Infant and Young Infant and Young Child Feeding in Child Feeding in 

Dadaab:Dadaab:Improving practices Improving practices in a protracted crisisin a protracted crisis

Mary LungMary Lung’’aho, CARE aho, CARE on behalf of on behalf of 

Interagency Dadaab IYCF TeamInteragency Dadaab IYCF Team

UNHCR, CARE & PartnersUNHCR, CARE & Partners

October 14, 2009October 14, 2009

IYCF Support in Dadaab: an Interagency Effort  IYCF Support in Dadaab: an Interagency Effort  

Dadaab IYCF Team MembersDadaab IYCF Team Members

UNHCR*UNHCR*

CARE*CARE*

GTZ*GTZ*

NCCKNCCK

IRC*IRC*

ACFACF

MSFMSF‐‐Swiss*Swiss*

* = current* = current

ObjectivesObjectives

Integrate support for Integrate support for appropriate IYCF into appropriate IYCF into multimulti‐‐sectoral sectoral programmingprogramming

Strengthen capacity of Strengthen capacity of staff/workers and staff/workers and partners to support partners to support IYCF in emergency IYCF in emergency contextscontexts

Protracted EmergencyProtracted EmergencyDadaab Refugee Camps in KenyaDadaab Refugee Camps in Kenya

Dadaab CampsDadaab Camps

Strengthening the SystemStrengthening the SystemWhat are the key elements?What are the key elements?

Orientation for all staff

Rapid assessment of new arrivals

Capacity‐building for staff & volunteers

IYCF support in on‐going programming

Behavior change communications

Monitoring

Health Post

Health Post

Dadaab IYCF Team UNHCR—CARE—GTZ—NCCK

AAH—Save UK

Hagadera Hospital Ifo Hospital Dagahaley Hospital

Health Post

IYCF Coordinating Team:

IYCF Health Post Team

IYCF Community Workers Health Post Staff • ANC consultant • Under five consultant • HIS staff • EPI staff • SFP and OTP staff

UNHCR Nutritionist CARE IYCF Supervisor GTZ Nutrition Coordinator NCCK

Community Workers • CHWs- Community Health Workers • TBAs- Traditional Birth Attendants • CDWs- Community Dev Workers • RHMs- Repro. Health Motivators • CPWs- Children Protection Workers

Community Volunteers-IYCF Counselors Mother-to-Mother Support Groups Secondary Targets

• Men’s support groups • School clubs • Youth groups • etc.

IYCF Officer. • Maternity staff • Pediatric staff • Under five

consultant • HIS staff • SC staff • PMTCT • etc.

IFE: Why it MattersIFE: Why it Matters

Key policy guidance:  Key policy guidance:  IFE Core Group: IFE Core Group: Ops GuidanceOps Guidance

Challenges in Challenges in implementationimplementation

Role and Role and responsibilities of all responsibilities of all sectorssectors

CME for medical staffCME for medical staff

Orientation for all staffOrientation for all staff

Ensure staff have Ensure staff have basic knowledgebasic knowledge

Rapid Assessment for New ArrivalsRapid Assessment for New Arrivals

Identify acute Identify acute feeding and care feeding and care problems needing problems needing immediate immediate attentionattention

Provide critical Provide critical informationinformation

Link to support Link to support systemssystems

Orientation & CapacityOrientation & Capacity‐‐Building MaterialsBuilding MaterialsOrientation:  interagency Orientation:  interagency Ops Guidance  & IFE Ops Guidance  & IFE Core Group Mod 1Core Group Mod 1

WHO/UNICEF BF WHO/UNICEF BF Counselling Counselling course (40 hr) course (40 hr) 

IYCF CommunityIYCF Community‐‐Focused Focused and Cand C‐‐F Plus (incorporates F Plus (incorporates ENA content) ApproachesENA content) Approaches

MotherMother‐‐toto‐‐Mother Mother Support Group:  Facilitator Support Group:  Facilitator TrainingTraining

Integration of IYCF Support Integration of IYCF Support into CTC/CMAMinto CTC/CMAM

CapacityCapacity‐‐BuildingBuildingIYCF CommunityIYCF Community‐‐Focused ApproachFocused Approach

Integration of IYCF Support into CTC/CMAM Integration of IYCF Support into CTC/CMAM 

CapacityCapacity‐‐Building:  Breastfeeding Counselling  Building:  Breastfeeding Counselling  WHO/UNICEF 40WHO/UNICEF 40‐‐hour coursehour course

CommunityCommunity‐‐Focused TrainingFocused Training

Strengthening Assessment Strengthening Assessment & Counselling Skills& Counselling Skills

Staff & Workers:  HandsStaff & Workers:  Hands‐‐on Practiceon Practice

Peer Support:  MtMSGPeer Support:  MtMSG

Camp Blocks showing Mother Support Group LocationsCamp Blocks showing Mother Support Group Locations

BCC ActivitiesBCC ActivitiesTransporting a video between health postsTransporting a video between health posts

IEC MaterialsIEC Materials

IYCF Support ActivitiesIYCF Support ActivitiesIYCF Counsellors:  staff, CHW incentive workers and mother volunteers (234 CHWs, 214 trained‐to‐date as IYCF Counsellors;  32 Trainers)Identified Contact Points (facility and community) to visit and counsel pregnant and lactating womenIYCF  counselling cards and other job aids for community workers Mother support groups spread throughout the blocks:   currently 658 functioning groups (610 with trained facilitators)Activities to engage community  ‐‐ including men;  involve religious leadersInstructional videos and action‐oriented educational talks in health postsFeedback to community

Tracking our ProgressTracking our ProgressHas it made a difference?Has it made a difference?

Monitoring of programme activities

Age‐disaggregation in UNHCR HIS

Annual nutrition survey

Measures child nutritional status

Provides coverage data

Tracks IYCF practices at population level using globally‐agreed indicators

Step‐by‐Step GUIDE to Collecting and Analyzing IYCF Data, with Tools

Annual nutrition surveysAnnual nutrition surveys

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

2005 2006 2007 2008 2009

Exclusive BF Dadaab 2005‐2009

Percent EBF Dag Hag Ifo

Projected EBF Rate from Baseline

IYCF Program Start

Influx of New Refugees

African Countries:  EBF 0African Countries:  EBF 0‐‐<6 Months<6 MonthsUNICEF State of the WorldUNICEF State of the World’’s Children 2009 s Children 2009 

& & 

EBF 0EBF 0‐‐<6 Months in Dadaab:  2005 & 2009<6 Months in Dadaab:  2005 & 2009

2424

0

10

20

30

40

50

60

70

80

90

100

Djibouti

Chad

Cote d'Ivoire

Dadaab 2005

Gabon

Algeria

South Africa

Sierra Leone

Niger

Somalia

Angola

Zimbabwe

Kenya

Guinea‐Bisseau

Nigeria

Congo

Cameroon

Central African Republic (CAR)

Namibia

Guinea

Mozambique

Swaziland

Botswana

Senegal

Liberia

DRC

Lesotho

Mali

Gambia

Tanzania

Benin

Burundi

Dadaab 2009

Ethiopia

Eritrea

Ghana

Cape Verde

Malawi

Uganda

Zambia

Madagascar

Rwanda

Exclusive Breastfeeding  0 <6  months

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

2005 2006 2007 2008 2009

Global Acute Malnutrition Dadaab 2005‐2009

Percent GAM Dag Hag Ifo

Ongoing ChallengesOngoing ChallengesContinued population influx:  134,000 to 289,307 …

Limited diet options

Quality:  limited food commodity diversity

Quantity:  continued pressure from influx

Concerns for maternal nutrition & care  

Post‐training mentoring of workers & volunteers

Ongoing staff turnover

Others …

This year:  transition to UNHCR coordination

The Dadaab experience suggests The Dadaab experience suggests that IYCF practices can be protected, that IYCF practices can be protected, and even improved, in some and even improved, in some emergency contexts. emergency contexts. 

Thank You!Thank You!