World Breastfeeding Trends Initiative World Breastfeeding Trends Initiative (WBT(WBTii))

Perspectives in challenges and future Perspectives in challenges and future actionsactions

Name of the Speaker:Name of the Speaker:

Prof. Prakash S. ShresthaProf. Prakash S. Shrestha

PresidentPresident

Nepal Breastfeeding Promotion ForumNepal Breastfeeding Promotion Forum

Name of the Country: NEPAL

What has changed since 2005 assessmentWhat has changed since 2005 assessment

% of babies breastfeed within one hour of % of babies breastfeed within one hour of birth increased by 4.3% (Current 35.4%)birth increased by 4.3% (Current 35.4%)

Median duration of Breastfeeding increased Median duration of Breastfeeding increased by 1 month (Current 34 months)by 1 month (Current 34 months)

% of babies receiving complementary foods % of babies receiving complementary foods at 6 – 9 months increased by 8.8% at 6 – 9 months increased by 8.8%

(Current 75%) (Current 75%)

What has changed since 2005 assessment What has changed since 2005 assessment cont …….cont …….

Maternity leave in Government office Maternity leave in Government office increased by 15 days (Current 60 days)increased by 15 days (Current 60 days)

Some improvement in Information SupportSome improvement in Information Support

Some improvement in Monitoring and Some improvement in Monitoring and EvaluationEvaluation

List of partners for the assessment processList of partners for the assessment process

1.1. Nepal Breastfeeding Promotion Forum (NEBPROF)Nepal Breastfeeding Promotion Forum (NEBPROF)2.2. Nepal Paediatric Society (NEPAS)Nepal Paediatric Society (NEPAS)3.3. Perinatal Society of Nepal (PESON)Perinatal Society of Nepal (PESON)4.4. Department of Child Health, IOMDepartment of Child Health, IOM5.5. Maharajgunj Nursing Campus, IOMMaharajgunj Nursing Campus, IOM6.6. TU Teaching HospitalTU Teaching Hospital7.7. Nutrition Section, Child Health DivisionNutrition Section, Child Health Division8.8. Kanti Children’s HospitalKanti Children’s Hospital9.9. Bhabisya NepalBhabisya Nepal10.10. Terredes HomesTerredes Homes11.11. Democracy for Election AllianceDemocracy for Election Alliance12.12. Stupa College of NursingStupa College of Nursing13.13. Mother and Infant Research Activity (MIRA)Mother and Infant Research Activity (MIRA)

Challenges faced during the processChallenges faced during the process

National Demographic Health Survey is done once National Demographic Health Survey is done once in 5 yearsin 5 years

Annual Health Report does not have all data Annual Health Report does not have all data required for WBTrequired for WBTii Assessment Assessment

Much variation in the pre-service curriculum of Much variation in the pre-service curriculum of different Institutionsdifferent Institutions

Variation in the figure coated in different source Variation in the figure coated in different source of the material availableof the material available

Much variation in maternity leave provides by Much variation in maternity leave provides by private organizationsprivate organizations

Data of various NGOs conducting IYCF service at Data of various NGOs conducting IYCF service at local level is not availablelocal level is not available

Challenges faced during the process Challenges faced during the process cont……cont……

Getting participation of all INGOs & NGOs Getting participation of all INGOs & NGOs working in IYCF during workshop on WBTworking in IYCF during workshop on WBTii

Lack of fund for participation by NGOs working Lack of fund for participation by NGOs working outside valleyoutside valley

Limited data is available on out reach clinicLimited data is available on out reach clinic Lack of support from government & INGOs for Lack of support from government & INGOs for

such activitiessuch activities No uniformity in different materials on IYCF No uniformity in different materials on IYCF

produced by different organizationsproduced by different organizations Difficult to collect exact information on emergency Difficult to collect exact information on emergency

situation carried out at local levelsituation carried out at local level

Methods used to tackle the challengesMethods used to tackle the challenges

Use of National Demographic Data of 2006 Use of National Demographic Data of 2006 in assessment of 2008in assessment of 2008

Used whatever latest data available in Used whatever latest data available in Annual Health ReportAnnual Health Report

Collected curriculum of many Institutions Collected curriculum of many Institutions & discussed in workshop& discussed in workshop

Used the mainly data produced by Used the mainly data produced by Government & INGOsGovernment & INGOs

Maternity leave provided by Government Maternity leave provided by Government was mainly usedwas mainly used

Methods used to tackle the challenges Methods used to tackle the challenges cont…..cont…..

Used whatever data could be collected regarding Used whatever data could be collected regarding IYCF service at local levelIYCF service at local level

Tried to get maximum participation of INGOs & Tried to get maximum participation of INGOs & NGOs by sending official invitation & reminder NGOs by sending official invitation & reminder by telephoneby telephone

NGOs working within Kathmandu valley only was NGOs working within Kathmandu valley only was includedincluded

1998 data of Nepal Paediatric Society on BFHI 1998 data of Nepal Paediatric Society on BFHI was usedwas used

Compiled whatever data could be collected on Compiled whatever data could be collected on outreach clinicoutreach clinic

Methods used to tackle the challenges Methods used to tackle the challenges cont…..cont…..

Need of uniformity in material was Need of uniformity in material was discussed during workshopdiscussed during workshop

Tried to collect as much information as Tried to collect as much information as possible on Emergency Situationpossible on Emergency Situation

To get support for Government, Chief of To get support for Government, Chief of the Nutrition Section was involved in the Nutrition Section was involved in assessment process.assessment process.

Positive experiences during the processPositive experiences during the process

Bringing different organizations working on IYCF Bringing different organizations working on IYCF in one platformin one platform

Compiling National data on breastfeeding & Compiling National data on breastfeeding & IYCFIYCF

Identification of existing gaps for the Identification of existing gaps for the improvement of IYCF in the countryimprovement of IYCF in the country

Bringing many pre-service trainers in Health Bringing many pre-service trainers in Health Professional in one platformProfessional in one platform

Positive experiences during the process Positive experiences during the process cont…..cont…..

Preparing WBTPreparing WBTi i report 2008 of the countryreport 2008 of the country

Nepal Breastfeeding Promotion Forum Nepal Breastfeeding Promotion Forum acting as Nodal Pointacting as Nodal Point

Drawing attention of Government for need Drawing attention of Government for need of more action plan with budgetary of more action plan with budgetary provision for Improvement of IYCF in provision for Improvement of IYCF in countrycountry

Suggestion for improving the processSuggestion for improving the process

Such assessment should be done annually or Such assessment should be done annually or once in two yearonce in two year

Providing some seed money to each country Providing some seed money to each country for this activityfor this activity

Getting support from WHO/UNICEF or Getting support from WHO/UNICEF or other INGO at country level for such other INGO at country level for such activityactivity

Getting commitment from the National Getting commitment from the National Government for such activityGovernment for such activity

Suggestion for improving the process cont…..Suggestion for improving the process cont…..

Making some changes in the WBTMaking some changes in the WBTii tool:- tool:- Using % prelactal feed as an indicatorUsing % prelactal feed as an indicator Including quality of complementary food as also Including quality of complementary food as also

an indicatoran indicator Sub grading Sub grading some degreesome degree to < 25%, 25-50% to < 25%, 25-50%

more than 50% for indicator numbers 10, 11, 12, more than 50% for indicator numbers 10, 11, 12, 13, 14, 1513, 14, 15

Scoring for International Code implementation Scoring for International Code implementation should be readjusted depending on strict should be readjusted depending on strict implementation of the Code as law, monitored implementation of the Code as law, monitored and enforced.and enforced.

e.g. Just having some Code as law gives a score of e.g. Just having some Code as law gives a score of 7, irrespective of how it is implemented.7, irrespective of how it is implemented.