1992

Accreditation of the first Mother and Baby Friendly Hospital. (La Paz –Bolivia)

1992 - 1997

Implementation of MBFHI

2006

Reactivation of the MBFHI under the leadership from the Ministry of Health and Sports.

Passing of Law 3460 on “Promotion of Breastfeeding and Marketing of Substitutes”.

2007

Publication of Technical Policy on MCFHI

2009

Approval of D.S. 0115 To Regulate Law 3460.

HISTORICAL MILESTONES OF MCFHI IN BOLIVIA

2013

Inclusion of the Initiative in First Level health system.

2014

Approval of the Specific Regulation on Infringements and sanctions to Law 3460.

2016

Plan for Economic and Social Development 2016 - 2020 & Health Sector Plan

- Pilar 8 Food

Sovereignty, Goal: Remove hunger, undernutrition and reduce malnutrition, Result:

To promote an increase of EBF to 84%

HISTORICAL MILESTONES OF MCFHI IN BOLIVIA

0

10

20

30

40

50

60

70

< 2 meses 2 -3 meses 4-5 meses Menor de 6 meses

68.5

53.2

35.6

46

69.5

56

39.5

54

69.6 68.8

43.6

60

0 0 0

64.3

ENDSA 1998 ENDSA 2003 ENDSA 2008 ESNUT 2012

EVOLUTION OF EXCLUSIVE BREASTFEEDING AMONG CHILDREN UNDER 6 MONTHS IN BOLIVIA DHS 1998-2003-2008

months months months Under 6 months

• With the support of the National Breastfeeding during 2007 & pursuant of Law 3460, step 11 is included in all the health system.

“Eradicate free and indiscriminate distribution of breast-milk substitutes”.

MOTHER AND CHILDHOOD FRIENDLY HOSPITAL INITIATIVE IN BOLIVIA – MODIFICATION OF THE TEN STEPS

• Bolivia defines 90% as standard for the approval of accomplishment of the 11 steps, with the purpose of seeking excellence and quality of care for mothers and newborns. • The percentage was modified in all Initiative tools.

• To ensure sustainability of the Initiative, it will be integrated into the National Accreditation System for Health Services in the Country.

ACCREDITATION STANDARD

Bolivia includes in the national health information system (SNIS-VE), the following indicators:

Percentage of newborns with early attachment (skin-to-skin) for one hour

Percentage of girls and boys under 6 months with Exclusive Breastfeeding

Percentage of newborns with rooming-in

Percentage of newborns with early Breastfeeding initiation

NATIONAL HEALTH INFORMATION SYSTEM – EPIDEMIOLOGICAL SURVEILLANCE EPIDEMIOLOGICA (SNIS-VE) INCLUDES BF INDICATORS

0 0 0 0 2

1

6

16

25

2 0

4

1 0

3

6 5

21

0 2 2

1 0 0

1 2

8

0

5

10

15

20

25

30

2009 2010 2011 2012 2013 2014 2015 2016 TOTAL

I Nivel II Nivel III Nivel

HEALTH INSTITUTIONS OF THE PUBLIC SYSTEM AND SHORT-TERM SECURITY SOCIAL SYSTEM ACCREDITED FROM 2009 TO 2016

• Law for breastfeeding promotion, including the Initiative, key for the implementation process.

• Identification and support by key staff to lead the implementation process in each health institution.

• Commitment of heads of health institutions.

• Individual certification for health staff as stimulus for the implementation of the Initiative.

• Institutionalization through the adoption of the Initiative as public policy under the decentralized system with budgetary allocation in the Economic Social and Sectoral Development Plan, programs and Project of the MOH (Zero Undernutrition Program).

• Institutionalization of a technical team at national level to lead breastfeeding-related activities.

LESSONS LEARNED

• Insert breastfeeding, including MCFHI in preservice curriculum.

• Implement a monitoring and re-assessment system for ongoing improvement of quality of care in health services.

• Identify a sustainable support system for mothers after discharge.

• Include sensitive indicators in the National Health System. • Seek alternative training alternatives for MCFHI

throughout the health system.

CHALLENGES

RECOMMENDATIONS

G R A C I A S