Roadmap to Baby Friendly Hospital

1. Roadmap to Baby Friendly Hospital Hesham Al-Girim ,MD Consultant Neonatologist Chairman, Pediatrics Department National Guard Health Affairs-Eastern Region

2. Outlines • Historical Background • KAH initiative • KAH Breastfeeding Committee formation • Initial Self appraisal • Experts assessment visit ( by whom? How?) • Assessment tool • Plan ( polices, training, changing practices) • Ten steps implementation in KAH • Final Self appraisal • Local committee assessment • National committee accreditation • Post accreditation ( training center, research)

3. Historical Background • Baby Friendly Hospital Initiative BFHI • International Code of Marketing of Breast milk Substitutes

4. BFHI • 1939 Dr. Cicely Williams speaks out against Milk and Murder • 1960s Dr. Derrick Jelliffe warned against Commerciogenic malnutrition • 1970s Nestlé faces negative publicity, lawsuit and consumer boycott • 1979 WHO/UNICEF recommends development of an international code • 1981 World Health Assembly adopts Code

5. BFHI • 1989 Joint WHO/UNICEF Statement: The special Role of Maternity Services to Protect Promote Breastfeeding • 1990 Innocenti Declaration pushes for Code Implementation • 1991 WHO/UNICEF launch Baby-Friendly Hospital Initiative BFHI • 1996 World Health Assembly addresses complementary feeding and the Code • 2002 World Health Assembly endorses the IYCF guidelines

6. INNOCENTI DECLARATIONOn the Protection, Promotion and Support of BreastfeedingFlorence, Italy-1 August 1990 • Produced and adopted by participants at the WHO/UNICEF policymakers' meeting on "Breastfeeding in the 1990s • WE THEREFORE DECLARE that • As a global goal for optimal maternal and child health and nutrition, all women should be enabled to practice exclusive breastfeeding and all infants should be fed exclusively on breastmilk from birth to 4-6 months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, for up to two years of age or beyond

7. The Baby Friendly Hospital Initiative (BFHI) • The Baby Friendly Hospital Initiative (BFHI), was launched by James P. Grant, Executive Director of UNICEF, and Hiroshi Nakajima, Director-General of WHO in 1991 • BFHI is thus a strategy to encourage the implementation of the "Ten Steps to Successful Breastfeeding". These steps were contained in a joint WHO/UNICEF statement (1989) entitle: "Protecting, promoting and supporting breastfeeding the special role of Maternity Service"

8. Goals of the Baby-friendly Hospital Initiative 1. To transform hospitals and maternity facilities through implementation of the “Ten steps”. 2. To end the practice of distribution of free and low-cost supplies of breast-milk substitutes to maternity wards and hospitals. Slide 3.8

9. Why we want to be aBaby Friendly Hospital? • Giving babies best start in life. • Improving babies health and decrease mortality and morbidity. • Improves mothers health. • To follow the instructions of WHO and UNICEF

10. Initial Self Appraisal Expert visit and assessment Action Plan Policies Training Changing Practices Ten Steps Implementation Final Self Appraisal Local Committee Assessment National Committee Assessment Accreditation

11. Accreditation Post Accreditation Maintenance of the Program Training Center for Breastfeeding Community awareness Researches Lecture in the General Orientation Lecture in the General Orientation Breastfeeding Room for the KAH female Employees International Lactation conference ( November 2011) BFHI support team

12. KAH Breastfeeding Committee Formation, Charges KAH Breastfeeding Committee formation, in March 2008

13. KAH Breastfeeding Committee Members • Chairman: DCN, Maternal/Child Health & NGHA-KAH • Co- Chairman: Director, Nursing Education • Members: • Chairman, Department of Pediatrics • Patient Educator, Patient Services • Nurse Manager, NICU/ICN/Nursery • Nurse Manager, Pediatric Ward and PICU • Nurse Manager, Labor and Delivery • Nurse Manager, Ward 1/Ob Gyne • Nurse Manager, Home Health Care • Assistant Nurse Manager,NICU/ICN/Nursery • Assistant Nurse Manager, Pediatric Ward 4 and PICU • Family physician, PHC • Patient Educator, PHC

14. Local Committee assessment

15. Breastfeeding Committee Charges To promote, protect and support successful breastfeeding for mothers and to achieve the goal of being “Baby Friendly” Hospital in Accordance with the BFHI’s 10 Steps to Successful breastfeeding

16. Goals • Getting accreditation • Training center (20h, 40h, 80h approved by SCHC,WHO,UNICEF) • Researches • Community awareness • International Breastfeeding week • Health awareness for the women's in the local communities (Mosque, housing compound) • Health awareness for the school female students

17. Action Plan Invite 2 experts: • Breastfeeding advocate • Lactation Consultant They did the Initial assessment in the 7th of May 2008

18. THE HOSPITAL SELF-APPRAISAL TOOL Completion of this initial self-appraisal checklist is the first stage of the process, But doesn't in itself qualify the hospital for designation as Baby-friendly

21. We have a breastfeeding policy Staff receive breastfeeding training Breastfeeding education during pregnancy “Skin to skin” contact immediately after birth Help mothers to start and maintain breastfeeding Breast milk is all babies need Keep mothers and babies together Baby-led feeding No teats or dummies for breastfeeding babies Breastfeeding support following discharge Ten Steps to Successful Breastfeeding Every facility providing maternity services and care for newborn infants should: From: Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services A Joint UNICEF/WHO Statement, 1989

22. STEP 1. Have a written breastfeeding policy that is routinely communicated to all health care staff

23. STEP 2. Train all health care staff in skills necessary to implement the policy

24. Summary Clinical Staff Training Report

25. STEP 3. Inform all pregnant women about the benefits and management of breastfeeding

26. STEP 4. Help mothers initiate breastfeeding within a half-hour of birth

27. STEP 5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants

28. STEP 6. Give newborn infants no food or drink other than breast milk, unless medically indicated

29. STEP 7. Practice rooming-in-allow mothers and infants to remain together – 24 hours a day

30. STEP 8. Encourage breastfeeding on demand

31. STEP 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants

32. STEP 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

33. The International code of marketing of breast-milk substitutes Slide 3.33

34. Aim To contribute to the provision of safe and adequate nutrition for infants by: • the protection and promotion of breastfeeding, and • ensuring the proper use of breast-milk substitutes, when these are necessary, on basis of adequate information and through appropriate marketing and distribution. Slide 3.34

35. Scope Marketing, practices related, quality and availability, and information concerning the use of: • breast-milk substitutes, including infant formula • other milk products, foods and beverages, including bottle-fed complementary foods, when intended for use as a partial or total replacement of breast milk • feeding bottles and teats Slide 3.35

36. The International Code of Marketing of Breast-milk Substitutes Summary of the main points • No advertising of breast-milk substitutes and other products to the public • No donations of breast-milk substitutes and supplies to maternity hospitals • No free samples to mothers • No promotion in the health services • No company personnel to advise mothers • No gifts or personal samples to health workers • No use of space, equipment or educational materials sponsored or produced by companies when • teaching mothers about infant feeding • No pictures of infants or other pictures idealizing artificial feeding on the labels of the products • Information to health workers should be scientific and factual • Information on artificial feeding, including labels, should explain the benefits of exclusive • breastfeeding and the costs and dangers associated with artificial feeding • Unsuitable products, such as sweetened condensed milk, should not be promoted for babies.

38. Compliance with the International Code of Marketing of Breast-milk Substitutes

41. Specific purposes of monitoring and reassessment • To support and motivate facility staff to maintain baby-friendly practices • To verify whether mothers’ experiences at the facility are helping them to breastfeed • To identify if the facility is doing poorly on any of the Ten Steps and thus whether needs to do further work to make needed improvements

42. How can the facility itself maintain standards? • Self-Appraisal Tool • Chart review • Review of “mother or baby cards” or “passports” • Review of hospital infant feeding policies • Review of training materials and records • Review of receipted invoices • Micro-planning • Data collection during home visits • Pediatric re-admissions

43. Hospital external assessment tool To determine if the hospital meets the criteria for “Baby-friendly" designation

44. Preparing for the external assessment • written breastfeeding/infant feeding policy covering all Ten Steps to Successful breastfeeding • written policy addressing mother-friendly care, if included in the criteria • written curriculum for training given to hospital staff caring for mothers and babies on breastfeeding management, feeding of the non-breastfeeding infant, and mother-friendly care • An outline of the content covered in antenatal health education on these topics

45. Preparing for the external assessment Proof of purchase of infant formula and various related supplies A list of the staff members who care for mothers and/or babies and the numbers of hours of training they have received on required topics.

46. OR Meets most Global Criteria and has at least 75% of mothers exclusively breastfeeding from birth to discharge Recognizes need for improvements but is unable to meet the standard at this point Requests Certificate of Commitment and proceeds to analyze areas which need to be modified Invites external assessment team to carry out formal evaluation Meets the global criteria for Baby-friendly designation Is unable to meet the Global Criteria at this time Awarded Baby-friendly Status Implements plan of action to raise standard, then carries out further self-assessment in preparation for evaluation by the external assessors Awarded Certificate of Commitment and encouraged to make necessary modifications prior to re-assessment The route to Baby-friendly designation

47. Differences between monitoring and reassessment Monitoring • Measures progress on the “10 steps” • Identifies areas needing improvement and helps in planning actions • Can be organized by the hospital or by the national BFHI coordination group Reassessment • Evaluates whether the hospital meets the Global Criteria for the “10 steps” • Same, but also used to decide if hospital should remain designated “Baby-friendly” • Is usually organized by the national BFHI coordination group

48. Differences between monitoring and reassessment • Monitoring • Can be performed by monitors “internal” to the hospital or from outside • Quite inexpensive if performed “internally” • Can be done frequently • Reassessment • Must be performed by “external” assessors • Somewhat more costly, as requires “external” assessors • Usually scheduled less frequently

49. Referrals to HHC

50. Refarral to HHC • PHC postnatal breastfeeding clinic, will baby clinic • Phone counselling • We are proceed breastfeeding support clinic