 M
N 15 15 15 17 17 17 12 12 12 12 14 14 14 14 13 13 13 13 6
% 60.0 86.7 80.0 70.6 88.2 76.5 58.3 75.0 50.0 66.7 14.3 42.9 85.7 64.3 92.3 61.5 92.3 84.6 MENA
Yemen 0 0 0 na na na na na na na na na na na 1 1 1 1 2
South Sudan 1 1 1 1 0 0 0 1 0 0 0 0 1 0 na na na na 3
North Sudan 1 1 0 1 1 0 0 0 1 0 0 0 1 0 1 0 0 1 4
n 2 2 1 2 1 0 0 1 1 0 0 0 2 0 2 1 1 2 M
N 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3
% 67 67 33 100 50 0 0 50 50 0 0 0 100 0 100 50 50 100 ROSA Bangladesh na na na na na na na na na na na na na na na na na na na
India 1 1 0 1 1 0 na na na na 1 0 0 0 1 0 0 0 3
Nepal 1 1 1 1 1 1 na na na na 0 0 1 0 1 0 1 0 5
Afghanistan 0 1 0 0 1 0 na na na na na na na na na na na na 1
Bhutan 0 0 0 1 1 1 na na na na 1 1 0 0 1 1 0 0 4
Sri Lanka 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10
n 3 4 2 4 5 3 1 1 1 1 3 2 2 1 4 2 2 1 M
N 5 5 5 5 5 5 1 1 1 1 4 4 4 4 4 4 4 4 5
% 60 80 40 80 100 60 100 100 100 100 75 50 50 25 100 50 50 25 WCAR Gambia na na na 0 1 1 na na na na 1 0 1 1 1 0 1 1 4
Niger 1 1 1 1 1 1 na na na na na na na na na na na na 3
Sierra Leone 0 1 1 0 1 1 na na na na na na na na 1 0 0 0 3
Cote d'Ivoire 1 0 0 na na na na na na na na na na na na na na na 1
Liberia 0 0 0 na na na na na na na na na na na na na na na 0
Congo 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 0 4
120
IYCF ELEMENTS MEDICAL TRAINING PACKGE
IYCF ELEMENTS NURSES/ OTHER HEALTH PROFESSIONALS
TRAINING PACKAGE REFERENCES MEDICAL DOCTORS REFERENCES HEALTH PROFESSIONALS INSERVICE REFS.
COUNTRY
Baby Friendly Practice
s Appropri
ate BF Appropriate CF
Baby Friendly Practice
s nurses/
HP
Appropriate BF nurses/
HP
Appropriate CF nurses/
HP
Global Strategy
DOCS Revised BHI
DOCS
Guiding Principles Breastfed
DOCS
Guiding Principles
for Feeding
Non-Breastfed
DOCS
Global Strategy (Nurses)
Revised BHI
(Nurses)
Guiding Principles Breastfed (Nurses)
Guiding Principles
Non-Breastfed (Nurses)
Global Strategy In-servic
e
Revised BHI
In-servic
e
Guiding Principles BF
In-service
Guiding Principles
for Feeding Non-BF
In-service
CURRICULA
SUBSCORE
Brazzaville
Gabon 1 1 1 1 0 0 0 1 0 0 0 0 1 0 na na na na 3
Benin na na na na na na 0 0 0 1 0 0 0 1 1 0 1 1 3
Ghana 1 1 1 1 1 1 1 1 0 0 0 1 0 0 1 1 0 0 6
Senegal 0 1 1 0 1 1 1 0 1 0 1 0 1 0 1 0 1 0 6
Mali 1 1 1 0 1 1 1 0 1 1 0 0 1 1 1 0 1 0 7
Burkina Faso 1 1 1 1 1 1 1 1 0 1 0 1 0 1 na na na na 6
C. Afr. Rep. 1 1 1 na na na 1 1 1 1 na na na na na na na na 4
Togo 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10
Mauritania 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 8
D.Rep.Congo 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9
Nigeria 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 9
n 12 13 12 9 11 11 9 9 7 8 5 5 9 8 11 3 9 5 M
N 15 15 15 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 5
% 80 87 80 69 85 85 75 75 58 67 42 42 75 67 100 27 82 45 COUNTRY TOTAL
n 39 47 43 39 46 38 24 27 24 23 14 18 38 26 11 3 9 5 M
N 56 56 56 54 54 54 41 41 41 41 46 46 46 46 11 11 11 11 5
% 69.6 83.9 76.8 72.2 85.2 70.4 58.5 65.9 58.5 56.1 30.4 39.1 82.6 56.5
100.0 27.3 81.8 45.5
Nutritionally vulnerable countries are highlighted in yellow
121
ANNEX 5e:
IYCF health workers capacity development
COUNTRY
PRE-SERVICE
TRAINING MEDICAL
INI-SERVICE TRAINING HEALTH PROF.
IN-SERVICE TRAINING
IYCF job aids/counseling cards for health
professionals
IYCF Training
2006
HW trained stand alone counseling
Capacity Development
Sub-Score
CEE/CIS Kosovo 0 na 1 1 1 1 7
Romania 1 1 0 0 0 na 3
Bosnia Herz. 0 1 0 0 0 na 2
Uzbekistan 1 1 1 0 1 1 8
Kyrgyzstan 1 1 1 1 1 1 10
Kazakhstan 1 na 0 1 1 1 7
Turkmenistan 0 1 1 0 1 1 7
Tajikistan 1 1 1 1 1 1 10
n 5 6 5 4 6 6 M
N 8 6 8 8 8 6 7
% 63 100 63 50 75 100 EAPR Cambodia 0 1 1 1 1 1 8
China 1 na 1 1 1 0 7
Myanmar 0 na 1 0 1 0 3
Timor-Leste 0 na 0 1 1 1 5
Philippines 0 na 1 1 1 1 7
Lao P.Dem. Rep. 1 1 1 0 1 1 8
Korea 0 na na 1 1 1 5
Indonesia 0 na 0 0 1 na 2
Thailand 0 na 1 1 1 1 7
Vietnam 0 na 0 1 1 1 5
Fiji 0 1 1 1 1 na 7
P.N.Guinea 0 1 0 1 1 1 7
Vanuatu 0 1 0 0 0 2
Mongolia 1 1 1 1 1 1 10
n 3 6 8 10 13 9 M
N 14 6 13 14 14 11 5
% 21 100 62 71 93 82 ESAR Somalia 1 na 1 1 1 0 7
Mozambique 1 1 0 0 1 1 7
Botswana 0 na 0 1 1 na 3
Namibia 0 1 na 1 0 na 3
Malawi 1 1 1 1 1 1 10
Madagascar 0 na 1 1 1 1 7
South Africa 1 1 1 1 1 1 10
Swaziland 0 na 1 0 1 1 5
Burundi 1 1 0 0 0 na 3
Angola 1 1 O 1 0 na 5
Kenya 1 1 1 1 1 1 10
Zambia 1 1 1 1 1 1 10
Tanzania 1 1 1 1 1 1 10
Ethiopia 1 1 0 1 1 1 8
Uganda 1 na 0 1 1 1 7
Rwanda 1 1 1 1 1 1 10
Zimbabwe 1 1 1 1 1 1 10
n 13 12 10 14 14 12 M
122
COUNTRY
PRE-SERVICE
TRAINING MEDICAL
INI-SERVICE TRAINING HEALTH PROF.
IN-SERVICE TRAINING
IYCF job aids/counseling cards for health
professionals
IYCF Training
2006
HW trained stand alone counseling
Capacity Development
Sub-Score
N 17 12 15 17 17 13 7
% 76 100 67 82 82 92 MENA Yemen 0 0 1 1 1 1 7
South Sudan 0 0 0 0 0 0
North Sudan 1 0 1 1 1 1 8
n 1 0 2 2 2 2 M
N 3 3 3 3 3 2 5
% 33 0 67 67 67 100 ROSA
Bangladesh 0 0 1 1 1 5
India 1 1 1 1 1 na 8
Nepal 0 1 0 0 1 na 3
Afghanistan 0 0 1 1 1 5
Bhutan 0 1 1 1 1 1 8
Sri Lanka 1 1 1 1 1 1 10
n 2 4 3 5 6 4
N 6 4 6 6 6 4 M
% 33 100 50 83 100 100 6
WCAR Gambia 0 0 1 1 1 5
Niger 1 1 1 0 1 na 7
Sierra Leone 1 1 0 0 1 na 5
Cote d'Ivoire 0 na 1 0 0 na 2
Liberia 0 na 0 na 0 na 0
Congo Brazzaville 1 na 0 1 0 na 3
Gabon 0 na na 0 1 1 3
Benin 0 0 1 0 1 1 5
Ghana 1 1 1 1 1 1 10
Senegal 0 1 1 1 1 na 7
Mali 1 1 0 1 1 na 7
Burkina Faso 0 1 1 1 1 1 8
C. Afr. Rep. 1 0 0 0 1 1 5
Togo 1 1 1 1 1 1 10
Mauritania 1 1 0 0 1 1 7
D.Rep.Congo 1 1 1 1 1 1 10
Nigeria 0 1 1 1 1 1 8
n 9 10 9 9 14 10 M
N 17 12 16 16 17 10 6
% 53 83 56 56 82 100 COUNTRY TOTAL
n 33 38 37 44 55 43 N 65 43 62 64 65 46 M
% 50.8 88.4 59.7 68.8 84.6 93.5 6
N=NUMBER, n= Total, %=percentage, M= Mean, na=not available, not applicable, no answer,
Nutritionally vulnerable countries are highlighted in yellow
123
ANNEX 5f:
Training of health providers on IYCF counseling
Country
No of HPs trained on stand-alone IYCF
counseling course since 2006
Total number of HPs in the Country
% of HPs trained on IYCF counselling course since 2006
Total no of districts/province/region
covered by the IYCF training
Total number of district /province/region in the
country
Coverage (% of district / province /
region covered by the training)
Coverage of IYCF counseling currently taking place within
the Health system (%)
CEE/CIS
Kosovo 350 7000 5.0 NI 36 - 30
Tajikistan 480 42673 1.1 NI 30 - -
BOSNIA AND HERZEGOVINA
NI NI - NI NI - -
UZBEKISTAN 2321 117754 2.0 102 199 51 60
Turkemnistan 920 6000 15.3 36 55 65 100
Romania NI NI - NI NI - -
KYRGYZSTAN 270 40000 0.7 1 7 14 -
KAZAKASTAN 20600 60656 34.0 6 16 38 65
EAPR
Korea 1000 70,000 1.4 101 206 49
Vanuatu NI NI - NI NI - 20
Mongolia 60 NI - 5 21 24 -
MYANMAR NI NI - NI 52 - 30
Indonesia 1000 223438 0.5 3 200 2 < 5
Papua New Guinea 138 NI - 20 20 100 100
Cambodia 500 NI - 18 77 23 71
China NI NI - NI 2800 - -
Thailand 200 NI - NI NI - 95
TIMOR-LESTE 100 NI - NI NI - -
South Africa 600 NI - 53 53 100 -
VIETNAM 1000 299100 0.3 100 690 14 -
Philippines 28,063 34,298 81.8 17 17 100 63
Fiji NI NI - 20 20 100 15
Lao People's Democratic Republic
1148 11000 10.4 63 142 44 40
ESAR
Madagascar 1800 NI - 27 119 23 -
Burundi 120 4422 2.7 6 45 13 25
Zambia 6207 NI - 54 72 75 100
Angola 0 0 0.0 0 164 0 -
Somalia NI NI - 2 128 2 -
Mozambique 3700 NI - 144 144 100 100
Botswana NI NI - NI NI - 94
UGANDA 1133 12585 9 20 56 35.7 32
NAMIBIA NI NI - NI NI - -
Tanzania 645 11081 5.8 11 135 8 -
SWAZILAND 300 NI - 4 4 100 100
RWANDA 480 42673 1.1 NI 30 - NI
124
Country
No of HPs trained on stand-alone IYCF
counseling course since 2006
Total number of HPs in the Country
% of HWs trained on IYCF counselling since
2006
Total no of districts/province/region
covered by the IYCF training
Total number of district/province/region
in the country
Coverage (% of district / province /
region covered by the training)
Coverage of IYCF counseling currently taking place within
the Health system (%)
Ethiopia 9000 59000 15.3 170 800 21 21
Malawi 540 8389 6.44 12 28 43 NI
Zimbabwe 200 25000 0.8 40 62 65 98
Kenya 3500 18587 18.8 165 284 58 -
MENA
YEMEN 105 NI - 0 334 0 -
North Sudan 500 NI - 81 131 62 -
South Sudan 0 NI - NI NI - NI
ROSA
BANGLADESH 250 150000 0.2 2 64 3
India 23450 192510 12.2 NI 642 - -
Nepal NI 12000 - 10 75 13 30
Sri Lanka 269 8500 3.2 17 26 65 ~ 80
AFGHANISTAN 1950 19235 10.1 NI 393 - 100
Bhutan 216 556 38.8 9 20 45 -
WCAR
Congo Brazzaville NI 187 - 27 27 100 -
CAR 20 2000 1.0 1 24 4 53
Gambia 118 NI - 6 6 100 -
Ghana 119 61841 0.2 38 170 22 100
GABON 37 NI - 5 54 9 -
Togo 2776 7000 39.7 35 35 100 100
BENIN 222 4374 5.1 3 34 9 90
NIGER 56 3404 1.6 5 42 11.9 NI
Sierra Leone 0 9954 0.0 13 13 100 -
MAURITANIA 421 10376 4.1 54 54 100 -
Senegal NI NI - NI NI - 60
DRC 750 65000 1.2 27 515 5.2 -
MALI NI NI - NI 60 - -
Nigeria 572 106338 0.5 NI 774 - -
Burkina Faso 1500 15603 9.6 63 63 100 100
Cote d'Ivoire NI NI - NI NI - -
Liberia NI NI - NI NI - -
Nutritionally vulnerable countries are highlighted in yellow , NI= No information
125
ANNEX 5g:
IYCF Health System Counselling
IYCF health service counselling
COUNTRY Counseling in health
system ANC PMTCT GMP IMCI ENA COUNSELLING
SUB-SCORE
CEE/CIS Kosovo 1 na na na na na 2
Romania 0 na na na na na 0
Bosnia Herz. 1 1 0 1 0 0 5
Uzbekistan 1 0 0 0 1 0 3
Kyrgyzstan 1 1 1 0 1 0 7
Kazakhstan 1 1 1 1 1 0 8
Turkmenistan 1 1 1 1 1 1 10
Tajikistan 1 0 1 1 1 0 7
n 7 4 4 4 5 1 M
N 8 6 6 6 6 6 5
% 87.5 66.7 66.7 66.7 83.3 16.7 EAPR Cambodia 1 1 1 1 1 0 8
China 1 0 1 0 1 0 5
Myanmar 1 0 0 1 0 0 3
Timor-Leste 1 na na na na na 2
Philippines 1 0 1 0 0 0 3
Lao P.Dem. Rep. 1 1 1 0 1 0 7
Korea 1 0 0 1 1 0 5
Indonesia 1 1 0 1 0 0 5
Thailand 1 1 1 0 0 0 5
Vietnam 1 0 1 1 0 0 5
Fiji 1 1 1 0 1 0 7
P.N.Guinea 1 1 1 1 1 0 8
Vanuatu 1 1 1 0 1 0 7
Mongolia 0 0 0 1 1 0 3
n 13 7 9 7 8 0 M
N 14 13 13 13 13 13 5
% 92.9 53.8 69.2 53.8 61.5 0.0 ESAR Somalia 0 na na na na na 0
Mozambique 1 1 1 1 1 1 10
Botswana 1 1 1 0 0 0 5
Namibia 1 0 0 1 0 0 3
Malawi 1 1 1 1 1 0 8
Madagascar 1 0 0 0 1 0 3
South Africa 1 0 1 1 1 0 7
Swaziland 1 0 1 0 1 0 5
Burundi 1 1 1 0 0 0 5
Angola 1 1 1 0 1 0 7
Kenya 1 1 1 0 1 0 7
Zambia 1 1 1 1 0 0 7
Tanzania 1 0 1 1 1 1 8
Ethiopia 1 0 0 1 1 1 7
Uganda 1 1 1 0 0 0 5
Rwanda 1 0 1 1 1 0 7
Zimbabwe 1 0 1 1 1 0 7
126
IYCF health service counselling
COUNTRY Counseling in health
system ANC PMTCT GMP IMCI ENA COUNSELLING
SUB-SCORE
n 16 8 13 9 11 3 M
N 17 16 16 16 16 16 6
% 94.1 50.0 81.3 56.3 68.8 18.8 MENA Yemen 1 1 0 0 1 0 5
South Sudan 0 1 1 0 1 1 7
North Sudan 1 1 1 1 1 1 10
n 2 3 2 1 3 2 M
N 3 3 3 3 3 3 7
% 66.7 100 66.7 33.3 100 66.7 ROSA Bangladesh 1 0 0 0 1 0 3
India 1 1 1 1 1 0 8
Nepal 1 0 0 1 1 0 5
Afghanistan 1 1 0 0 1 0 5
Bhutan 1 1 1 1 1 0 8
Sri Lanka 1 1 0 1 0 0 5
n 6 4 2 4 5 0 M
N 6 6 6 6 6 6 6
% 100 66.7 33.3 66.7 83.3 0.0 WCAR Gambia 1 1 1 1 1 0 8
Niger 1 1 1 1 1 1 10
Sierra Leone 0 na na na na na 0
Cote d'Ivoire 1 1 na 1 1 0 7
Liberia 0
0
Congo Brazzaville 1 0 1 0 1 0 5
Gabon 1 0 1 0 1 0 5
Benin 1 1 1 0 1 1 8
Ghana 1 0 1 1 1 1 8
Senegal 1 1 1 1 1 1 10
Mali 1 0 1 0 1 1 7
Burkina Faso 1 0 1 0 1 0 5
C. Afr. Rep. 1 0 1 0 1 1 7
Togo 1 0 1 1 1 1 8
Mauritania 1 1 1 1 0 0 7
D.Rep.Congo 1 0 1 1 1 1 8
Nigeria 1 1 1 1 1 1 10
n 15 7 14 9 14 9 N 17 15 14 15 15 15 M
% 88.2 46.7 100 60.0 93.3 60.0 7
COUNTRY TOTAL n 59 33 44 34 46 15
N 65 59 58 59 59 59 M
% 90.8 55.9 75.9 57.6 78.0 25.4 6
n= number, N= Total, %=percentage Nutritionally vulnerable countries are highlighted in yellow, 1=Yes, 0= No
127
ANNEX 5h:
Baby-Friendly Hospital Initiative
HSCOUNTRY Ever Certified
hospitals Ever re-certified
% of
institutional Births
% ever certified Baby Friendly
Hospital
% re-certified Baby Friendly
Hospital
BFHI SUB-
SCORE
CEE/CIS
Uzbekistan 1 1 99 51 20 4
Turkmenistan 1 0 99 87 0 4
Tajikistan 1 0 64 1 0 0
Romania 1 1 96 11 11 1
Kyrgyzstan 1 1 66 63 23 4
Kosovo 1 1 96 100 76 9
Kazakhstan 1 1 100 16 14 2
Bosnia and Herz. 1 0 99 62 0 3
n 8 5
N 8 8 M M M
% 100 62.5 48.9 18.0 3
EAPR
China 1 0 95 NI 0
Cambodia 1 0 22 11 0 1
Fiji 1 1 99 100 52 8
Indonesia 1 0 46 0 0 0
Korea 1 0 NI NI 0
Lao PDR 1 0 20 41 0 2
Mongolia 1 0 98 NI 0
Myanmar 1 0 NI NI 0
Papua New Guinea 1 1 36 15 5 1
Philippines 1 0 40 83 0 4
Thailand 1 1 96 67 10 4
Timor Leste 1 0 NI NI 0
Vanuatu 0 0 80 0 0 0
Vietnam 1 1 79 8 0 0
n 13 4
N 14 14 M M M
% 93 29 36.1 4.79 2
ESAR
Zimbabwe 1 1 60 4 1 0
Zambia 1 0 48 23 0 1
Uganda 1 0 41 1 0 0
128
HSCOUNTRY Ever Certified
hospitals Ever re-certified
% of
institutional Births
% ever certified Baby Friendly
Hospital
% re-certified Baby Friendly
Hospital
BFHI SUB-
SCORE
Tanzania 1 1 50 2 0 0
Swaziland 1 1 74 59 18 4
South Africa 1 1 95 46 47 5
Somalia 1 0 9 1 0 0
Rwanda 1 0 64 1 0 0
Namibia 1 0 81 100 0 5
Mozambique 0 0 50 0 0 0
Malawi 1 1 72 5 2 0
Madagascar 1 0 30 3 0 0
Kenya 1 1 44 NI
Ethiopia 0 0 18 0 0 0
Burundi 1 1 56 1 1 0
Botswana 0 0 94 5 0 0
Angola 1 0 42 2 0 0
n 14 6
N 16 14 M M M
% 87.5 42.9 15.8 4.31 0
MENA
Yemen 0 0 20 0 0 0
South Sudan 0 0 NI 0 0 0
North Sudan 1 1 19 12 12 1
n 1 1
N 3 3 M M M
% 33 33 4 4 0
ROSA
India 1 0 41 10 0 0
Sri Lanka 1 0 98 23 0 1
Nepal 1 0 21 8 0 0
Bhutan 1 0 63 1 0 0
Bangladesh 1 0 18 50 0 2
Afghanistan 0 0 15 0 0 0
n 5 0
N 6 6 M M M
% 83 0 15.3 0.0 0
WCAR
Benin 1 1 78 3 1 0
129
HSCOUNTRY Ever Certified
hospitals Ever re-certified
% of
institutional Births
% ever certified Baby Friendly
Hospital
% re-certified Baby Friendly
Hospital
BFHI SUB-
SCORE
Burkina Faso 1 0 NI 70 0 3
C. Afr. Rep. 1 0 68 4 0 0
Congo Brazzaville 1 0 80 2 0 0
Cote d'Ivoire 1 0 NI 9 0 0
D. Rep. Congo 1 0 64 1 0 0
Gabon 1 0 NI NI 0
Gambia 0 0 NI 0 0 0
Ghana 1 1 57 29 0 1
Liberia 0 0 NI 0 0 0
Mali 1 1 NI 5 4 0
Mauritania 1 1 - 3 2 0
Niger 1 1 30 76 31 5
Nigeria 1 0 39 8 0 0
Senegal 1 0 66 16 0 0
Sierra Leone 0 0 25 0 0 0
Togo 1 0 33 34 0 2
n 14 5
N 17 17 M M M
% 82 29 16.3 2.24 1
ALL Countries
n 55 22 M M M
N 65 65 22.7 5.56 1
% 85 34
N= number, N= Total, %= percent, na=data not available/no answer, not applicable; NI= No information. Nutritionally vulnerable countries are highlighted
in yellow
130
ANNEX 5i:
Health system level IYCF actions score
COUNTRY BFHI SUB-
SCORE CIRRICULA SUB-
SCORE CAPACITY DEVELOPMENT
SUB-SCORE COUNSELLING
SUB-SCORE HEALTH SYSTEM ACTIONS SCORE
CEE/CIS
Uzbekistan 4 8 8 3 6
Turkmenistan 4 7 7 10 7
Tajikistan 0 9 10 7 7
Romania 1 1 3 0 1
Kyrgyzstan 4 7 10 7 7
Kosovo 9 1 7 2 5
Kazakhstan 2 7 7 8 6
Bosnia Herz. 3 3 2 5 3
MEAN 3 5 7 5 5
EAPR
China 0
4 7 5 4
Cambodia 1
3 8 8 5
Fiji 8
7 7 7 7
Indonesia 0
3 2 5 2
Korea 0
4 5 5 3
Lao P.Dem. Rep. 2
6 8 7 6
Mongolia 0
8 10 3 5
Myanmar 0
1 3 3 2
P.N.Guinea 1
7 7 8 6
Philippines 4
1 7 3 4
Thailand 4
8 7 5 6
Timor-Leste 0
0 5 2 2
Vanuatu 0
7 2 7 4
Vietnam 0
4 5 5 3
MEAN 2 5 6 5 5
ESAR
Zimbabwe 0
9 10 7 6
Zambia 1
7 10 7 6
Uganda 0
8 7 5 5
Tanzania 0
9 10 8 7
Swaziland 4
4 5 5 4
South Africa 5
8 10 7 7
Somalia 0
1 7 0 2
Rwanda 0
9 10 7 6
Namibia 5
4 3 3 4
Mozambique 0
3 7 10 5
Malawi 0
3 10 8 5
131
COUNTRY
BFHI SUB-
SCORE CIRRICULA SUB-
SCORE CAPACITY DEVELOPMENT
SUB-SCORE COUNSELLING
SUB-SCORE HEALTH SYSTEM ACTIONS SCORE
Madagascar 0
5 7 3 4
Kenya 0
7 10 7 6
Ethiopia 0
7 8 7 5
Burundi 0
6 3 5 3
Botswana 0
2 3 5 2
Angola 0
4 5 7 4
MEAN 0 6 7 6 5
MENA
Yemen 0
2 7 5 3
South Sudan 0
3 0 7 2
North Sudan 1
4 8 10 6
MEAN 0 3 5 7 4
ROSA
India 0 3 8 8 5
Sri Lanka 1 10 10 5 6
Nepal 0 5 3 5 3
Bhutan 0
4 8 8 5
Bangladesh 2
na 5 3 3
Afghanistan 0
1 5 5 3
MEAN 0 4 7 6 4
WCAR
Benin 0 3 5 8 4
Burkina Faso 3 6 8 5 5
C. Afr. Rep. 0 4 5 7 4
Congo Brazzaville 0 4 3 5 3
Cote d'Ivoire 0 1 2 7 2
D.Rep.Congo 0 9 10 8 6
Gabon 0 3 3 5 3
Gambia 0 4 5 8 4
Ghana 1 6 10 8 6
Liberia 0 0 na na na
Mali 0 7 7 7 5
Mauritania 0 8 7 7 5
Niger 5 3 7 10 6
Nigeria 0 9 8 10 7
Senegal 0 6 7 10 6
Sierra Leone 0 3 5 0 2
Togo 2 10 10 8 7
MEAN 1 5 6 7 5
Total Mean 1 5 6 6 5
Nutritionally vulnerable countries are highlighted in yellow
132
ANNEX 5j:
Community-based IYCF actions
Country COMMUNITY-BASED PROGRAMMES WHICH INCLUDE IYCF ACTIVITIES / IMPLEMENTATION Community-level CD Community-level M &E Community-based System actions Score
Comm.
Activity
Activity
standalone
PMTCT
ANC GMP IMCI ENA Mother
to Mother
Dedicated
IYCF CHWs
Multi-
purpose
CHWs
TBA or
THP
Mothers
support
groups
COMM. SYSTEM INTEGRATION SUB-SCORE
Training on
IYCF 2006
Capa. buildin
g on comm. skills
for CHW
COMM. CD
SUBSCORE
Routine monitoring of IYCF activities
Routine monitori
ng of skills of
CHW
Routine monitori
ng of quality
of counseli
ng
Supportive
supervision CHW
Recognition
mechanism
M&E SUBSCORE
CEE/CIS
Bosnia and Herz.
1 1 0 1 0 0 0 0 1 0 0
0 3 0 1 5 0 1 0 0 0 2 3
Kazakhstan 0 0 0 0 0 1 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 1
Kosovo 1 na na na na na na na na na na na 1 0 na 0 na na na na na 0 0
Kyrgyzstan 1 0 0 0 0 1 0 0 1 0 0 0 2 1 1 10 0 0 0 1 1 4 5
Romania 0 na na na na na na na na na na na 0 na na 0 0 na na na na 0 0
Tajikistan 1 0 0 0 0 1 0 0 0 1 0 1 3 0 1 5
0 0 0 na 0 3
Turkmenistan
1 1 0 0 0 0 0 na na 0 0
1 2 1 na 5 na na na na na 0 2
Uzbekistan 0 0 na na na na na na 1 0 0 0 1 na na 0 na na na na na 0 0
n 5 2 0 1 0 3 0 0 3 1 0 3 M 2 3 M 0 1 0 1 1 M M
N 8 6 5 5 5 5 5 4 5 6 6 6 2 6 4 3 4 4 4 4 3 1 2
% 62.5 33.3 0.0 20.0 0.0 60.0 0.0 0.0 60.0 16.7 0.0 50.0 33.3 75.0 0.0 25.0 0.0 25.0 33.3 EAPR
Vietnam 1 0 0 0 1 0 0 0 0 1 0 na 2 1 1 10 na na na 1 na 2 5
Vanuatu 1 1 na na na na na na na na na 0 2 0 0 0 0 0 0 0 0 0 1
Timor-Leste 1 0 0 0 0 0 0 1 0 0 0 0 2 0 na 0 0 0 0 0 0 0 1
Thailand na na na na na na na na na na na na 0 na na 0 na na na na na 0 0
Philippines 1 na 0 0 0 1 0 0 na na na 0 2 1 na 5
0 1 0 na 2 3
P. N. Guinea 1 0 0 1 0 0 0 0 0 1 0 0 2 1 1 10 0 0 0 0 na 0 4
Myanmar 0 na na na na na na na na na na na 0 0 na 0 0 na na na na 0 0
Mongolia 0 na 0 0 0 1 0 0 na na na na 1 0 0 0 0 na na na na 0 0
Lao P. D. Rep.
1 0 0 0 0 1 0 0 1 1 0
1 4 1 na 5 na na na na na 0 3
Korea na na na na na na na na 1 na na na 1 1 na 5 na na na na na 0 2
Indonesia 1 0 na na na na na na na na na na 1 na na 0 na na na na na 0 0
Fiji 1 0 0 1 0 0 0 0 0 1 0 0 2 1 na 5 0 0 0 1 1 4 4
China 1 1 na na na na na na 0 1 0 1 3 1 1 10 0 0 0 0 na 0 4
Cambodia 1 0 na na na na na na 1 1 0 1 3 1 1 10 1 1 0 1 0 6 6
n 10 2 0 2 1 3 0 1 3 6 0 3 M 8 4 M 1 1 1 3 1 M M
N 12 9 7 7 7 7 7 7 8 7 7 8 2 12 6 4 8 7 7 8 4 1 2
% 83.3 22.2 0.0 28.6 14.3 42.9 0.0 14.3 37.5 85.7 0.0 37.5 66.7 66.7 12.5 14.3 14.3 37.5 25.0 ESAR
Zimbabwe 1 0 0 0 1 0 0 0 0 1 0 0 2 0 1 5 0 0 0 1 0 2 3
Zambia 1 0 0 1 0 0 0 0 1 0 0 1 3 1 DK 5 0 0 na na na 0 3
Uganda 1 1 0 1 0 0 0 0 0 1 0 0 3 1 0 5 0 0 0 0 0 0 3
Tanzania 1 0 0 0 0 0 0 1 1 1 0 1 4 1 1 10 0 0 0 0 na 0 4
Swaziland 1 0 0 0 0 0 0 1 0 1 0 0 2 1 0 5 0 0 0 0 0 0 2
South Africa 1 0 na na na na na na 1 0 0 0 2 1 na 5 1 0 0 1 na 4 3
Somalia 1 1 0 0 0 0 1 0 1 0 0 1 4 1 1 10 1 0 0 1 na 4 5
Rwanda 1 0 0 0 0 0 1 0 1 1 1 1 5 1 0 5 1 1 1 1 0 8 6
Namibia 1 0 0 0 0 1 0 0 0 1 0 0 2 1 0 5 0 0 0 0 0 0 2
133
Country COMMUNITY-BASED PROGRAMMES WHICH INCLUDE IYCF ACTIVITIES Community-based CD Community-based M &E
Community-based System actions Score
Comm. Activity
Activity standalone
PMTCT ANC GMP IMCI ENA Mother to Mother
IYCF CHWs
Multi-purpose CHWs
TBA or THP
Mothers support groups
COMM. SYSTEM INTEGRATION SUB-SCORE
Training on IYCF 2006
Capa. building on comm. skills for CHW
COMM. CD SUBSCORE
Routine monitoring of IYCF activities
Routine monitoring of skills of CHW
Routine monitoring of quality of counseling
Supportive supervision CHW
Recognition mechanism
M&E SUBSCORE
ESAR
Mozambique
1 1 na na na na na na
1 0 0
0 2 1 0 5 0 0 0 1 0 2 3
Malawi 1 0 1 0 0 0 0 0 1 1 0 0 3 1 na 5 0 0 na na na 0 3
Madagascar
1 1 na na na na na na 1 0 0
1 3 1 1 10 1 1 1 1 na 8 5
Kenya 1 0 0 1 0 0 0 0 0 1 0 0 2 1 1 10 1 1 0 1 1 8 5
Ethiopia 1 0 0 0 0 0 1 0 0 1 0 0 2 1 0 5 0 0 0 0 na 0 2
Burundi 0 0 0 1 0 0 0 0 0 1 0 0 2 0 0 0 0 0 0 0 na 0 1
Botswana 0 0 na na na na na na 1 1 0 0 2 0 na 0 na na na na na 0 1
Angola 0 0 na na na na na na 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0
n 14 4 1 4 1 1 3 2 9 12 1 5 M 13 5 M 5 3 2 7 1 M M
N 17 17 12 12 12 12 12 12 17 17 17 17 3 17 13 5 16 16 14 14 8 2 3
% 82.4 23.5 8.3 33.3 8.3 8.3 25.0 16.7 52.9 70.6 5.9 29.4 76.5 38.5 31.3 18.8 14.3 50.0 12.5
MENA
Yemen 1 0 na na na na na na 1 1 1 1 4 1 0 5 0 0 0 0 0 0 3
South Sudan
1 0 na na na na na na 0 1 1
1 3 na na 0 na na na na na 0 2
North Sudan
1 1 0 0 0 0 0 1 0 0 1
1 4 1 0 5 0 0 0 0 0 0 3
n 3 1 0 0 0 0 0 1 1 2 3 3 M 2 0 M 0 0 0 0 0 M M
N 3 3 1 1 1 1 1 1 3 3 3 3 4 2 2 3 2 2 2 2 2 0 3
% 100
33.3 0.0 0.0 0.0 0.0 0.0 100.0 33.3 66.7 100.0
100.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0
ROSA
Afghanistan
1 1 na na na na na na
1 0 0
1 3 0 1 5 1 1 0 1 na
6 5
Bangladesh
1 0 0 0 1 0 0 0 0 1
0 0 2 0 1 5 0 0 0 1 0 2 3
Bhutan 0 na na na na na na na na na na na 0 0 0 0 0 0 0 0 0 0 0
India 1 0 0 1 0 0 0 0 0 1 0 0 2 0 0 0
0 0 0 na 0 1
Nepal 1 0 0 0 1 0 0 0 0 1 0 0 2 0 0 0 0 0 0 0 0 0 1
Sri Lanka 1 0 0 0 1 0 0 0 1 0 0 1 3 1 1 10 0 0 0 1 na 2 5
n 5 1 0 1 3 0 0 0 2 3 0 2 M 1 3 M 1 1 0 3
N 6 5 4 4 4 4 4 4 5 5 5 5 3 6 6 4 5 6 6 6
M M
% 83.3 20.0 0.0 25.0 75.0 0.0 0.0 0.0 40.0 60.0 0.0 40.0 16.7 50.0 20.0 16.7 0.0 50.0 1 2
WCAR
Benin 1 0 0 0 0 1 0 0 0 1 0 0 2 1 1 10 0 0 0 0 na 0 4
Burkina Faso
1 0
1 1 0
0 2 1 0 5 1 0 0 1 na 4 4
C. Afr. Rep. 1 0 0 0 0 1 0 0 1 1 1 1 5 1 1 10 1 0 0 1 1 6 7
Congo Brazzaville
0 0 0 0 0 1 0 0 1 0 0
1 2 0 1 5 0 0 0
0 0 2
Cote D'Ivoire
1 na na na na na na na
1 1 1
1 4 1 1 10 1 1 0 1 na
6 7
Dem. Rep. Congo
1 0 0 0 0 0 1 0 0 1 0
1 3 1 0 5 0 0 0 0 0 0 3
Gabon 1 na na na na na na na na na na 1 2 0 na 0 na na na na na 0 1
Gambia 1 0 0 0 0 0 0 1 0 1 1 0 3 1 1 10 0 na na na na 0 4
Ghana 1 0 0 0 1 0 0 0 1 0 0 na 2 na na 0 na na na na na 0 1
134
COMMUNITY-BASED PROGRAMMES WHICH INCLUDE IYCF ACTIVITIES Community-based CD Community-based M &E
Community-based actions Score
Country Comm. Activity
Activity standalone
PMTCT ANC GMP IMCI ENA Mother to Mother
IYCF CHWs
Multi-purpose CHWs
TBA or THP
Mothers support groups
COMM. SYSTEM INTEGRATION SUB-SCORE
Training on IYCF 2006
Capa. building on comm. skills for CHW
COMM. CD SUBSCORE
Routine monitoring of IYCF activities
Routine monitoring of skills of CHW
Routine monitoring of quality of counseling
Supportive supervision CHW
Recognition mechanism
M&E SUBSCORE
Liberia 1 na na na na na na na 0 1 1 0 2 1 1 10 1 1 0 1 na 6 6
Mali 1 0 0 0 0 0 1 0 1 0 0 1 3 0 na 0 na na na na na 0 1
Mauritania 1 0 na na na na na na 1 1 0 0 2 1 1 10 1 1 0 1 na 6 6
Niger 1 1 0 0 1 0 0 0 1 0 0 1 4 1 1 10 0 0 0 0 0 0 5
Nigeria 1 0 0 1 0 0 0 0 1 1 1 1 5 1 1 10 1 1 1 1 1 10 8
Senegal 1 0 0 0 0 1 0 0 1 1 0 1 4 1 1 10 na 1 1 1 NA 6 7
Sierra Leone
1 0 na na na na na na
0 0 0
1 2 1 1 10 1 1 0 1 0 6 6
Togo 1 0 0 0 0 1 0 0 1 0 0 0 2 1 1 10 1 1 1 1 na 8 7
n 16 1 0 1 2 5 2 1 11 10 5 10 13 12 8 7 3 9 2
N 17 14 11 11 11 11 11 11 16 16 16 16 M 16 14 M 13 13 13 12 6 M M
% 94.1 7.1 0.0 9.1 18.2 45.5 18.2 9.1 68.8 62.5 31.3 62.5 3 81.3 85.7 7.4 61.5 53.8 23.1 75.0 33.3 3 5
COUNTRY TOTAL
n 53 11 1 9 7 12 5 5 29 34 9 26 M 39 27 M 15 13 6 23 5 M M
N 63 54 40 40 40 40 40 39 54 54 54 55 3 59 45 5 48 48 46 46 26 1 3
% 84.1 20.3 2.5 22.5 17.5 30.0 12.5 12.8 53.7 62.9 16.7 47.3 66.1 60.0 31.2 27.1 13.0 50.0 19.2
na= not applicable/ no answer/no data available, M=Mean, 1= yes, 0=no . Nutritionally vulnerable countries highlighted in yellow
135
ANNEX 5k: Capacity development and coverage of community based IYCF actions
COUNTRY Training of community health workers on community-based IYCF IYCF Community-based activity coverage
No of IYCF CHWs trained on community-based IYCF since 2006
No of Community health workers trained in IYCF as part of another health course 2006-2009
Total number of community health workers in the country
% CHW trained on Community-based IYCF since 2006
% CHW trained in IYCF as part of another health course 2006-2009
Total number of districts/region/municipalities implementing CHW programmes with IYCF included
Total number of districts/regions/municipalities etc... in the country
Coverage (% of district implementing CHW programmes including IYCF)
Proportion of the population living in target districts
CEE/CIS
Kosovo NI NI NI - - 26 36 72 NI
Tajikistan NI NI 3500 - - 15 65 23 75000 CHILDREN
BOSNIA AND HERZEGOVINA
NI NI 620 - - NI NI - NI
UZBEKISTAN NI NI NI - - NI NI - NI
Turkemnistan NI NI 0 - - 0 0 0 NI
Romania NI NI 400 - - NI NI - NI
KYRGYZSTAN NI 1300 1300 - 100 7 7 100 NI
KAZAKASTAN NI NI 0 - - NI NI - NI
EAPR
VIETNAM NI 10,000 10,000 - 100 682 682 100 NI
Vanuatu NI NI 206 - - 1 6 17 NI
Cambodia 1200 NI 28000 4 - 30 77 39 NI
China 300 NI NI - - NI 2800 - NI
Mongolia NI NI 0 - - NI NI - NI
MYANMAR NI NI NI - - NI NI - NI
Papua New Guinea
50 100 2499 2 4 NI 20 - 30%
TIMOR-LESTE NI NI NI - - 9 13 69 NI
Thailand NI NI NI - - NI NI NI
VIETNAM TOO NI NI 103026 - - 690 690 100 NI
Philippines NI NI NI - - 17 17 100 NI
Fiji NI NI NI - - 3 3 100 NI
Indonesia 150 700 1200000 < 1 < 1 5 200 2.5 < 5
Korea NI NI NI - - 1 206 0 NI
Lao People's Democratic Republic
NI NI NI - - 90 142 63 72
ESAR
Madagascar 6000 NI NI - - 5555 NI - 33
Burundi NI NI 8360 - - 10 45 22 NI
Zambia 60 187 NI - - NI NI - NI
Angola 0 0 0 0 0 - 164
26%
Somalia NI NI NI - - 20 NI NI NI
Mozambique 0 NI 1500 0 - 148 148 100 NI
Botswana NI NI NI - - 24 24 100 100%
Ethiopia 55,800 50,200 106000 53 47 170 800 21 25,500,000
Tanzania 3000 580 12000 25 5 56 135 42 41%
RWANDA 230 342 30000 1 1 15 30 50 1390440
136
COUNTRY Training of community health workers on community-based IYCF IYCF Community-based activity coverage
No of IYCF CHWs trained on community-based IYCF since 2006
No of Community health workers trained in IYCF as part of another health course 2006-2009
Total number of community health workers in the country
% CHW trained on Community-based IYCF since 2006
% CHW trained in IYCF as part of another health course 2006-2009
Total number of districts/region/municipalities implementing CHW programmes with IYCF included
Total number of districts/regions/municipalities etc... in the country
Coverage (% of district implementing CHW programmes including IYCF)
Proportion of the population living in target districts
South Africa 1165 NI 1600 73 6 53 11 NI
UGANDA NI NI 90,000 - - 24 112 21 NI
NAMIBIA NI NI NI - - 12 34 35 70%
SWAZILAND 68 1000 4900 1 20 4 4 100 100%
Zimbabwe NI NI NI - - 57 62 92 90%
Malawi 400 NI 4859 8.23 - 28 28 100 100%
Kenya 4000 NI 44432 9 - 284 284 100 15%
MENA
YEMEN NI NI 0 - - NI 334 - NI
South Sudan NI NI NI - - NI NI - NI
North Sudan NI NI NI - - 79 131 60 NI
ROSA
India 469000 NI 1200000 39 - 642 642 100 100%
Nepal NI NI 5000 - - 23 75 31 NI
Sri Lanka NI NI 10 000 - - 26 26 100 NI
AFGHANISTAN NI NI 18641 - - NI NI - NI
Bhutan NI NI 1200 - - NI NI - NI
BANGLADESH 4500 NI 150000 3 - 16 64 25 7%
WCAR
Congo Brazzaville
365 129 295 124 44 5 27 19 NI
MAURITANIA NI 3800 NI - - 2 11 18 20%
CAR NI 1746 1746 - 100 18 24 75 75%
Gambia 400 NI NI - - 6 6 100 100%
Senegal NI 5000 8000 - 63 64 75 85 NI
Ghana 4000 10,000 16,500 24 61 170 170 100 NI
GABON NI NI NI - NI NI - NI
Togo 1765 1320 8524 - 15 18 35 51 50%
BENIN NI 7190 NI - - 14 34 41 40%
NIGER 1898 NI 3752 50.6 - 5 42 11.9 14.5%
Sierra Leone NI 2205 NI - - 13 13 100 100%
DRC NI 423 834624 NI 0.05 27 515 5 8%
MALI NI NI NI - - 60 60 100 NI
Nigeria NI 95 40,491 - - 774 774 100 100%
Burkina Faso 700 NI 1057 66 - 63 63 100 100%
Liberia 0 NI NI - - NI NI - NI
Cote D'Ivoire NI NI NI - - 6 NI - 35%
"-" Dash= Value could not be calculated because there was no information provided, NI= No information. Nutritionally vulnerable countries are highlighted in yellow
137
ANNEX 5l:
IYCF community activity implementer
Other groups conducting IYCF community-based actions
Region/ Country Groups
CEE/CIS Kosovo Volunteers of Red Cross of Kosovo are providing counseling/promotion to parents about breastfeeding and child nutrition
MENA Yemen Through CBPHC volunteers
EAPR Timor-Leste There are no CHW in Timor-Leste but there are volunteers (Mother Support Group members) who conducts and have been trained on counseling
ESAR South Africa the mothers to mothers programme provides this support to a limited extent
EAPR China provided by all sorts of groups including local government and also companies in the cities
WCAR Mali PMTCT, Mother to Mother and IMCI
WCAR Cote d’Ivoire PEV CPN
WCAR Niger not at national scale
ROSA Afghanistan NGOs who implement CMAM
ESAR Angola National catholic church train the activist for counseling of mothers on IYCF
CEE/CIS Bosnia And Herzegovina
IBFAN Local branch
WCAR Car health workers
ESAR Madagascar growth monitoring
ESAR Uganda Diverse community groups, small scale projects
ROSA India Community volunteers called (ASHA)
WCAR Nigeria Community Resource Persons, provide individual counseling and support to mothers on KHHP including IYCF
WCAR Mauritania Community nutrition centers, BCC community agents, supplementary feeding centers for MAM
ESAR Kenya Community health strategy, mother to mother support groups and workplace support initiative with private sector (better business practices for children).
EAPR Fiji Community Health Nurses and Dieticians
WCAR Ghana community based volunteers
138
ANNEX 5m:
Communication on IYCF
IYCF communication channels
BCC Channels BCC Health System Mass media BCC Community BCC
COUNTRY
Nation
al radio
National TV
National
Campaign
Posters
Interpersona
l Communicati
on
Mobile Phone Messa
ges
Other Chann
els
Religio
us Leader
s
Community
Leaders
BCC HS
Posters and
leaflets
Videos on
IYCF
HW grp. IYCF
sessions
Mass media
Mass media WBF
week.
Mass media frequently/on an
ongoing
National
Campaigns
Ongoing
community BCC
CHWs conduc
t group sessio
ns
Mother
support
groups/other groups
TBAs or
traditional
health practitioners
CHANNELS
SUBSCORE
CEE/CIS Uzbekistan 0 1 1 1 1 0 0 1 1 na 1 1 1 1 1 0 1 1 na na na 6 Turkmenistan
1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 1 1 1 0 7
Tajikistan 0 1 1 1 1 0 0 0 1 na 0 na 0 0 1 0 0 na 0 na na 3 Romania 0 1 1 0 1 0 1 0 0 1 1 1 1 1 1 0 0 1 1 1 0 6 Kyrgyzstan 0 1 1 1 1 0 0 1 1 na na 1 1 1 0 0 1 na 1 na 5 Kosovo 1 1 1 0 1 0 0 0 0 1 0 1 0 1 1 0 0 1 na 1 na 5 Kazakhstan 0 1 1 0 1 0 1 0 0 1 1 1 0 1 1 0 1 1 1 1 1 7 Bosnia Herz. 1 1 0 1 0 0 1 0 0 1 1 1 1 1 1 0 1 na na na na 5 n 3 8 7 5 7 1 3 2 3 5 5 7 4 7 8 0 3 6 3 5 1 N 8 8 8 8 8 8 8 8 8 5 7 7 7 8 8 8 8 6 4 5 3 % 37.5 100 87.5 62.5 87.5 12.5 37.5 25.0 37.5 100 71.4 100 57.1 87.5 100 0.0 37.5 100 75.0 100 33.3 6 EAPR Vietnam 1 1 1 1 1 0 1 0 1 1 na na na 1 1 0 0 na na na na 5 Vanuatu 1 1 1 1 1 0 0 0 0 1 1 0 1 1 1 1 1 0 6 Timor Leste na 0 1 1 1 1 1 0 1 1 1 1 1 1 5 Thailand 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 0 0 0 0 0 0 5 Philippines 0 1 1 0 0 0 1 0 0 1 1 1 1 1 1 0 0 0 4 P.N.Guinea 1 1 0 1 1 1 0 1 1 1 1 1 0 1 0 0 1 0 6 Myanmar 1 1 1 1 0 0 0 0 0 1 1 0 1 1 1 1 0 1 1 0 1 6 Mongolia 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 6 Lao PDR 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 0 7 Korea 0 1 1 0 1 0 0 1 1 1 1 1 0 1 0 1 1 1 1 1 0 7 Indonesia 0 0 1 1 1 0 0 0 1 na na 1 1 1 na na na 1 1 1 0 5 Fiji 0 0 1 1 1 0 1 0 0 1 1 0 1 na 1 0 1 1 1 1 1 6 China 0 1 1 0 1 0 0 0 1 1 0 0 0 1 1 0 0 1 na 1 0 4 Cambodia 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 0 1 1 1 0 8 n 8 11 11 9 10 1 4 4 8 13 11 8 9 13 8 5 6 9 8 8 4 N 13 13 13 13 13 13 14 13 13 13 12 13 13 13 12 12 12 13 9 10 10 M % 61.5 84.6 84.6 69.2 76.9 7.7 28.6 30.8 61.5 100 91.7 61.5 69.2 100 66.7 41.7 50.0 69.2 88.9 80.0 40.0 6 ESAR Zimbabwe 0 1 1 0 1 0 0 0 0 1 1 0 0 1 0 0 0 1 na na na 3 Zambia 1 1 1 1 1 0 1 1 1 1 1 0 0 1 1 0 0 0 0 0 0 6 Uganda 1 1 0 1 1 0 0 0 1 1 1 0 1 1 1 0 0 1 1 1 0 6
139
IYCF communication channels
BCC Channels BCC Health System Mass media BCC Community BCC
COUNTRY
Nation
al radio
National TV
National
Campaign
Posters
Interpersona
l Communicati
on
Mobile Phone Messa
ges
Other Chann
els
Religio
us Leader
s
Community
Leaders
BCC HS
Posters and
leaflets
Videos on
IYCF
HW grp. IYCF
sessions
Mass media
Mass media WBF
week.
Mass media frequently/on an
ongoing
National
Campaigns
Ongoing
community BCC
CHWs conduc
t group sessio
ns
Mother
support
groups/other groups
TBAs or
traditional
health practitioners
CHANNELS
SUBSCORE
Tanzania 1 1 1 1 1 0 1 1 1 0 1 0 1 1 1 0 0 0 6 Swaziland 0 1 1 0 1 0 0 0 0 1 0 0 1 1 1 0 0 1 1 1 0 5 South Africa 1 0 1 0 0 0 0 1 1 1 1 0 1 1 0 1 0 1 0 1 0 5 Somalia 0 0 0 1 1 0 0 1 1 0 0 0 0 1 1 0 0 0 3 Rwanda 0 1 1 0 1 1 0 1 1 0 0 0 1 1 1 0 0 1 1 0 0 5 Namibia na na na na na na 0 na na 1 1 0 1 1 0 0 1 1 1 1 0 4 Mozambique 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 9 Malawi 0 1 1 1 0 0 0 1 1 1 na 1 1 1 1 0 0 1 1 1 na 6 Madagascar 0 0 0 1 1 0 0 0 0 na 0 0 0 1 1 0 0 1 1 1 0 3 Kenya 1 1 1 1 1 0 1 1 1 1 0 1 1 0 1 1 1 1 1 na 8 Ethiopia 0 1 1 0 0 0 0 1 1 0 na 0 0 1 1 0 0 na na na 3 Burundi 0 1 1 1 1 0 0 1 1 1 1 0 1 1 0 1 0 1 1 0 0 6 Botswana na 0 1 1 0 1 1 1 0 0 1 1 0 0 3 Angola 1 1 0 1 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 7 n 7 12 11 10 11 1 2 10 12 12 11 2 12 17 12 4 4 13 11 9 1 N 15 15 15 15 15 15 16 15 15 16 15 17 17 17 17 17 17 16 13 13 11 M % 46.7 80.0 73.3 66.7 73.3 6.7 12.5 66.7 80.0 75.0 73.3 11.8 70.6 100.
0 70.6 23.5 23.5 81.3 84.6 69.2 9.1
5 MENA Yemen 1 1 1 1 1 1 0 1 0 1 1 0 0 1 1 0 1 1 0 0 0 6 South Sudan 1 1 0 0 1 1 0 1 1 1 1 0 0 1 1 0 0 1 0 1 1 6 North Sudan 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 1 0 0 7 n 3 3 2 2 3 2 0 2 2 3 3 1 1 3 2 1 2 3 1 1 1 N 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 M % 100 100 66.7 66.7 100 66.7 0.0 66.7 66.7 100 100 33.3 33.3 100 66.7 33.3 66.7 100 33.3 33.3 33.3 7 ROSA Sri Lanka 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 8 Nepal 0 1 1 1 0 0 0 0 0 1 0 0 0 1 1 1 0 1 0 0 1 4 India 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 8 Bhutan 1 1 1 1 1 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 na 7 Bangladesh 0 0 0 0 1 0 0 1 1 1 1 0 1 1 1 0 0 1 1 1 1 6 Afghanistan 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 1 0 0 6 n 4 5 5 5 5 0 0 3 4 6 5 1 5 6 6 3 3 5 4 4 2 N 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 5 5 4 M % 66.7 83.3 83.3 83.3 83.3 0.0 0.0 50.0 66.7 100 83.3 16.7 83.3 100 100 50.0 50.0 83.3 80.0 80.0 50.0 6 WCAR Togo 0 1 1 0 1 0 1 1 1 1 0 1 1 0 0 1 1 0 0 5 Sierra Leone 0 0 1 1 1 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 0 7
140
IYCF communication channels
BCC Channels BCC Health System Mass media BCC Community BCC
COUNTRY
Nation
al radio
National TV
National
Campaign
Posters
Interpersona
l Communicati
on
Mobile Phone Messa
ges
Other Chann
els
Religio
us Leader
s
Community
Leaders
BCC HS
Posters and
leaflets
Videos on
IYCF
HW grp. IYCF
sessions
Mass media
Mass media WBF
week.
Mass media frequently/on an
ongoing
National
Campaigns
Ongoing
community BCC
CHWs conduc
t group sessio
ns
Mother
support
groups/other groups
TBAs or
traditional
health practitioners
CHANNELS
SUBSCORE
Senegal 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 0 1 1 1 1 1 8 Nigeria 0 1 1 0 1 0 0 1 1 1 1 0 1 1 0 1 0 1 1 1 1 7 Niger 1 1 0 0 1 0 0 1 1 1 1 0 1 1 0 1 1 1 1 1 1 7 Mauritania 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 1 1 1 9 Mali 0 1 1 0 1 0 0 0 1 1 1 0 1 1 1 0 0 1 1 1 0 6 Liberia na na na na na na na na na 0 na na na 1 1 0 0 1 na na na 1 Ghana 0 1 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 8 Gabon 0 1 1 0 0 0 0 1 1 1 1 1 0 1 0 0 1 1 1 1 0 6 Dem. Rep. Congo
1 1 0 0 1 0 0 1 0 na na na na na na na na na na na na 2
Cote D'Ivoire na na na na na na 0 na na 1 1 0 1 1 1 0 0 0 2 Congo B. 0 1 1 0 0 0 0 1 1 1 1 0 1 1 0 1 0 1 1 1 0 6 C. Afr. Rep na na na na na na 0 na na 1 1 na 1 1 1 0 na 1 1 1 1 4 Burkina Faso 0 1 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 8 Benin 0 1 1 0 1 0 1 1 1 1 1 1 1 1 0 1 0 1 1 1 0 7 Gambia 1 1 1 1 1 0 0 1 1 1 0 1 1 1 1 0 na 1 1 1 1 8 n 5 13 12 4 12 2 5 13 13 15 12 3 13 16 10 8 7 15 14 13 7 N 14 14 14 14 14 14 16 14 14 16 15 13 14 16 16 16 14 16 14 14 14 M % 35.7 92.9 85.7 28.6 85.7 14.3 31.3 92.9 92.9 93.8 80.0 23.1 92.9 100 62.5 50.0 50.0 93.8 100 92.9 50.0 6
Country Totals n 30 52 48 35 48 7 14 34 42 54 47 22 44 62 46 21 25 50 40 39 15
N 59 59 59 59 59 59 63 59 59 59 57 59 60 63 62 62 60 59 47 49 44 M
% 50.9 88.1 81.4 59.3 81.4 11.9 22.2 57.6 71.2 91.5 82.5 37.3 73.3 98.4 74.2 33.9 41.7 84.7 85.1 79.6 34.1 6
M=Mean, n=number, N=total, %= percent, na= not applicable, data not available, no response; Nutritionally vulnerable countries are highlighted in yellow
141
ANNEX 5n:
Communication on IYCF: Strategy, materials and monitoring/evaluation
National BCC, M and E and BCC materials
NATIONAL communication on IYCF* Behaviour change and communication M & E Behaviour change and communication materials
COUNTRY
Comm.
Strategy on IYCF
WBW
Health
Days
National Campaig
ns
Comm. Strat.
on IYCF in
Natl IYCF / Nutri strate
gy
Cord. Mechanism implementing agency
NATIONAL BCC SUBSCORE
Monitoring IYCF
comm.activities
Monitoring
people reached media
messages
Monitoring
quality grp
sessions
BCC MONTORI
NG COMMS
SUBSCORE
BCC materia
ls
BF Poste
rs / leafle
ts
CF Poster
s /leafle
ts
Flipcharts for group
sessions
Participato
ry materials other
BCC Materia
ls SUBSco
re
CEE/CIS Bosnia
Herz. 0 1 1 0 0 1
5 0 0 0
0 1 1 0 0 0 1
5
Kazakhstan 1 0 1 1 1 1 8 1 0 0 3 1 1 1 0 1 na 7
Kosovo 0 1 1 0 0 1 5 0 na na 0 1 1 1 0 0 na 5
Kyrgyzstan 1 1 0 1 0 1 7 na 0 0 0 1 1 1 1 1 na 8
Romania 0
0 1 2 0 na na 0 1 1 1 0 0 na 5
Tajikistan 0 1 1 0 1 1 7 0 0 0 0 1 1 0 0 0 na 3
Turkmenistan
0 1 1 0 0 1 5
0 0 0 0 1
1 1 0 0 na 5
Uzbekistan 1 1 1 1 1 1 10 0 na na 0 1 1 0 0 0 na 3
n 3 6 6 3 3 8
1 0 0
8 8 5 1 2 1 N 8 7 7 7 8 8 M 7 5 5 M 8 8 8 8 8 1 M
% 37.5 85.7 85.7 42.9 37.5 100 6 14.3 0.0 0.0 0 100 100 62.5 12.5 25.0 100 5
EAPR Vietnam 0 1 1 0 1 1 7 na na na 0 1 1 1 1 0 na 7
Cambodia 1 1 0 1 1 1 8 0 0 0 0 1 1 1 1 1 na 8
China 1 1 0 0 1 1 7 0 0 0 0 1 1 1 0 0 na 5
Fiji 0 na na na 1 1 3 0 0 0 0 1 1 1 0 0 na 5
Indonesia 0 na na na 0 1 2 0 0 0 0 1 1 0 1 0 na 5
Korea 1 0 1 0 1 1 7 1 1 1 10 1 0 1 0 0 na 3
Lao PDR 1 1 1 1 1 1 10 0 na na 0 1 1 1 1 1 na 8
Mongolia 0 na na na 1 1 3 1 1 0 7 1 1 1 1 0 na 7
Myanmar 1 1 0 0 1 1 7 0 0 0 0 1 1 1 0 0 na 5
P.N.Guinea 1 1 0 1 1 1 8 0 na na 0 1 1 1 1 1 na 8
Philippines 1 0 1 0 1 1 7 0 na na 0 1 na na na na 1 3
Thailand 1 1 0 1 1 1 8 0 0 0 0 1 1 1 0 0 na 5
Timor-Leste
0 na na na na 1 2
na 1 0 3
1 na na na na na 2
Vanuatu 1 1 1 1 1 1 10 0 0 0 0 1 1 1 1 0 na 7
n 9 8 5 5 12 14
2 3 1
14 11 11 7 3 1 N 14 10 10 10 13 14 M 12 10 10 M 14 12 12 12 12 1 M
% 64.3 80.0 50.0 50.0 92.3 100 6 16.7 30.0 10.0 1 100 91.7 91.7 58.3 25.0 100 6
142
National BCC, M and E and BCC materials
NATIONAL communication on IYCF* Behaviour change and communication M & E Behaviour change and communication materials
COUNTRY
Comm.
Strategy on IYCF
WBW
Health
Days
National Campaig
ns
Comm. Strat.
on IYCF in
Natl IYCF / Nutri strate
gy
Cord. Mechanism implementing agency
NATIONAL BCC SUBSCORE
Monitoring IYCF
comm.activities
Monitoring
people reached media
messages
Monitoring
quality grp
sessions
BCC MONTORI
NG COMMS
SUBSCORE
BCC materia
ls
BF Poste
rs / leafle
ts
CF Poster
s /leafle
ts
Flipcharts for group
sessions
Participato
ry materials other
BCC Materia
ls SUBSco
re
ESAR Zimbabwe 0 na na na 1 1 3 1 na na 3 0 na na na na na 0
Zambia 0 na na na 0 1 2 0 0 0 0 1 1 1 1 0 na 7
Uganda 0 na na na 1 1 3 0 na na 0 1 1 1 1 1 1 10
Tanzania 1 1 1 1 1 1 10 0 0 0 0 1 1 1 1 1 na 8
Swaziland 0 1 1 0 1 1 7 0 0 0 0 1 1 0 0 0 na 3
South Africa
0 na na na 1 1 3
0 0 0 0
1 0 1 0 0 na 3
Somalia 0 na na na 1 1 3 0 na na 1 1 1 1 0 na 7
Rwanda 0 na na na 1 1 3 0 0 1 3 1 1 1 1 1 na 8
Namibia 0 1 1 0 1 1 7 1 0 0 3 1 1 1 1 1 na 8
Mozambique
1 1 0 1 1 1 8
1 1 1 10
1 1 0 0 0 na 3
Malawi 0 1 1 1 1 1 8 na 0 0 0 1 1 1 0 0 na 5
Madagascar
1 0 0 0 1 1 5
0 0 0 0
1 1 0 1 0 na 5
Kenya 1 1 1 1 1 1 10 0 0 1 3 1 1 1 1 0 na 7
Ethiopia 1 1 1 0 1 1 8 0 na na 1 na na na na 1 3
Burundi 0 na na na 0 1 2 0 0 0 0 1 1 1 1 0 1 8
Botswana 0 na na na 0 0 0 0 0 0 0 0 na na na na na 0
Angola 0 na na na 0 0 0 0 0 na 0 1 1 1 1 0 1 8
n 5 7 6 4 13 15
3 1 3
15 13 11 10 4 4 N 17 8 8 8 17 17 M 16 13 12 M 17 14 14 14 14 4 M
% 29.4 87.5 75.0 50.0 76.5 88.2 5 18.8 7.7 25.0 2 88.2 92.9 78.6 71.4 28.6 100.0 6
MENA
Yemen 1 1 0 0 na 1 5 0 0 0 0 1 1 1 1 0 na 7
South Sudan
0
na
na
na
0
1 2
0
0
0 0
1
1
1
1
0
na 7
North Sudan
1 1 1 0
1 1 8
na na na 0
1 1 0 1 0 na 5
n 2 2 1 0 1 3
0 0 0
3 3 2 3 0 0 N 3 2 2 2 2 3 M 2 2 2 M 3 3 3 3 3 0 M
% 66.7 100 50.0 0.0 50.0 100 5.0 0.0 0.0 0.0 0.0 100 100 66.7 100.0 0.0 0.0 6
ROSA
Sri Lanka 1 1 0 1 1 1 8 0 0 0 0 1 1 1 0 1 1 8
Nepal 0 na na na na 1 2 0 0 0 0 1 1 1 1 0 na 7
India 1 1 1 1 1 1 10 1 0 0 3 1 1 1 0 0 na 5
Bhutan 0 na na na 0 1 2 1 0 0 3 1 1 1 0 0 na 5
143
National BCC, M and E and BCC materials
NATIONAL communication on IYCF* Behaviour change and communication M & E Behaviour change and communication materials
COUNTRY
Comm.
Strategy on IYCF
WBW
Health
Days
National Campaig
ns
Comm. Strat.
on IYCF in
Natl IYCF / Nutri strate
gy
Cord. Mechanism implementing agency
NATIONAL BCC SUBSCORE
Monitoring IYCF
comm.activities
Monitoring
people reached media
messages
Monitoring
quality grp
sessions
BCC MONTORI
NG COMMS
SUBSCORE
BCC materia
ls
BF Poste
rs / leafle
ts
CF Poster
s /leafle
ts
Flipcharts for group
sessions
Participato
ry materials other
BCC Materia
ls SUBSco
re
Bangladesh 1 1 0 1 1 1 8 0 0 0 0 1 1 1 1 0 na 7
Afghanistan
0 na na na 1 1 3
0 na na 0
1 1 1 1 0 1 8
n 3 3 1 3 4 6
2 0 0
6 6 6 3 1 N 6 3 3 3 5 6 M 6 5 5 M 6 6 6 6 6
M
% 50.0 100 33.3 100 80.0 100 6 33.3 0.0 0.0 1 100 100 100 50.0 16.7
7
WCAR
Togo 1 1 1 1 1 1 10 na 1 0 3 1 1 1 1 1 na 8
Sierra Leone 0 na na na 1 1 3 1 1 0 7 1 1 1 1 1 na 8
Senegal 1 1 1 1 1 1 10 1 1 0 7 1 1 1 1 1 na 8
Nigeria 1 1 1 1 1 1 10 1 0 0 3 1 1 1 1 1 na 8
Niger 1 1 0 1 1 1 8 1 0 0 3 1 0 0 1 0 1 5
Mauritania 1 1 1 1 1 1 10 1 0 1 7 1 1 1 1 0 na 7
Mali 1 1 1 1 1 1 10 0 0 0 0 1 0 1 0 0 na 3
Liberia na na na na na na 0 0 na na 0 1 1 1 0 1 na 7
Ghana 1 1 1 1 0 1 8 1 0 1 7 1 1 1 0 0 1 7
Gabon 0 na na na 1 1 3 0 na na 0 na na na na na na 0
D. Rep. Congo
0 na na na 1 1 3
0 na na 0
1 1 1 0 0 na 5
Cote'd'Ivoire na na na na na na 0 0 na na 0 1 1 1 0 1 na 7
Congo Brazzaville
1 1 0 0 1 1 7
1 1 1 10
1 0 1 0 0 na 3
C.Afr. Rep. 0
1 1 3 0 0 na na na na na 0
Burkina Faso 1 1 1 0 1 1 8 1 1 1 10 1 1 1 1 1 na 8
Benin 1 1 0 0 1 1 7 0 0 0 0 1 0 0 1 0 na 3
Gambia 1 1 0 0 1 1 7 na na na 0 1 1 1 0 0 na 5
n 11 11 7 7 14 15
8 5 4
15 11 13 8 7 2 N 15 11 11 11 15 15 M 14 11 11 M 16 15 15 15 15 2 M
% 73.3 100 63.6 63.6 93.3 100 6 57.1 45.5 36.4 2 93.8 73.3 86.7 53.3 46.7 100 5
Country Totals
n 33 37 26 22 47 61
16 9 8
61 52 48 32 17 10
N 63 41 41 41 60 63
57 46 44
64 58 58 58 58 10 M
% 52.4 90.2 63.4 53.7 78.3 96.8
28.1 19.6 18.2
95.3 89.6 82.7 55.2 29.3 100 6
na= not available/not applicable/ no response M= Mean, 1=Yes, 2=No,
Nutritionally vulnerable countries are highlighted in yellow *36 countries with 5 or more communication on IYCF channels and 4 countries with 8 communications on IYCF channels
144
ANNEX 5o:
Communication on IYCF actions score
COUNTRY BCC MONTORING COMMS
SUBSCORE CHANNELS SUBSCORE
NATIONAL BCC SUBSCORE
BCC Materials SUBSCORE
Communication on IYCF actions SCORE
CEE/CIS Uzbekistan 0 6 10 3 5
Turkmenistan 0 7 5 5 4
Tajikistan 0 3 7 3 3
Romania 0 6 2 5 3
Kyrgyzstan 0 5 7 8 5
Kosovo 0 5 5 5 4
Kazakhstan 3 7 8 7 6
Bosnia Herz. 0 5 5 5 4
Mean 0 6 6 5 4
EAPR Vietnam 0 5 7 7 5
Vanuatu 0 6 10 7 6
Timor-Leste 3 5 2 2 3
Thailand 0 5 8 5 4
Philippines 0 4 7 3 3
P. N.Guinea 0 6 8 8 5
Myanmar 0 6 7 5 4
Mongolia 7 6 3 7 6
Lao PDR 0 7 10 8 6
Korea 10 7 7 3 7
Indonesia 0 5 2 5 3
Fiji 0 6 3 5 4
China 0 4 7 5 4
Cambodia 0 8 8 8 6
Mean 1 6 6 6 5
145
COUNTRY BCC MONTORING COMMS
SUBSCORE CHANNELS SUBSCORE
NATIONAL BCC SUBSCORE
BCC Materials SUBSCORE
Communication on IYCF actions SCORE
ESAR Zimbabwe 3 3 3 0 2
Zambia 0 6 2 7 4
Uganda 0 6 3 10 5
Tanzania 0 6 10 8 6
Swaziland 0 5 7 3 4
South Africa 0 5 3 3 3
Somalia 0 3 3 7 3
Rwanda 3 5 3 8 5
Namibia 3 4 7 8 5
Mozambique 10 9 8 3 7
Malawi 0 6 8 5 5
Madagascar 0 3 5 5 3
Kenya 3 8 10 7 7
Ethiopia 0 3 8 3 3
Burundi 0 6 2 8 4
Botswana 0 3 2 0 1
Angola 0 7 2 8 4
Mean 1 5 5 6 4
MENA Yemen 0 6 5 7 4
South Sudan 0 6 2 7 4
North Sudan 0 7 8 5 5
Mean 0 7 5 6 4
ROSA Sri Lanka 0 8 8 8 6
Nepal 0 4 2 7 3
India 3 8 10 5 6
Bhutan 3 7 2 5 4
146
COUNTRY BCC MONTORING COMMS
SUBSCORE CHANNELS SUBSCORE
NATIONAL BCC SUBSCORE
BCC Materials SUBSCORE
Communication on IYCF actions SCORE
Bangladesh 0 6 8 7 5
Afghanistan 0 6 3 8 4
Mean 1 6 6 7 5
WCAR Togo 3 5 10 8 6
Sierra Leone 7 7 3 8 6
Senegal 7 8 10 8 8
Nigeria 3 7 10 8 7
Niger 3 7 8 5 6
Mauritania 7 9 10 7 8
Mali 0 6 10 3 5
Liberia 0 1 0 7 2
Ghana 7 8 8 7 7
Gabon 0 6 3 0 2
D. Rep. Congo 0 2 3 5 2
Cote D'Ivoire 0 2 0 7 2
Congo Brazzaville 10 6 7 3 6
Cen. Afr. Rep. 0 4 3 0 2
Burkina Faso 10 8 8 8 8
Benin 0 7 7 3 4
Gambia 0 8 7 5 5
Mean 3 6 6 5 5
TOTAL Mean 2 6 6 6 5
Nutritionally vulnerable countries highlighted in yellow
147
ANNEX 5p: Complementary feeding components / intervention
COUNTRY
Micronutrient supplements
( single/multi)
Single micronutrient
Multi-micronutrie
nt
In emergency
non-emergency
Targeted food
supplements
Local CFs (
unfortified)
Industrially
blended CFs
un-fortifie
d
Fortif
ied local CFs
Fortified
industrially-
blended CFs
Lipid
based
Social protec
tion progra
m
Prov. of CF suppl. Sub
score
Caregivers
counselled in home prep. of CF
Cooking Classe
s
Food preparation
demonstrations
on TV
Food preparatio
n demonstrations on
radio
Local food
events
Publis
hed recipe guides
for mother
s
Counseling cards
on food
preparation (
for health system
)
Counseling cards
on food
preparation (
for community)
CF counseling sub score
CF Score
CEE/CIS
Bosnia Herz. 1 1 1 1 0 1 0 1 0 1 na 1 7 0 0 4 Kazakhstan 1 1 0 0 1 0 na na na na na 1 3 1 0 1 0 0 0 0 0 3 3
Kosovo 1 1 1 1 0 0 na na na na na 0 3 1 0 1 0 0 1 1 0 5 4 Kyrgyzstan 1 0 1 0 1 1 1 0 0 0 0 0 4 0 0 2
Romania 1 1 0 1 1 0 na na na na na 0 3 0 0 2
Tajikistan 0 na na na na 0 na na na na na 0 0 0 0 0 Turkmenistan 1 1 1 1 0 1 1 1 0 0 0 0 6 0 0 1 0 0 1 0 0 3 4
Uzbekistan 1 0 1 0 1 0 na na na na na 0 2 0 0 1 n 7 5 5 4 4 3 2 2 0 1 0 2 M 2 0 3 0 0 2 1 0 M M N 8 7 7 7 7 8 3 3 3 3 2 8 3 8 3 3 3 3 3 3 3 1 2
% 87.5 71.4 71.4 57 57.1 37.5 67 66.7 0 33.3 0 25 25.0 0.0 100.0 0.0 0.0 66.7 33.3 0.0
EAPR
Cambodia 1 0 1 0 1 1 0 0 0 1 0 1 5 1 0 1 0 0 0 1 1 5 5
China 1 0 1 1 0 1 0 0 0 0 0 1 4 1 0 1 0 0 0 1 0 4 4 Fiji 0 na na na na 1 0 0 0 1 0 0 2 0 0 1
Indonesia 1 1 1 0 1 1 1 0 0 1 0 1 7 0 0 4
Korea 1 0 1 0 1 1 1 na 1 na na 5 0 3 Lao People's Democratic Republic
1 0 1 0 1 0 na na na na na 0 2 0 0 1
Mongolia 1 1 1 0 1 1 1 1 0 0 0 1 7 1 1 0 0 1 1 1 6 7
Myanmar 0 na na na na 1 1 1 0 0 0 0 2 1 0 1 0 0 1 0 0 4 3 Papua New Guinea
0 na na na na 0 na na na na na 0 0 1 0 0 0 1 1 1 1 6 3
Philippines 1 0 1 0 1 1 0 na 1 na na 1 5 1 0 1 0 0 0 0 0 3 4 Thailand 1 0 1 0 1 0 na na na na na 0 2 0 0 1
Timor-Lest 0 na na na na 1 1 0 0 0 0 na 2 0 1 Vanuatu 1 1 0 1 0 0 na na na na na 0 2 0 0 1 Vietnam 1 1 1 0 1 1 0 1 1 na 1 7 1 0 0 0 1 0 1 1 5 6
n 10 4 9 2 8 10 5 2 3 4 0 6 M 7 0 5 0 2 3 5 4 M N 14 10 10 10 10 14 9 8 10 8 7 12 4 12 6 7 7 7 7 7 7 2 % 71.4 40 90 20 80 71.4 56 25 30 50 0 50 58.3 0.0 71.4 0.0 28.6 42.9 71.4 57.1
ESAR
Angola 0 na na 0 0 0 na na na na na na 0 0 0 0 Botswana 0 na na na na 1 0 0 0 1 0 1 2 1 1 2 Burundi 1 1 0 0 1 0 na na na na na 0 2 0 0 1 Ethiopia 0 na na na na 0 na na na na na na 0 0 0 0 Kenya 1 0 1 1 0 1 1 0 1 0 na 1 6 0 0 3 Madagascar 1 na na 0 1 1 0 0 0 0 0 0 2 1 1 0 0 1 1 0 1 6 4 Malawi 1 1 1 0 1 1 1 0 0 1 na 1 7 1 0 1 0 0 0 1 0 4 5 Mozambique 1 1 0 1 1 1 0 0 0 1 1 na 6 1 0 0 0 1 0 0 0 3 4 Namibia 1 0 1 0 1 1 0 na 1 na na 0 4 1 0 0 0 0 1 0 3 3 Rwanda 0 na na na na 0 na na na na na 0 0 0 0 0 Somalia 1 1 0 0 1 0 na na na na na na 2 1 0 0 0 1 0 1 0 4 3 South Africa 1 0 1 0 1 1 0 1 0 1 0 1 6 1 0 1 0 0 0 1 0 4 5 Swaziland 1 0 1 0 1 1 0 0 1 1 0 0 5 0 3 Tanzania 1 0 1 0 1 1 0 0 0 1 1 1 6 1 0 0 0 0 1 0 3 4
148
COUNTRY
Micronutrient supplements
( single/multi)
Single micronutrient
Multi-micronutrie
nt
In emergency
non-emergency
Targeted food
supplements
Local CFs (
unfortified)
Industrially
blended CFs
un-fortifie
d
Fortif
ied local CFs
Fortified
industrially-
blended CFs
Lipid
based
Social protec
tion progra
m
Prov. of CF suppl.
Sub score
Caregiver
s counselled in
home prep. of CF
Cooking
Classes
Food preparation
demonstrations
on TV
Food preparatio
n demonstrations on
radio
Local food
events
Publis
hed recipe guides
for mother
s
Counseling
cards on food prepara
tion ( for
health system
)
Counseling
cards on food prepara
tion ( for
community)
CF counseling sub
score
CF Score
Uganda 1 1 0 0 1 0 na na na na na 0 2 1 0 1 1 1 0 0 1 6 4 Zambia 1 1 0 1 0 0 na na na na na 1 3 1 0 1 0 0 0 1 0 4 3 Zimbabwe 0 na na 0 1 0 na na na na na 1 2 1 0 1 0 0 1 1 1 6 4 n 12 6 6 3 11 9 2 1 3 6 2 7 M 11 1 5 1 4 2 7 3 M M N 17 11 11 14 14 17 9 8 9 8 7 13 3 16 8 10 10 10 10 10 7 3 3
% 70.6 54.5 54.5 21 78.6 52.9 22 12.5 33 75 29 53.8 68.8 12.5 50.0 10.0 40.0 20.0 70.0 42.9
MENA North Sudan 1 1 0 0 1 1 0 0 0 1 1 0 5 1 1 0 0 0 1 0 0 4 4 South Sudan 0 na na na na 1 0 0 0 1 0 0 2 1 0 0 0 1 0 0 0 3 2 Yemen 1 0 1 1 0 1 0 na 0 0 0 na 3 0 0 0 0 0 1 0 1 2 n 2 1 1 1 1 3 0 0 0 2 1 0 M 2 1 0 0 1 1 1 0 M M N 3 2 2 2 2 3 3 2 3 3 3 2 3 3 2 3 3 3 3 3 3 3 3 % 66.7 50 50 50 50 100 0 0 0 66.7 33 0
ROSA
Afghanistan 1 0 1 1 0 0 na na na na na 0 2 1 0 0 0 0 1 0 1 4 3 Bangladesh 1 1 1 0 1 1 0 0 0 0 0 1 5 1 0 1 0 0 0 0 0 3 4 Bhutan 1 1 1 1 0 1 1 0 0 0 0 0 5 0 0 3 India 1 1 1 1 1 1 1 na 1 na 1 8 1 0 0 0 1 1 0 1 5 7 Nepal 1 1 1 1 0 1 0 0 0 1 0 1 6 0 0 3 Sri Lanka 1 0 1 0 1 1 0 0 0 0 0 1 4 1 1 1 1 1 1 0 0 8 6 n 6 4 6 4 3 5 2 0 1 1 0 4 M 4 1 2 1 2 3 0 2 M M N 6 6 6 6 6 6 5 4 5 4 4 6 5 6 4 4 4 4 4 4 4 3 4 % 100 66.7 100 67 50 83.3 40 0 20 25 0 66.7 66.7 ## 50.0 25.0 50.0 75.0 0.0 50.0
WCAR Benin 1 1 1 1 0 0 na na na na na 0 2 1 0 1 0 0 0 1 1 5 4 Burkina Faso 1 1 0 0 1 1 0 0 1 1 0 0 5 1 0 1 0 0 1 1 1 6 6 C. Afr. Rep. 1 1 0 0 1 0 na na na na na na 2 1 0 0 0 1 0 0 0 3 2 Congo Brazzaville 1 1 0 0 1 0 na na na na na na 2 0 0 1 Cote d'Ivoire 1 1 1 1 na 1 1 na na na 1 0 6 1 1 4 DR. Congo 0 na na na na 0 na na na na na 0 0 0 0 0 Gabon 1 1 0 0 1 0 na na na na na 0 2 0 0 1 Gambia 1 1 0 0 1 0 na na na na na na 2 1 0 1 0 0 0 1 0 4 3 Ghana 1 1 0 0 1 1 1 0 1 na na 0 5 1 0 1 0 0 0 0 0 3 4 Liberia 1 1 1 0 1 1 0 na na na na 0 4 0 4 Mali 0 na na na na 1 na 1 1 1 0 0 3 1 0 1 0 0 1 1 1 6 5 Mauritania 1 1 0 0 1 1 1 0 0 0 1 1 6 0 0 3 Niger 1 1 0 1 1 0 0 0 1 1 0 5 0 0 3 Nigeria 1 1 0 0 1 1 0 0 0 1 0 0 4 1 0 1 0 0 1 1 1 6 5 Senegal 1 1 1 0 1 1 1 1 na 1 0 1 8 1 1 0 1 1 0 1 1 8 8 Sierra Leone 0 na na na na 1 1 0 0 0 0 0 1 1 1 0 0 1 0 0 0 4 2 Togo 1 1 0 1 0 1 0 0 0 na na 1 4 1 0 1 0 0 1 1 1 6 5 n 14 14 4 3 11 10 5 2 3 5 3 3 M 11 2 7 1 3 4 7 6 M M N 17 14 14 13 13 17 10 9 8 7 8 14 4 17 10 10 10 10 10 10 10 3 3 % 82.4 100 28.6 23 84.6 58.8 50 22.2 38 71.4 38 21.4 64.7 20 70.0 10.0 30.0 40.0 70.0 60.0 Country Total
n 51 34 31 17 38 40 16 7 10 19 6 22 M 37 5 22 3 12 15 21 15 M M N 65 50 50 52 52 65 39 34 38 33 31 55 4 62 33 37 37 37 37 37 34 3 4 % 78.5 68 62 33 73.1 61.5 41 20.6 26 57.6 19 40 59.7 15.2 59.5 8.1 32.4 40.5 56.8 44.1
M=Mean, n=number, N=Total, %=percent, na=data not available, Nutritionally vulnerable countries highlighted in yellow
149
ANNEX 5q:
IYCF in difficult circumstances
IYCF in difficult circumstances (HIV and infant feeding)
POLICY TRAINING/ COUNSELLING BMS
Country
IF a
nd
HIV
po
licy
IF &
HIV
in n
atio
nal
IYC
F p
olic
y
IF &
HIV
in P
MTC
T
IF p
olic
y u
pd
ated
b
ased
on
WH
O2
010
gu
idel
ine
IF
tr
ain
ing/
cou
nse
lin
g fo
r H
IV +
m
oth
ers
HIV
& IF
in IY
CF
mat
eria
ls
IF & HIV IYCF
materials
updated
IF in PMTC
T mater
ials
PMTCT
material
s updated Jo
b a
ids
on
HIV
&
IF
Job
aid
s u
pd
ated
HW
tra
ined
on
IF
& H
IV?
HW
tra
ined
on
HIV
& IF
co
un
selin
g IF
co
un
selin
g
inte
grat
ed in
P
MTC
T
HIV
+ m
oth
ers
sup
po
rt o
n IF
Fr
ee in
fan
t
form
ula
to
HIV
+m
oth
ers
Infa
nt
Form
ula
pro
vid
ed b
y G
ove
rnm
ent
Infa
nt
form
ula
pro
vid
ed b
y N
GO
s
Mo
nit
ori
ng
syst
em
on
IF p
ract
ices
amo
ng
HIV
+ m
oth
ers
HIV and IF SCORE
CEE/CIS Uzbekistan 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 9 Romania 0 na 1 1 1 1 1 1 1 1 1 1 na 1 1 1 1 0 0 7 Kosovo 0 na na na 1 1 1 1 1 0 na na 0 1 0 1 1 0 na 4 Kazakhstan 0 0 1 0 0 na na 1 1 na na na 1 na na 0 na na 0 2 Bosnia & Herz.
0 na na na 1 na na na na na na 1 na na na 1 0 1 0 2
Turkmenistan
1 na 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na 8
Tajikistan 1 1 1 1 1 1 1 1 1 0 na 1 0 1 1 1 1 0 0 7 Kyrgyzstan 1 1 1 0 0 na na 1 1 0 1 1 1 1 1 1 0 1 1 7 Number 4 2 5 4 6 5 5 6 6 3 3 5 3 5 4 7 5 2 1
Total 8 3 5 5 8 5 5 6 6 5 3 5 5 5 5 8 6 6 6
Percent 50.0 66.7 100 80 75.0 100 100 100 100 60 100 100 60 100 80 87.5 83.3 33.3 16.7 M=6 EAPR Vietnam 1 1 1 1 1 1 1 na 1 1 1 1 1 1 1 1 1 1 0 8 Philippines 1 1 1 1 1 1 1 1 1 1 na na 1 0 1 1 0 1 0 7 China 1 0 1 1 1 0 na 1 1 1 1 1 1 1 1 1 1 0 1 8 Thailand 1 1 1 1 0 na na 1 1 na na 1 1 1 na 1 1 0 1 6 Vanuatu 1 1 1 1 1 1 1 1 na 1 na 1 1 1 1 0 na na 0 7 Indonesia 1 1 1 0 0 na na 0 na 0 na 0 0 0 0 0 na na 0 2 Myanmar 1 1 1 1 1 1 1 1 1 na na 0 0 1 1 1 0 1 0 7 Korea 0 na na na 0 na na 0 na na na na 0 na na 1 0 1 0 1 P. N. Guinea
1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 na 1 0 8
Lao PDR 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 na na 1 8 Mongolia 1 1 0 1 0 na na 0 na 0 na 1 1 0 0 0 na na 0 3 Fiji 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 8 Timor Leste
0 na 0 1 0 na 1 1 na 1 1 na 0 0 0 0 na na 0 3
Cambodia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 na na 1 9
150
IYCF in difficult circumstances (HIV and infant feeding)
POLICY TRAINING/ COUNSELLING BMS
Country
IF a
nd
HIV
po
licy
IF &
HIV
in n
atio
nal
IYC
F p
olic
y
IF &
HIV
in P
MTC
T
IF p
olic
y u
pd
ated
b
ased
on
WH
O2
010
gu
idel
ine
IF
tr
ain
ing/
cou
nse
lin
g fo
r H
IV +
m
oth
ers
HIV
& IF
in IY
CF
mat
eria
ls
IF & HIV IYCF
materials
updated
IF in PMTC
T mater
ials
PMTCT
material
s updated Jo
b a
ids
on
HIV
&
IF
Job
aid
s u
pd
ated
HW
tra
ined
on
IF
& H
IV?
HW
tra
ined
on
HIV
& IF
co
un
selin
g IF
co
un
selin
g
inte
grat
ed in
P
MTC
T
HIV
+ m
oth
ers
sup
po
rt o
n IF
Fr
ee in
fan
t
form
ula
to
HIV
+m
oth
ers
Infa
nt
Form
ula
pro
vid
ed b
y G
ove
rnm
ent
Infa
nt
form
ula
pro
vid
ed b
y N
GO
s
Mo
nit
ori
ng
syst
em
on
IF p
ract
ices
amo
ng
HIV
+ m
oth
ers
HIV and IF SCORE
Number 12 9 10 12 9 8 9 10 9 9 7 9 10 9 8 9 4 5 5
Total 14 12 13 13 14 9 9 13 9 11 7 11 14 13 12 14 7 8 14
Percent 85.7 75.0 76.9 92.3 64.3 88.9 100 76.9 100 81.8
100 81.8 71.4 69.2 66.7 64.3 57.1 62.5 35.7
ESAR 7
Rwanda 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 9
Zimbabwe 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9
Mozambique 1 1 1 1
1 na
1 1 0 1 na 1 1 1 1 1 1 0 1 8
Zambia 1 na 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9
Malawi 1 1 1 1 1 1 0 1 0 1 na na 1 1 1 na na na na 6
Swaziland 1 1 1 1 1 1 0 1 0 1 0 1 1 1 1 1 0 1 1 8
Namibia 1 1 1 1 1 1 1 1 na 0 na 1 na 1 1 1 0 1 0 7
South Africa 1 1 1 na
1 1 0 1 1 0 na 1 1 1 1 1 0 1 1 7
Kenya 1 1 1 1 1 1 0 1 0 1 0 1 1 1 1 0 na na 0 6
Ethiopia 1 1 1 0 1 1 0 1 0 1 0 0 1 1 0 0 na na 0 5
Botswana 0 na na na 1 0 na 1 0 1 0 na 1 0 1 0 na na 0 3
Madagascar 1 1 1 1
1 1 1 1 na 1 1 na 1 1 na 0 na na 1 7
Burundi 1 0 1 0 0 na na 1 1 0 na 0 0 1 0 0 na na 0 3
Angola 1 0 1 0 0 na na 1 0 0 na 1 1 1 0 na na 0 3
Uganda 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 1 8
Tanzania 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 0 8
Somalia 1 1 1 1 1 1 1 1 1 0 na 1 1 1 1 0 na na 0 7
Number 16 13 16 11 15 13 9 17 8 12 6 12 15 16 13 7 2 5 2
Total 17 15 16 15 17 14 14 17 15 17 10 14 16 17 16 15 7 7 17
Percent 94.1 86.7 100 73.3 88.2 92.9 64.3 100 53.3 70.
6 60.0 85.7 93.8 94.1 81.3 46.7 28.6 71.4 11.8
M=7 MENA
Yemen 0 na na na na na na 1 0 na na 1 1 1 1 0 na na 0 3
S. Sudan 1 1 1 0 0 na na 0 na 0 na na 0 0 0 1 0 1 0 3
N. Sudan 1 1 1 0 0 na na na na 0 na na 0 0 0 0 na na 0 3
Number 2 2 2 0 0 na na 1 0 0 na na 1 1 1 1 0 1 0
Total 3 2 2 2 2 na na 2 1 2 na na 3 3 3 3 1 1 3
Percent 66.7 100 100 0.0 0.0 na na 50.0 0.0 0.0 na na 33.3 33.3 33.3 33.3 0.0 100 0.0 M=3 ROSA
Afghanistan 1 1 1 1
0 na na 1 1 0 na 1 1 1 1 1 1 0 na 6
Banglades 1 1 1 1 0 na na 1 1 1 0 1 0 0 0 1 0 1 0 5
151
IYCF in difficult circumstances (HIV and infant feeding)
POLICY TRAINING/ COUNSELLING BMS
Country
IF a
nd
HIV
po
licy
IF &
HIV
in n
atio
nal
IYC
F p
olic
y
IF &
HIV
in P
MTC
T
IF p
olic
y u
pd
ated
b
ased
on
WH
O2
010
gu
idel
ine
IF
tr
ain
ing/
cou
nse
lin
g fo
r H
IV +
m
oth
ers
HIV
& IF
in IY
CF
mat
eria
ls
IF & HIV IYCF
materials
updated
IF in PMTC
T mater
ials
PMTCT
material
s updated Jo
b a
ids
on
HIV
&
IF
Job
aid
s u
pd
ated
HW
tra
ined
on
IF
& H
IV?
HW
tra
ined
on
HIV
& IF
co
un
selin
g IF
co
un
selin
g
inte
grat
ed in
P
MTC
T
HIV
+ m
oth
ers
sup
po
rt o
n IF
Fr
ee in
fan
t
form
ula
to
HIV
+m
oth
ers
Infa
nt
Form
ula
pro
vid
ed b
y G
ove
rnm
ent
Infa
nt
form
ula
pro
vid
ed b
y N
GO
s
Mo
nit
ori
ng
syst
em
on
IF p
ract
ices
amo
ng
HIV
+ m
oth
ers
HIV and IF SCORE
h
Bhutan 1 1 1 0 1 1 0 1 0 1 0 1 1 1 0 1 1 0 0 6
India 0 na na na 1 0 na 1 1 0 na 1 0 1 0 0 na na 0 3
Nepal 1 1 0 1 0 na na 1 1 0 na 0 0 na 1 na na na 0 3
Sri Lanka 1 1 1 1 0 na na 0 na 0 na 0 0 0 0 0 na na 1 3
Number 5 5 4 4 2 1 0 5 4 2 0 4 2 3 2 3 2 1 3
Total 6 5 5 5 6 2 1 6 5 6 2 6 6 5 6 5 3 3 6
Percent 83.3 100.
0 80.0 80.0 33.3 50.0 0.0 83.3 80.0 33.
3 0.0 66.7 33.3 60.0 33.3 60.0 66.7 33.3 50.0
M=4 WCAR
Benin 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 9
B. Faso 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 1 8
CAR 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 8
Congo B. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 na 9
Cote D'Ivoire
1 1 1 0 1 1 1 1 1 1 na 1 1 1 1 1 0 1 na 8
DRC 0 na 1 1 1 1 1 1 1 1 1 1 1 1 0 1 na na 0 7
Gabon 1 1 na 0 1 1 0 1 0 1 0 na 1 1 1 1 0 1 na 6
Gambia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 1 8
Ghana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9
Liberia 0 na na na 1 1 0 1 1 1 0 1 1 1 0 0 na na na 4
Mali 1 1 1 0 1 0 na 1 0 0 na 1 0 1 1 1 0 1 1 6
Mauritania 1 1 1 1 0 0 na 1 1 0 na 1 1 1 0 0 na na 0 5
Niger 1 1 1 1 1 1 na 1 na 0 na 1 1 1 na 0 na na 1 6
Nigeria 1 1 1 1 1 1 0 1 na 1 na na na 1 0 1 0 1 1 6
Senegal 1 1 1 0 1 0 na 1 1 0 0 0 1 0 0 na na na 4
S. Leone 1 1 1 1 1 1 1 0 na na na 0 na na na na 0 na 0 4
Togo 1 1 1 1 0 na na na na na na na na na na na na na 1 3
Number 15 15 15 11 15 13 9 15 11 11 7 12 12 15 9 9 1 7 4
Total 17 15 15 16 17 16 12 16 13 15 9 14 14 15 14 15 9 8 14
Percent 88.2 100 100 68.8 88.2 81.3 75.0 93.8 84.6 73.
3 77.8 85.7 85.7 100.
0 64.3 60.0 11.1 87.5 28.6
M=6
ALL
Number 54 47 53 42 47 40 31 55 38 36 23 45 44 50 38 35 14 21 17
Total 64 53 57 57 65 46 41 61 50 57 31 54 59 58 57 60 33 33 62
Percent 84.4 88.7 93.0 73.7 72.3 87.0 75.6 90.2 76.0 63.
2 74.2 83.3 74.6 86.2 66.7 58.3 42.4 63.6 27.4 M=6
na= no response /not applicable, 1=Yes, 0= No; Nutritionally vulnerable countries highlighted in yellow
152
ANNEX 5r:
IYCF in difficult circumstances
IYCF in difficult circumstances (Infant feeding in emergency)
Country
Nat
ion
al IY
CF
po
licy
incl
ud
es IY
CF
in
Emer
g.
Nat
ion
al
Emer
g.p
rep
ared
nes
s
pla
n in
clu
de
IYC
F in
Em
erg.
Nat
ion
al E
mer
g.
Pre
p.
Pla
n u
pd
ated
*
Up
-to
-dat
e gu
idel
ines
/tra
inin
g
mat
eria
ls o
n IY
CF
in
Emer
g.
HW
s/IY
CF
cou
nse
llors
tra
ined
o
n IY
CF
in E
me
rg.
Trai
nin
g m
ater
ials
p
rete
sted
Effe
ctiv
enes
s o
f m
essa
ges
test
ed
Bas
elin
e o
n K
AP
con
du
cted
Po
st-i
nte
rven
tio
n o
f
KA
P c
on
du
cted
BM
S p
rovi
ded
in
emer
gen
cies
Go
vt
pro
cure
s/d
istr
ibu
te
BM
S d
uri
ng
emer
gen
cies
Go
vt a
ccep
t
do
nat
ion
s o
f in
fan
t
foo
ds
IF in
Em
erg
en
cies
SCO
RE
CEE/CIS Uzbekistan 0 0 na na 0 na 0 na na 1 1 1 2
Romania 0 0 na na 0 na na na na 0 na Na 0
Kosovo na na na na 0 na na na na 0 na na 0
Kazakhstan 0 0 na na 0 na 0 na na 0 na na 0
Bosnia & Herz. 0 0 na na 0 na 0 0 0 1 1 1 2
Turkmenistan 0 na na na 0 na na na na 0 na na 0
Tajikistan 1 1 0 0 0 0 0 0 0 0 0 0 2
Kyrgyzstan 0 0 na na 0 na 0 0 0 1 0 1 2
Number 1 1 0 0 0 0 0 0 0 3 2 3 M = 1.0
Total 7 6 1 1 7 1 5 4 4 8 4 4
Percent 14.3 16.7 0 0 0 0 0 0 0 37.5 50.0 75.0 EAPR
Vietnam 1 1 1 na 0 na 0 na na 0 na na 2 Philippines 1 na na 0 1 1 na 1 na 1 1 0 5 China 0 0 na na 1 1 na 1 1 1 0 1 5 Thailand 1 1 1 na na na na na na 1 0 1 4 Vanuatu 1 1 1 1 0 na 0 0 0 1 0 na 4 Indonesia 0 1 1 1 1 na 0 na na 1 0 0 4 Myanmar 1 1 0 1 0 0 0 0 0 0 na na 2 Korea na 1 na 1 na na na na na 0 na na 2 P. N. Guinea 0 0 0 0 1 0 0 0 0 0 0 0 1 Lao PDR 0 0 na na 0 0 0 0 0 0 na na 0 Mongolia 0 0 na na 0 na 0 na na 0 na na 0 Fiji 0 1 na 0 0 na 0 0 0 0 na na 1 Timor Leste 0 1 0 0 0 0 0 0 0 0 0 1 2 Cambodia 1 0 0 na 0 na 0 na na 0 na na 2 Number 6 8 5 4 4 2 0 2 1 5 1 3
Total 13 13 8 8 12 7 10 8 7 14 7 6 M = 2.4
Percent 46.2 61.5 62.5 50.0 33.3 28.6 0.0 25.0 14.3 35.7 14.3 50.0 ESAR
Rwanda 1 1 1 0 0 0 0 0 0 0 0 0 2
Zimbabwe 0 1 na na 0 na 0 na na 0 na na 1
Mozambique 0 0 0 na 0 na 0 na na 0 na na 0
Zambia 0 0 na na 0 na 0 na na 0 na na 0
Malawi 1 1 na na 0 na 1 na na 0 na na 2
153
IYCF in difficult circumstances (Infant feeding in emergency)
Country
Nat
ion
al IY
CF
po
licy
incl
ud
es IY
CF
in
Emer
g.
Nat
ion
al
Emer
g.p
rep
ared
nes
s
pla
n in
clu
de
IYC
F in
Em
erg.
Nat
ion
al E
mer
g.
Pre
p.
Pla
n u
pd
ated
*
Up
-to
-dat
e gu
idel
ines
/tra
inin
g
mat
eria
ls o
n IY
CF
in
Emer
g.
HW
s/IY
CF
cou
nse
llors
tra
ined
o
n IY
CF
in E
me
rg.
Trai
nin
g m
ater
ials
p
rete
sted
Effe
ctiv
enes
s o
f m
essa
ges
test
ed
Bas
elin
e o
n K
AP
con
du
cted
Po
st-i
nte
rven
tio
n o
f
KA
P c
on
du
cted
BM
S p
rovi
ded
in
emer
gen
cies
Go
vt
pro
cure
s/d
istr
ibu
te
BM
S d
uri
ng
emer
gen
cies
Go
vt a
ccep
t
do
nat
ion
s o
f in
fan
t
foo
ds
IF in
Em
erg
en
cies
SCO
RE
Swaziland 0 1 0 0 0 1 0 0 0 0 0 0 2
Namibia 0 0 na na 0 na 0 na na 0 na na 0
South Africa 1 0 0 0 0 na 0 0 0 1 0 1 2
Kenya 1 1 1 0 0 na 0 0 0 0 0 0 2
Ethiopia 1 0 na na 0 na na na na 0 na na 1
Botswana 0 0 na na 0 na 0 na na 1 1 0 2
Madagascar 0 1 1 na na na 0 na na 0 na na 2
Burundi 0 0 na na 0 0 na 0 na 0 na na 0
Angola 0 0 na na 0 na 0 0 0 0 0 0 0
Uganda 1 0 - na 0 0 0 0 0 0 na na 2
Tanzania 1 1 na 1 0 na na na na 0 na na 2
Somalia 0 0 na na 0 na 0 na na 0 na na 0
Number 7 7 4 1 0 1 1 0 0 2 1 1
Total 17 17 7 5 16 4 14 10 6 17 6 6 M = 1.2
Percent 41.2 41.2 57.1 20.0 0.0 25.0 7.1 0.0 0.0 11.8 16.7 16.7 MENA
Yemen 1 1 0 0 1 1 0 0 0 0 0 0 3
S. Sudan na 1 0 0 1 1 1 1 0 0 na na 4
N. Sudan 1 1 1 0 0 0 0 1 0 0 na na 3
Number 2 3 1 0 2 2 1 2 0 0 0 0
Total 2 3 3 3 2 3 3 3 3 3 1 1 M = 3.3
Percent 100 100 33.3 0.0 66.7 33.3 66.7 0.0 0.0 0.0 0.0 0.0 ROSA
Afghanistan 1 1 0 0 0 na na na na 1 0 0 2
Bangladesh 1 0 0 na 0 0 0 0 0 1 0 0 2
Bhutan 1 1 0 0 0 na 0 0 0 na na na 2
India 0 0 na na 0 na 0 na na 0 na na 0
Nepal 1 1 na 1 1 0 na 0 0 0 0 0 3
Sri Lanka 1 1 1 1 na na na na na 1 0 1 5
Number 5 4 2 2 1 0 0 0 0 3 0 1
Total 6 6 4 4 5 2 3 3 3 5 4 4 M = 2.3
Percent 83.3 66.7 50.0 50.0 20.0 0.0 0.0 0.0 0.0 60.0 0.0 25.0 WCAR
Benin 0 0 na na 0 0 0 0 0 0 0 0 0
B. Faso 0 0 na na 0 na 1 1 0 na na na 2
CAR 1 1 0 0 0 na 0 na na 0 na na 2
Congo B. 1 1 0 na 1 0 1 1 1 0 na na 5
Cote D'Ivoire na na na na na na na na na na na na 0
DRC 1 1 0 0 0 0 0 0 0 1 0 0 2
Gabon 1 na na na na 0 na 0 0 0 na na 1
Gambia 1 0 1 na 1 0 0 0 0 0 0 0 2
Ghana 1 1 1 1 1 1 0 0 0 0 na na 5
154
IYCF in difficult circumstances (Infant feeding in emergency)
Country
Nat
ion
al IY
CF
po
licy
incl
ud
es IY
CF
in
Emer
g.
Nat
ion
al
Emer
g.p
rep
ared
nes
s
pla
n in
clu
de
IYC
F in
Em
erg.
Nat
ion
al E
mer
g.
Pre
p.
Pla
n u
pd
ated
*
Up
-to
-dat
e gu
idel
ines
/tra
inin
g
mat
eria
ls o
n IY
CF
in
Emer
g.
HW
s/IY
CF
cou
nse
llors
tra
ined
o
n IY
CF
in E
me
rg.
Trai
nin
g m
ater
ials
p
rete
sted
Effe
ctiv
enes
s o
f m
essa
ges
test
ed
Bas
elin
e o
n K
AP
con
du
cted
Po
st-i
nte
rven
tio
n o
f
KA
P c
on
du
cted
BM
S p
rovi
ded
in
emer
gen
cies
Go
vt
pro
cure
s/d
istr
ibu
te
BM
S d
uri
ng
emer
gen
cies
Go
vt a
ccep
t
do
nat
ion
s o
f in
fan
t
foo
ds
IF in
Em
erg
en
cies
SCO
RE
Liberia 0 na na na na na na na na na 0 0 0
Mali 1 0 - na 1 1 1 0 0 1 0 1 6
Mauritania 1 1 1 0 0 1 na 0 0 1 na 1 5
Niger 1 0 na na 0 na 0 na na 0 na na 1
Nigeria 1 1 1 1 1 1 0 1 1 0 0 0 7
Senegal 1 1 1 na 0 na 1 1 1 1 1 1 7
S. Leone 0 0 na na 1 0 0 0 0 0 na na 1
Togo 1 1 1 1 1 1 1 1 0 0 na na 7
Number 12 8 7 3 7 5 5 5 3 4 1 3
Total 16 14 10 6 15 10 14 13 13 14 7 8
Percent 75.0 57.1 70.0 50.0 46.7 50.0 35.7 38.5 23.1 28.6 14.3 37.5 M =3.1
ALL 26 24 15 9 14 9 6 9 4 15 4 10 2.1
Number 63 59 59 27 58 58 49 41 36 61 29 29
Total 41.3 40.7 25.4 33.3 24.1 15.5 12.2 22.0 11.1 24.6 13.8 34.5
Percent
na= no response /not applicable, 1=Yes, 0= No, 1= yes, 0=no Nutritionally vulnerable countries highlighted in yellow.
155
ANNEX 5S:
Overall IYCF in difficult circumstances
Country HIV and IF
SUB-SCORE IF in Emergencies
SUB-SCORE IYCF in Diff. Circums.
SCORE
CEE/CIS
Uzbekistan 9 2 5
Romania 7 0 3
Kosovo 4 0 2
Kazakhstan 2 0 1
Bosnia & Herz. 2 2 2
Turkmenistan 8 0 4
Tajikistan 7 2 4
Kyrgyzstan 7 2 4
Mean 6 1 3
EAPR
Vietnam 8 2 5
Philippines 7 5 6
China 8 5 6
Thailand 6 4 5
Vanuatu 7 4 5
Indonesia 2 4 3
Myanmar 7 2 4
Korea 1 2 1
P. N. Guinea 8 1 4
Lao PDR 8 0 4
Mongolia 3 0 1
Fiji 8 1 4
Timor Leste 3 2 2
Cambodia 9 2 5
Mean 6 2 4
ESAR
Rwanda 9 2 5
Zimbabwe 9 1 5
Mozambique 8 0 4
Zambia 9 0 4
Malawi 6 2 4
Swaziland 8 2 5
Namibia 7 0 3
South Africa 7 2 4
Kenya 6 2 4
Ethiopia 5 1 3
Botswana 3 2 2
Madagascar 7 2 4
Burundi 3 0 1
Angola 3 0 1
Uganda 8 2 5
Tanzania 8 2 5
Somalia 7 0 3
Mean 7 1 4
Country HIV and IF IF in Emergencies IYCF in Diff. Circums.
156
SUB-SCORE SUB-SCORE SCORE
MENA
Yemen 3 3 3
S. Sudan 3 4 3
N. Sudan 3 3 3
Mean 3 3 3
ROSA
Afghanistan 6 2 4
Bangladesh 5 2 3
Bhutan 6 2 4
India 3 0 1
Nepal 3 3 3
Sri Lanka 3 5 4
Mean 4 2 3
WCAR
Benin 9 0 4
B. Faso 8 2 5
CAR 8 2 5
Congo B. 9 5 7
Cote D'Ivoire 8 0 4
DRC 7 2 4
Gabon 6 1 3
Gambia 8 2 5
Ghana 9 5 7
Liberia 4 0 2
Mali 6 6 6
Mauritania 5 5 5
Niger 6 1 3
Nigeria 6 7 6
Senegal 4 7 5
S. Leone 4 1 2
Togo 3 7 5
Mean 6 3 5
TOTAL MEAN 6 2 4
na= no response /not applicable, 1=Yes, 0= No
157
ANNEX 5t:
IYCF Monitoring and evaluation
National level M&E system
M&E at the health system level
M&E at the Community-
level
COUNTRY
M & E for
national
IYCF
undertaken
Baseline
assessment
of EBF
rate
available
Baseline
assessment
of barriers
and
facilitators
for
breastfeeding
available eg.
KAP study
Baseline
assessment
of CF
situation
available
Ongoing
food
security
surveillance
system
Ongoing
nutrition
surveillance
system
Routine
monitoring
of ongoing
IYCF
activities?
Routine
monitoring
of skills of
health
workers?
Routine
monitoring
of quality
of
counseling
_e.g. KAP
surveys of
mothers_?
Monitoring
of other
program
process
indicators
_e.g. # HW
trained)
Evaluation
or review
of IYCF
situation?
Routine
monitoring
of ongoing
IYCF
activities in
the
community?
Routine
monitoring
of skills of
community
health
workers?
Routine
monitoring
of quality
of
counseling
by CHW
_e.g. KAP
surveys of
mothers_?
M&E
Score
CEE/CIS
BOSNIA AND
HERZEGOVINA
0 1 0 1 0 0 0 1 0 0 0 0 1 0
3
KAZAKASTAN 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1
Kosovo 0 1 0 0 0 0 na na na na na na na na 1
KYRGYZSTAN 1 na 1 1 1 1 1 0 0 1 0 0 0 5
Romania 0 0 0 0 0 0 0 na na 0 0 0 na na 0
Tajikistan 1 1 1 1 1 1 1 1 1 0 1 na 0 0 7
Turkemnistan 0 1 1 1 1 0 0 0 0 0 1 na na na 3
UZBEKISTAN 1 0 0 0 0 0 1 1 0 1 1 na na 3
n 3 5 2 4 4 2 3 4 1 1 4 0 1 0
N 8 7 8 8 8 8 7 6 6 7 7 4 4 5 M
% 37.5 71.4 25.0 50.0 50.0 25.0 42.9 66.7 16.7 14.3 57.1 0.0 25.0 0.0 3
EAPR
Cambodia 1 1 1 1 na na 1 1 1 1 0 1 1 0 7
China 1 0 1 1 1 1 0 0 0 0 0 0 0 0 3
Fiji 0 1 1 0 0 1 0 0 0 0 0 0 0 0 2
Indonesia 1 1 1 1 na 1 1 0 0 0 0 na na na 4
Korea na 1 0 1 na na na na na na na na na na 1
Lao People's 1 1 1 1 0 0 0 0 0 1 0 na na na 3
158
National level M&E system
M&E at the health system level
M&E at the Community-
level
COUNTRY
M & E for
national
IYCF
undertaken
Baseline
assessment
of EBF
rate
available
Baseline
assessment
of barriers
and
facilitators
for
breastfeeding
available eg.
KAP study
Baseline
assessment
of CF
situation
available
Ongoing
food
security
surveillance
system
Ongoing
nutrition
surveillance
system
Routine
monitoring
of ongoing
IYCF
activities?
Routine
monitoring
of skills of
health
workers?
Routine
monitoring
of quality
of
counseling
_e.g. KAP
surveys of
mothers_?
Monitoring
of other
program
process
indicators
_e.g. # HW
trained)
Evaluation
or review
of IYCF
situation?
Routine
monitoring
of ongoing
IYCF
activities in
the
community?
Routine
monitoring
of skills of
community
health
workers?
Routine
monitoring
of quality
of
counseling
by CHW
_e.g. KAP
surveys of
mothers_?
M&E
Score
Democratic
Republic
Mongolia 1 1 0 1 0 1 1 1 0 0 1 0 na na 5
MYANMAR na 1 1 1 na 1 1 0 0 0 1 0 na na 4
Papua New Guinea 0 1 1 1 0 1 0 0 0 0 1 0 0 0 3
Philippines 1 1 1 na na na 1 na 0 1 1 na 0 na 4
Thailand 1 1 1 na na na 1 na na na 0 na na na 3
TIMOR-LESTE na 1 1 1 1 1 1 0 0 0 1 0 0 0 4
Vanuatu 0 1 1 1 0 1 0 0 0 0 1 0 0 0 3
VIETNAM 1 1 1 1 1 1 1 1 0 1 1 1 0 0 7
n 8 13 12 11 3 9 8 3 1 4 7 2 1 0
N 11 14 14 12 8 10 13 11 12 12 13 9 8 7 M
% 72.7 92.9 85.7 91.7 37.5 90.0 61.5 27.3 8.3 33.3 53.8 22.2 12.5 0.0 4
ESAR
Angola 0 1 1 0 1 0 0 0 0 0 0 0 0 0 2
Botswana 1 1 na 0 1 1 0 na na 0 1 na na na 3
Burundi 0 1 1 1 1 1 0 0 0 0 0 0 0 0 3
Ethiopia 1 1 0 1 1 0 0 na na 1 0 0 0 0 3
Kenya 1 1 1 1 1 0 0 0 0 0 1 1 1 0 5
Madagascar 1 1 1 0 1 1 0 0 0 0 0 1 1 1 5
Malawi 1 1 0 1 1 1 1 1 0 1 1 0 0 na 6
Mozambique 1 1 1 0 1 1 1 0 0 1 0 0 0 0 5
NAMIBIA 1 1 1 0 0 na 0 0 0 0 0 0 0 0 2
RWANDA 1 1 1 1 1 1 1 1 1 0 1 1 1 1 9
159
National level M&E system
M&E at the health system level
M&E at the Community-
level
COUNTRY
M & E for
national
IYCF
undertaken
Baseline
assessment
of EBF
rate
available
Baseline
assessment
of barriers
and
facilitators
for
breastfeeding
available eg.
KAP study
Baseline
assessment
of CF
situation
available
Ongoing
food
security
surveillance
system
Ongoing
nutrition
surveillance
system
Routine
monitoring
of ongoing
IYCF
activities?
Routine
monitoring
of skills of
health
workers?
Routine
monitoring
of quality
of
counseling
_e.g. KAP
surveys of
mothers_?
Monitoring
of other
program
process
indicators
_e.g. # HW
trained)
Evaluation
or review
of IYCF
situation?
Routine
monitoring
of ongoing
IYCF
activities in
the
community?
Routine
monitoring
of skills of
community
health
workers?
Routine
monitoring
of quality
of
counseling
by CHW
_e.g. KAP
surveys of
mothers_?
M&E
Score
Somalia 1 1 1 1 1 1 1 0 0 1 1 1 0 0 7
South Africa 1 1 1 0 0 0 1 0 0 1 0 1 0 0 4
SWAZILAND 0 1 0 1 1 1 0 0 0 0 1 0 0 0 3
Tanzania 0 1 0 0 1 1 1 0 0 1 0 0 0 0 3
UGANDA 1 1 0 0 1 0 0 0 0 0 1 0 0 0 3
Zambia 1 1 0 1 1 1 0 na na 1 1 0 0 na 5
Zimbabwe 1 1 0 1 1 1 0 0 0 0 0 0 0 0 3
n 13 17 9 9 15 11 6 2 1 7 8 5 3 2
N 17 17 16 17 17 17 17 14 14 17 17 16 16 14 M
% 76.5 100.0 56.3 52.9 88.2 64.7 35.3 14.3 7.1 41.2 47.1 31.3 18.8 14.3 4
MENA
North Sudan 1 1 1 1 1 1 1 0 0 1 0 0 0 0 5
South Sudan 0 1 0 0 1 1 0 0 0 0 0 na na na 2
YEMEN 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
n 1 3 1 1 2 2 1 0 0 1 0 0 0 0
N 3 3 3 3 3 3 3 3 3 3 3 2 2 2 M
% 33.3 100.0 33.3 33.3 66.7 66.7 33.3 0.0 0.0 33.3 0.0 0.0 0.0 0.0 3
ROSA
AFGHANISTAN 1 1 1 0 0 0 1 0 0 0 0 1 1 0 4
BANGLADESH 0 1 1 1 1 1 1 1 0 0 1 0 0 0 5
Bhutan 0 1 1 1 0 1 0 na na 0 1 0 0 0 3
India 1 1 1 1 0 1 1 1 1 na 1 na 0 0 6
Nepal 0 1 1 1 1 0 0 0 0 0 1 0 0 0 3
160
National level M&E system
M&E at the health system level
M&E at the Community-
level
COUNTRY
M & E for
national
IYCF
undertaken
Baseline
assessment
of EBF
rate
available
Baseline
assessment
of barriers
and
facilitators
for
breastfeeding
available eg.
KAP study
Baseline
assessment
of CF
situation
available
Ongoing
food
security
surveillance
system
Ongoing
nutrition
surveillance
system
Routine
monitoring
of ongoing
IYCF
activities?
Routine
monitoring
of skills of
health
workers?
Routine
monitoring
of quality
of
counseling
_e.g. KAP
surveys of
mothers_?
Monitoring
of other
program
process
indicators
_e.g. # HW
trained)
Evaluation
or review
of IYCF
situation?
Routine
monitoring
of ongoing
IYCF
activities in
the
community?
Routine
monitoring
of skills of
community
health
workers?
Routine
monitoring
of quality
of
counseling
by CHW
_e.g. KAP
surveys of
mothers_?
M&E
Score
Sri Lanka 1 1 1 1 0 1 1 1 1 1 0 0 0 0 6
n 3 6 6 5 2 4 4 3 2 1 4 1 1 0
N 6 6 6 6 6 6 6 5 5 5 6 5 6 6 M
% 50.0 100.0 100.0 83.3 33.3 66.7 66.7 60.0 40.0 20.0 66.7 20.0 16.7 0.0 5
WCAR
Gambia 1 1 1 0 1 1 1 0 0 1 1 1 0 0 6
BENIN 0 1 1 0 1 0 0 0 0 0 1 0 0 0 3
Burkina Faso 1 1 1 1 1 1 0 0 0 1 0 1 1 0 6
CAR 1 1 0 0 1 0 0 1 1 1 1 0 0 0 5
Congo Brazzaville na 1 0 0 0 1 0 na na 0 1 0 0 0 2
Cote d'Ivoire 0 na na na na na 0 na na na na na na na 0
DRC 1 1 1 1 1 1 1 1 1 0 1 0 na na 7
GABON 0 1 na 1 0 1 1 1 1 0 1 na na na 5
Ghana 1 1 1 1 1 0 1 1 0 1 1 1 1 0 7
Liberia 1 1 1 1 1 0 0 na na na na na na na 3
MALI 1 1 0 0 1 1 1 0 0 0 0 1 1 0 5
MAURITANIA 1 1 1 1 1 1 1 0 0 1 1 1 0 0 7
NIGER 1 1 0 1 1 1 na 0 0 0 0 0 0 0 3
Nigeria 0 1 1 1 1 1 1 1 1 1 1 1 1 1 9
Senegal 1 1 1 1 1 1 0 na na na 1 na 1 1 6
Sierra Leone 0 1 1 0 0 1 1 0 na 0 0 1 1 0 4
Togo 1 1 1 1 1 1 1 1 1 na 1 1 1 1 9
n 11 16 11 10 13 12 9 6 5 6 11 8 7 3
N 16 17 15 16 16 16 16 14 12 13 15 13 13 13 M
161
National level M&E system
M&E at the health system level
M&E at the Community-
level
COUNTRY
M & E for
national
IYCF
undertaken
Baseline
assessment
of EBF
rate
available
Baseline
assessment
of barriers
and
facilitators
for
breastfeeding
available eg.
KAP study
Baseline
assessment
of CF
situation
available
Ongoing
food
security
surveillance
system
Ongoing
nutrition
surveillance
system
Routine
monitoring
of ongoing
IYCF
activities?
Routine
monitoring
of skills of
health
workers?
Routine
monitoring
of quality
of
counseling
_e.g. KAP
surveys of
mothers_?
Monitoring
of other
program
process
indicators
_e.g. # HW
trained)
Evaluation
or review
of IYCF
situation?
Routine
monitoring
of ongoing
IYCF
activities in
the
community?
Routine
monitoring
of skills of
community
health
workers?
Routine
monitoring
of quality
of
counseling
by CHW
_e.g. KAP
surveys of
mothers_?
M&E
Score
% 68.8 94.1 73.3 62.5 81.3 75.0 56.3 42.9 41.7 46.2 73.3 61.5 53.8 23.1 5
ALL COUNTRY M
n 39 60 41 40 39 40 31 18 10 20 34 16 13 5 4
N 61 64 62 62 58 60 62 53 52 57 61 49 49 47
% 63.9 93.8 66.1 64.5 67.2 66.7 50.0 34.0 19.2 35.1 55.7 32.7 26.5 10.6