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INFORMATION FOR

Program Delivery Examples

TPDG11: National standards and guidelines for breastfeeding promotion and support have been developed and disseminated to all facilities and personnel providing maternity and newborn care.

Example: The Brazilian Ministry of Health has issued and disseminated a series of guidelines to standardize and ensure high-quality breastfeeding care. This series includes:

  • • Newborn health care: a guide for health professionals (4 volumes)
    • Child health: growth and development (Primary Healthcare Book 33)
    • Child health: breastfeeding and complementary feeding (Primary Healthcare Book 23)
    • Ten Steps for a Healthy Feeding: feeding guide for child under two years - a guide for the Professional in the Primary Health Care
    • Breastfeeding and the use of medicines and other substances
    • Legislation and marketing of products that interfere with breastfeeding: a health professionals guide
    • Breastfeeding. Distribution of Milk and Infant Formulas in Health Establishments and Legislation
    • Essentials of breastfeeding for working woman
    Humanized Care Low Birth Weight: Kangaroo Method: technical manual
    • Manual for Kangaroo Method: shared follow-up between Hospital Care and Primary Care.

These materials are the standard national guidelines to promote, protect and support breastfeeding and complementary food and are disseminated within all facilities providing maternity and newborn care (including hospitals, clinics, and primary health care/community services).

Score: Major Progress
Domain- Existence: Yes
Domain- Coverage: Standards and guidelines for breastfeeding promotion and support have been developed and disseminated nationally to all facilities and personnel providing maternity care.

TPDG12: Assessment systems are in place for designating BFHI/Ten Steps facilities.

Example: The New Zealand Breastfeeding Alliance (NZBA) is a coalition of 30 breastfeeding stakeholder organizations and is funded by the Ministry of Health to manage and assess the BFHI/BBF initiatives.

Score: Major Progress
Domain- Existence: Yes
Domain- Quality: Based on the BFHI UNICEF/WHO global criteria
Domain- Effective: National Strategic Plan of Action for Breastfeeding 2008–2012 has a goal of all District Health Boards achieving and maintaining Baby Friendly Hospital accreditation

TPDG13: Reassessment systems are in place to reevaluate designated Baby-Friendly/Ten Steps hospitals or maternity services to determine if they continue to adhere to the Baby-Friendly/Ten Steps criteria.

Example: The New Zealand Breastfeeding Alliance (NZBA), which is a coalition of 30 breastfeeding stakeholder organizations and is funded by the Ministry of Health to manage and assess the BFHI/BBF initiatives, also reassesses maternity facilities to determine if they continue to adhere to the Baby-Friendly/Ten Steps criteria.

Score: Major Progress
Domain- Existence: Yes
Domain- Quality: National Strategic Plan of Action set a timeframe for all District Health Boards achieving and maintaining Baby Friendly Hospital accreditation as a priority area for 2008-2010

TPDG14: More than 66.6% of deliveries take place in hospitals and maternity facilities designated or reassessed as “Baby Friendly” in the last 5 years.

Example: Between 2011 and 2014, Uruguay stands out as having made dramatic progress on the BFHI. Fifty-two out of a total of 64 hospitals providing delivery-care services were certified or recertified.
For calculating the number of deliveries within BFHI facilities the following information was used:

  1. the annual number of birth (2010-2013) was 49,000;
  2. deliveries occurring in health facilities (2010-2013) 99.5%;
  3. health facilities that have been certified or recertified as baby-friendly since 2008 54/64 (84.4%); and
  4. health facility deliveries occurring in facilities certified/recertified since 2008, 75.2%.

Score: Major Progress
Domain- Coverage: More than 66.6% of deliveries took place in hospitals and maternity facilities designated or reassessed as “Baby-Friendly” in the last 5 years.

TPDG15: Health care facility-based community outreach and support activities related to breastfeeding are being implemented.

Example: Sri Lanka's Lactation Management Centres are run out of specialist hospitals. The service is run by Nursing Officers who are available seven days a week from 7 am – 5 pm, via in-patient care, out-patient visits and telephone hotlines. Any mother with breastfeeding problems may use the center for free, without referral letters or appointments. In addition, they speak at ante-natal health educational classes, take part in special day/half-day programmes organized to educate nursing officers staff on other wards, and run lecture/clinical sessions for nursing students and midwifery students.

Score : Minimal Progress
Domain- Existence: Yes
Domain- Quality: Lactation Centers are implemented in specialist hospitals only so there is not national coverage
Domain- Effective: Not enough information to assess linkages with community programs

TPDG16: Community-based breastfeeding outreach and support activities have national coverage.

Example : The LINKAGES Project in Bolivia, a community based behavioral change project, reached one million people, and covered eight of nine departments, three eco-regions, 155 municipalities, and 2,389 communities. The purpose was to increase timely initiation of breastfeeding and the rate of exclusive breastfeeding through BCC, training, and community activities using the existing network of CHWs.

Score: Partial Progress
Domain- Existence: Yes
Domain- Coverage: Extensive but not national

TPDG17: There are trained and certified lactation management specialists available to provide supportive supervision for breastfeeding program delivery.

Example: In Indonesia, to become a breastfeeding counselor, the WHO/UNICEF’s breastfeeding counseling training module is required (a total of 40 hours). There is no education prerequisite for the training and after completing the training, one counseling assignment must take place within the month to obtain the certificate. Breastfeeding counselors do not have a clear mechanism for starting a practice, so they can practice anywhere without supervision. Other than this, there is no other regulation regarding breastfeeding counseling, including what types of services may be performed or any obligation to comply with the code of ethics.
There is an official association for breastfeeding counselors, the Indonesian Breastfeeding Counselors Association, with approximately 200 members. If a breastfeeding counselor wants to become a member, he or she will be given an ethics code of conduct to follow. This association also offers supervision that standardizes care among their members. There is no obligation for a breastfeeding counselor or specialist to become a member. Coordination to issue a national license needs to be establish as well as to standardize care and increase coverage nationally.

Score: Minimal Progress
Domain- Existence: Yes
Domain- Coverage: Local coverage only