SEA-NUT-171

Distribution: General

Implementation of the Global Strategy

for Infant and Young Child Feeding
in the South-East Asia Region
Report of a Regional Workshop
Jaipur, India, 27–29 April 2006

WHO Project: ICP CAH 003

ICP NUT 001
 © World Health Organization

This document is not a formal publication of the World Health Organization

(WHO), and all rights are reserved by the Organization. The document may,
however, be freely reviewed, abstracted, reproduced or translated, in part or
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The views expressed in documents by named authors are solely the
responsibility of those authors.

December 2006
 CONTENTS
Page

1. Introduction and rationale............................................................................. 1

2. Objectives of the workshop........................................................................... 2

3. Proceedings of the workshop......................................................................... 2

3.1 Inaugural session .............................................................................................2
3.2 Technical sessions ...........................................................................................3

4. Recommendations ...................................................................................... 11
4.1 For interagency and inter-programmatic coordination....................................11
4.2 Overall recommendations .............................................................................12

Annexes

1. List of participants ....................................................................................... 15

2. Programme ................................................................................................. 21

3. Tools and materials on infant and young child feeding ................................ 23

4. Group work ................................................................................................ 25

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1. Introduction and rationale
Malnutrition during infancy and early childhood is a serious problem in the
South-East Asia Region. Adequate and appropriate nutrition is not only a
child rights issue, but is also an important determinant of the prevalent high
infant and under-five mortality rates in the Region. Malnutrition contributes
to over half of the mortality in under-five children and would need to be
addressed more aggressively if the Millennium Development Goal (MDG)
for reducing child mortality (Goal # 4) has to be achieved by 2015. The
Lancet series (2003) has shown that breastfeeding could prevent 13%, and
complementary feeding 6% of all child deaths. Though positive trends in
indicators like exclusive breastfeeding rates and appropriate
complementary feeding practices are discernible, in most countries the
progress is not optimal and the achievements are relatively modest.

In a few countries, some aspects of nutrition (like the micronutrient

supplementation programmes) are implemented by the ministries of health,
while overall nutrition, including infant feeding is with another
ministry/department that deals with issues related to women and
children/family health. This leads to a situation where infant and young
child nutrition issues become a divided responsibility. It is therefore
necessary to orient stakeholders on a common platform to take the agenda
forward. In many countries, information regarding nutrition-related
indicators and infant feeding practices is scanty. Absence of reliable
information results in the issue not receiving adequate attention. Further,
objective programming for nutrition is hindered.

The adoption of the Global Strategy on Infant and Young Child

Feeding (GSIYCF) by the 55th World Health Assembly (WHA) in April 2002
set the stage for countries to formulate comprehensive strategies and
technical guidelines for improving the nutritional status of infants and young
children. Some countries have accordingly developed their own national
strategies, whereas others have not taken specific steps to do so. As HIV
and infant feeding is one of the new challenges to be addressed in the
global strategy, programme managers for child health, particularly those
responsible for the Integrated Management of Childhood Illnesses (IMCI),
Nutrition, and HIV/AIDS need to be involved in its implementation, and

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updated accordingly. Usage of WHO’s "Infant and Young Child Feeding: a

tool for assessing practices, policies and programmes", and the suggestions
for monitoring certain indicators, will enable countries to make a periodic
and realistic assessment of their progress.

In view of the above scenario, a workshop was organized in

collaboration with UNICEF and CARE-India, to share progress regarding
implementation of the global strategy, and identify areas which need to be
emphasized for further action.

2. Objectives of the workshop

The general objective of the workshop was to review the progress of
implementation of the GSIYCF in the Member States of the South-East Asia
Region (SEAR), and to plan future steps for accelerating implementation.
The specific objectives were to:

¾ Review the current status of implementation of the GSIYCF in

the Member countries, using the global indicators for
monitoring; and
¾ Prioritize activities for inclusion/acceleration of implementation
of the strategy and it’s nine operational targets, at the regional
and country levels, emphasizing inter-programmatic work
among nutrition, IMCI, and prevention of mother-to-child
transmission (PMTCT) of HIV/AIDS.

3. Proceedings of the workshop

3.1 Inaugural session

Dr Rukhsana Haider, Regional Adviser, Nutrition for Health and

Development, WHO-SEARO, welcomed the participants. Thereafter, Mr
Cedric Finch, Regional Programme Director, CARE-India formally
welcomed the participants from Member States and representatives from
the UN and other agencies and organizations. He stated that CARE India
was committed to take forward the agenda of Infant and Young Child
Feeding (IYCF), and was happy that they have been able to collaborate with
WHO and UNICEF for the regional workshop.

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The inaugural address of Dr. Samlee Plianbangchang, Regional

Director, WHO South-East Asia Region was read out by Dr. Dini Latief,
Director, Department of Family and Community Health, WHO/SEARO. Dr.
Samlee stated that this workshop was the first one being organized in the
Region, where experiences in implementation of the global strategy in the
respective countries, and the challenges faced will be shared. This will
ultimately facilitate the development of a joint plan to accelerate
implementation of the strategy. Interventions for improvement of infant and
child feeding practices is a first crucial step to achieve the MDG # 1 that
calls for eradication of extreme poverty and hunger, and for which one of
the indicators is the prevalence of underweight children below five years of
age. Similarly, improved nutritional status of children will help to achieve
MDG # 4 related to the reduction in child mortality. HIV and infant
feeding is one of the new challenges which the global strategy seeks to
address, considering the importance of prevention of mother-to-child
transmission. Appropriate infant feeding during emergencies, and in severe
malnutrition, also needs special emphasis in national strategies. Dr Samlee
further stated that to address infant and young child nutrition, a multi-
disciplinary approach is needed. Programme managers for child health, in
particular those responsible for IMCI, nutrition, and HIV/AIDS, all need to
work together for effective implementation.

Dr Satish Kumar, State Representative, UNICEF Rajasthan, in his

opening remarks stated that promoting IYCF reduces child malnutrition,
and reduction in malnutrition increases lifetime individual earnings and
reduces expenditure on health care. Promoting IYCF practices invariably
includes protection and promotion of exclusive breastfeeding and
appropriate infant feeding, which are also human rights issues. IYCF
strategies are built upon the Baby Friendly Hospital Initiative (BFHI),
Maternity Benefit Acts, and national nutrition policies. He said that progress
in BFHI must be continuously monitored, and expanding the scope of the
Maternity Benefit Acts be strongly advocated.

3.2 Technical sessions

All countries in the South-East Asia Region participated with the exception
of the Democratic People’s Republic of Korea (Annex 1). Pakistan
participated (with UNICEF support) in this workshop as they are included in
UNICEF’s South Asia Region. The technical sessions included plenary
sessions, country poster sessions, and group work (Annex 2).

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Update on infant and young child feeding in the South-East Asia Region

Dr Haider provided an update on the status of implementation of the

global strategy in SEAR, highlighting the progress made. She explained that
her presentation was based on the information received from the Member
States through a questionnaire. Countries were shown to be at varying
levels of implementation, some even in the infancy stage. Very few
countries had developed concrete implementation plans. The key gaps and
challenges identified were: lack of capacity of national health service
providers, including limited efforts to build the capacity of
private health service providersinadequate progress with BFHI,
with no additional components added subsequent to the global
strategy;

¾ inadequate progress in some countries in implementation of the

Code of Marketing of Breastmilk Substitutes;
¾ legislation not been revised in some countries with regard to
maternity protection and inadequate implementation in other
countries;
¾ inadequate progress with regard to feeding in exceptionally
difficult circumstances;
¾ no guidelines for HIV and emergencies in many countries and
status of implementation unknown in those countries which
have the guidelines;
¾ limited efforts to strengthen community based support and no
linkages with Baby Friendly hospitals;
¾ opportunities to integrate IYCF activities with health and other
systems not utilized;
¾ no comprehensive behaviour change component (BCC) strategy
in place;
¾ no systematic monitoring and evaluation mechanisms;
¾ lack of funding in some countries;
¾ lack of availability of information from countries.

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The key recommendations following this session were:

¾ Develop generic Terms of Reference for collecting information on

IYCF which can be coordinated by WHO and UNICEF with the
respective countries.
¾ Develop a Monitoring Information System (MIS) for tracking progress
of IYCF in all the countries.

Progress in implementation of the global strategy in other regions

Mrs Randa Saadeh, Scientist, NHD, Geneva, presented an overview of the

global strategy and status of implementation in other Regions. She
highlighted the constraining and facilitating factors in its implementation.
The constraining factors were similar to those in SEAR, and included: lack
of political commitment and advocacy; no core group of resource people
and master trainers; ineffective training (lecture type, lack of involvement of
community workers, lack of dialogue); no supportive supervision provided
to the community and health centre staff; sufficient resource
materials/guidance tools but not reaching the right people, and,
additionally, a language barrier; inadequate allocation of resources (human
and financial). The facilitating factors highlighted were: involvement of key
stakeholders at all levels especially in the national planning meetings; clear
definition and assignment of roles and responsibilities of all stakeholders;
commitment, ownership and leadership of the government; use of the
WHO assessment tools leading to data-driven strategy development; use of
the strategy as an advocacy and resource mobilization tool and also to
revitalize BFHI; code implementation, capacity building and review of HIV
and infant feeding policies enabling community health workers to identify
their key issues on IYCF peer counselling and a decentralized training
approach.

IYCF programme issues: barriers to implementation

Ms Deepika Srivastava, from UNICEF-India, facilitated a Visualization in

Participatory Process (VIPP) session to identify key barriers to
implementation. Participants were asked to prioritize the key challenges
they were facing. The major barriers identified were: Generating political
commitment to implement the strategy and inadequate coordination
among various partners and intersectoral coordination. There was

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inadequate support from the health system (e.g. from paediatricians and
gynaecologists), inadequate capacities of health workers, and lack of
lactation counsellors. The status and quality of the baby-friendly hospitals
was not satisfactory, and code enforcement was lacking. Where the
community was concerned, there was lack of awareness/information
available and inadequate support for working women. There was no
monitoring system to track progress as well as inadequate budgets and
staffing for IYCF.

Case studies from India, Maldives, Myanmar and Nepal:

implementation of national strategies

These countries had been selected as they had already developed their
national strategies/guidelines on IYCF.

India

Highlights of the presentation by Dr Shashi Prabha Gupta were: National

IYCF guidelines were developed in 2004; sensitization of Chief Secretaries
and Secretaries in charge of Women and Child Development was
undertaken for preparation of action plans at the state level; public
awareness had been created through advertisement campaigns, mass media
communication and nutrition orientation of functionaries. Regional
meetings on nutrition were conducted in different parts of the country for
awareness building. Some of the special initiatives of the states for
promoting IYCF include: Madhya Pradesh – Bal Sanjivini programme, Bihar
and Jharkhand – the Dular strategy, Rajasthan – Anchal se Angan Tak and
Janani programmes and West Bengal – Kano Parbo Na programme (Positive
Deviance).

Maldives

Mr Mohamed Shaheed presented the implementation status of the IYCF

strategy. He said that the IYCF strategy had been drafted, but not yet
finalized; mother support groups had been established in all the Baby
Friendly hospitals; Code of Marketing of Breastmilk substitutes had been
drafted and was awaiting finalization; and IYCF indicators will be integrated
in newborn care as well as Early Childhood Development activities to

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produce a community integrated package which would be implemented at

all levels.

Myanmar

Dr Myint Myint Than stated that a National Strategy for IYCF had been
developed in 2003; IYCF manuals for trainees (basic health staff) and
trainers were developed in 2004, and training of trainers was conducted at
central, state, division and townships levels in 2004-2005. Many of the
hospitals are baby-friendly; and Guidelines on HIV/AIDS and infant feeding
were available.

Nepal

Mrs Sharada Pandey presented the implementation status of IYCF strategy.

She said that the IYCF strategy was adopted in 2005 and an action plan
developed. Advocacy has been done, and training conducted at various
levels, with focal persons at the district level trained. Public awareness had
been created through TV spots and radio jingles.

Promoting breastfeeding at the community level

Dr S.M. Moazzem Hossain from UNICEF, New York, shared experiences

from Gambia, Madagascar, Bolivia and Ghana on promoting breastfeeding
at the community level. He emphasized focussing on two to three key
context-specific messages within the Behaviour Change Communication
approach to facilitate behaviour change. He laid out the elements of
success in taking breastfeeding to scale, namely; partnerships;
harmonization across all levels; integrating IYCF into a package of ‘Essential
Nutrition Actions’; and increasing coverage by using multiple programme
opportunities within the health sector and outside, whenever possible.

The key discussion points following the presentation were:

¾ Formative research is essential to develop context-specific messages

¾ Monitoring IYCF practices should be an integral part of a programme
¾ International agencies need to play a catalytic role.

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Country poster presentations

In the poster session, representatives from each country shared the progress
made, and identified the gaps in the IYCF area.

Prevention of mother-to-child transmission of HIV and infant feeding

Dr Constanza Vallenas, Medical Officer, Child and Adolescent Health,

WHO/HQ, highlighted the UN recommendations for prevention of
mother-to-child transmission which are:

¾ When HIV status is negative or unknown: to exclusively

breastfeed for six months and continue breastfeeding for two
years or beyond.
¾ When HIV status is positive and if replacement feeding is
acceptable, feasible, affordable, sustainable and safe, avoidance
of all breastfeeding is recommended. Otherwise exclusive
breastfeeding is recommended for the first months of life.
Counselling should include information about the risks and
benefits of various infant feeding options, and guidance in
selecting the most suitable option.

Dr Vallenas also pointed out that the global strategy in the context of
HIV emphasizes that all HIV-infected mothers should receive counselling.
Adequate replacement feeding is needed for infants born to HIV-positive
mothers who choose not to breastfeed. She added that only health workers
should demonstrate preparation of breast-milk substitutes, and only to
mothers who need to use it. Dr Vallenas shared the guidelines, tools and
material on counselling available on the subject. Dr Vallenas and Mrs
Saadeh shared the tools and materials available with WHO in the area of
IYCF including those on HIV and infant feeding counselling. A list is
provided in Annex 3.

A key comment following this presentation was “a government forcefully

banning breastfeeding in HIV-positive women is a violation of human
rights”

Feeding in exceptionally difficult circumstances, including emergencies

Dr Haider explained that the term, "exceptionally difficult circumstances”,

covered people suffering the consequences of complex emergencies,

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including natural or human-induced disasters (floods, drought, earthquake,

war, civil unrest and severe political and economic living conditions), low
birth weight infants, malnourished infants and children and HIV-infected
mothers and their infants. WHO’s response has been the ten Guiding
Principles that serve as a basis for action to:

¾ Clarify that optimal practices are the same

¾ Inform decision-makers about key interventions
¾ Provide a starting point for designing interventions

These principles were described in the presentation. The inadequate

progress in this area was reiterated. While countries which have guidelines
with regard to HIV, and for emergencies need to make them operational,
there are some countries which have yet to develop these guidelines.

The key comments subsequent to this presentation were:

¾ Following the earthquake in Pakistan, the government responded

within 7 days to focus on IYCF, and sent 200 modules on nutrition
and infant feeding to the disaster area.
¾ Countries need to be very well prepared to tackle emergency
situations.

CARE’s Reproductive and Child Health and Nutrition and HIV/AIDS

(RACHNA) Programme: Experiences with complementary feeding

Dr Sunil Babu explained that CARE’s RACHNA programme supports the

Government of India’s Integrated and Child Development Services (ICDS)
and Reproductive and Child Health (RCH) programmes through systematic
engagement for focussing on critical interventions and critical tasks.
Interventions supported by the RACHNA programme include IYCF as part
of a larger maternal and child health nutrition package. District level data is
collected (from one district in each of the 8 States RACHNA operates in)
using a rapid assessment method to understand changes in programme
processes, outcomes (behaviours) and nutritional impact over the
programme period. Results indicate that complementary feeding practices
(timely initiation, quantity, appropriateness and quality) have shown a
positive shift in many districts and, likewise, contacts and advice given by

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health service providers have also shown improvements. The key factors
contributing to change in these practices include; the Essential Nutrition
Actions framework demystified nutrition interventions and provided
guidance on how to deliver these at the district, block, sector and village
levels; timely home contacts during 1 to 6, and 6 to 12 month periods for
promoting and supporting breastfeeding and establishing complementary
feeding, respectively, including supervision of these contacts; use of simple
tools e.g. home visit planner, supervisory checklist by ICDS and RCH
frontline and supervisory programme staff; and use of job aids for problem
solving and multi-channel behaviour change communication ensuring
consistency in messages and in addressing barriers.

¾ Strengthening the system of record keeping and data analysis at

the AWC level
¾ Strengthening supervisory systems for regular problem solving,
monitoring and ongoing capacity building
¾ Capacity building with emphasis on techno-managerial skills to
deliver child nutrition and health interventions
¾ Operationlizing BCC (both IEC and IPC) for promoting
awareness, and greater acceptance of key behaviours and
practices

Group work

The group work was facilitated by Dr Sudhansh Malhotra. Two sets of tasks
were assigned in the group work. These were:

(1) To develop an operational framework with priority activities for

inclusion/acceleration of implementation of the strategy.
(2) Proposing a monitoring and evaluation system within the
framework.

Three groups were constituted with the following composition:

Group I: India, Nepal, Bangladesh and Pakistan

Group II: Indonesia, Sri Lanka, Timor-Leste and Maldives

Group III: Bhutan, Myanmar and Thailand

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The group work guidelines and expected outputs were explained to

the participants. Their outputs are given in Annex 4.

Some of the recommendations made by the group were:

¾ Integrated course on IYCF should be implemented

¾ IYCF should be introduced in the pre-service training curriculum
as a separate chapter.
¾ Advocacy should be undertaken with local NGOs to involve
them in IYCF activities.

4. Recommendations
4.1 For interagency and inter-programmatic coordination

Specific recommendations were requested from participants from the

government (MoH and other ministries) and partners (WHO, UNICEF,
CARE India, BASICS, BPNI) for interagency and inter-programmatic
coordination for promoting Infant and Young Child Feeding (IYCF).

The following recommendations emerged from the group:

Programmatic coordination

¾ Develop theme groups around the Millennium Development

Goals (MDGs) e.g. goal # 4 reduce child mortality, which should
specifically integrate IYCF activities
¾ Establish a National IYCF committee to oversee IYCF progress
and issues
¾ Establish working groups with Terms of Reference and an action
plan
¾ Involve gynaecologists, obstetricians and nutritionists
¾ Involve NGOs
¾ Revitalize the Baby Friendly Health Initiative (BFHI), certification
from the government will be more sustainable and integrate
newborn care

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¾ In the Indian context, the National Rural Health Mission and the
Integrated and Child Development Services (ICDS) should be
the mechanisms for implementing IYCF
¾ Involve other sectors / ministries such as education, agriculture,
etc.
¾ Government should be in the lead
¾ Joint orders need to be issued and followed.

Interagency coordination

¾ Establish coordination mechanisms e.g. regular meetings,

committees to share lessons learnt on a regular basis
¾ All agencies should coordinate training activities
¾ Involve UNFPA

4.2 Overall recommendations

The participants were asked to make recommendations separately for the

country level and for agencies involved with IYCF implementation.

Country level

The key recommendations for IYCF implementation at country level are

summarized below under the heads of “protect”, “promote” and
“support”:

Protect
¾ Ensure political commitment by strengthening advocacy at all
levels
¾ Develop a time-bound action plan; common country assessment
to serve as an input to develop a joint plan and also leverage
resources
¾ Establish a steering committee and designate a focal point for
IYCF with specific Terms of Reference and linkages with the
relevant agencies / stakeholders

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¾ Sensitize professional bodies on the Code of Marketing of

Breastmilk Substitutes
¾ Integrate IYCF with child health programmes.

Promote
¾ Build capacities of health workers
¾ Include IYCF in pre-service curriculum of health providers
¾ Enhance communications efforts through public figures and mass
media
¾ Establish mechanisms and guidelines for monitoring and
evaluation

Support
¾ Energize BFHI and expand it to become mother-and-baby-
friendly

Build community volunteers

¾ Create and sustain baby-friendly villages.

Agency support

The key recommendations for international agencies are summarized

below:

¾ Undertake high level advocacy and sensitization for ensuring

political commitment to prioritize IYCF
¾ Provide technical assistance in terms of:
– Disseminating policies/updates/guidelines in a timely manner
– Building capacities at all levels
– Developing a framework for advocacy on nutrition issues
particularly IYCF

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– Developing a framework for integrating nutrition

interventions specifically IYCF within the basic health
services package
– Assisting countries to develop a road map for providing
leadership, guidelines, technical support and a workable
strategy for IYCF
– Developing guidelines for district level plans
– Developing tools to assess the situation of IYCF towards
achieving MDGs
¾ Foster close coordination between all UN agencies and better
collaboration with government counterparts at country level
¾ Form a coordinating body with funding support
¾ Develop a joint plan of action on IYCF based on Common
Country Assessment
¾ Assign focal points among stakeholder agencies such as UNICEF,
WHO, UNFPA, etc. and evaluate IYCF implementation status
towards achieving MDGs
¾ Benchmark IYCF and related MDGs yearly to record progress
¾ Support the continuous flow of adequate resources for IYCF.

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Annex 1

List of participants

Bangladesh Ir Kresnawan
Dr Z.A. Motin Al Helal Head, Sub-Directorate of Food Consumption
Deputy Programme Manager (CDD) Directorate of Community Health
Directorate-General of Health Services Directorate General of Community Health
EPI Bhaban, Mohakhali, Dhaka Ministry of Health
Tele: 9887570 (O) Republic of Indonesia, Jakarta
Mobile: 01711020254 Tele: 62-21-5277152
Fax: 8802 8821914 E-mail: [email protected]

Dr Md Mozammel Hoque Dr Muh. Ilhamy Setyahadi

Deputy Programme Manager SpOG,
National AIDS/STD Programme Sub-Directorate of Pregnant Mother
Directorate-General of Health Services Directorate of Maternal Health
House No.B-62, Road No. 3, Block-B Directorate General of Community Health
Niketan, Gulshan-1, Dhaka-1212 Ministry of Health
Tele: 8853263, 8829720 (O) Republic of Indonesia, Jakarta
Mobile: 01712-761998 Tele/Fax: +62 21 78890808 (R)
E-mail: [email protected] Mobile: +62 811 126926
Mobile Fax: +62 811 120237
Dr S.M. Mustafizur Rahman Tele: +62 21 5270969 (O)
Assistant Director Fax:+62 21 520 3884 0969; +62 21 526
National Nutrition Programme (NNP) 5001(O)
House No. 46, Road No. 5 E-mail: [email protected]
Dhanmondi Res. Area, Dhaka-1205 [email protected]
Tele: 8854162
E-mail: [email protected] Maldives
Mr Mohamed Shaheed
Bhutan Deputy Director
Mrs Ugyen Zangmo Department of Public Health
Programme Assistant Ministry of Health, Male
Nutrition Programme Republic of Maldives
Department of Public Health Tele: 009603325193
Thimphu E-mail: [email protected]
Tele: 00-975-2-322602
Email: [email protected] Myanmar
Dr Myint Myint Than
Indonesia Assistant Director
Dr Penina Regina Bebena Women and Child Health Development
Head, Sub-Directorate of Child Health Project
Directorate General of Community Health Department of Health
Ministry of Health Ministry of Health
Republic of Indonesia, Jakarta Myanmar
Tele: 021. 521 4891; Fax : 021.521 4891 Tele: 095-9-5002709 (M)
Email : [email protected] E-mail: [email protected]

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Dr Zin Thet Myo Thailand

Medical Officer Dr Somsak Pattarakulvanich
National Nutrition Centre Director
Department of Health Bureau of Health Promotion
Ministry of Health Department of Health
Yangon, Myanmar Ministry of Public Health
Tele: 095-1-290794 (O) Nonthaburi 11000 Thailand
Tele: 66 2 590 4121, 4122
Dr Nwei Nwei Tin Fax: 66 2 590 4457
Consultant Paediatrician E-mail: [email protected]
Mandalay Children’s Hospital
Ministry of Health Dr Narong Saiwongse
Mandalay, Myanmar Director
Tele: 095-2-33694 (R) Nutrition Division
Department of Health
Nepal Ministry of Public Health
Nonthaburi 11000 Thailand
Dr Sun Lal Thapa Tele: 66 2 590 4328
Chief, CDD/ARI Section E-mail: [email protected]
Child Health Division
Ministry of Health & Population Dr Nipunporn Voramongkol
HMG of Nepal, Teku Chief
Tel: 977-1-4261660 Maternal and Child Health Group
Fax: 977-1-4261463 Bureau of Health Promotion
Department of Health
Mrs Sharada Pandey Ministry of Public Health
Chief, Nutrition Section Nonthaburi 11000 Thailand
Child Health Division Tele: 66 2 590 4418; Fax: 66 2 590 4427
Ministry of Health & Population E-mail: [email protected]
HMG of Nepal, Teku [email protected]
Tele: 977-1-4261660; 4225558
Fax: Fax: 977-1-4261463 Timor-Leste
E-mail: [email protected]
Miss Dirce Maria Soares Araujo
Nutrition Officer
Sri Lanka Department of Mother and Child Health
Dr (Mrs) S. Fernandopulle Ministry of Health
Medical Officer Democratic Republic of Timor-Leste
Family Health Bureau Caicoli Street
231 De Saram Place Dili, Timor-Leste
Colombo 10 Tele:+670 7254899
Sri Lanka E-mail: [email protected]
Tele/Fax: 01194112696508
E-mail: [email protected] ; WHO Collaborating Centres
[email protected] National Institute of Nutrition (NIN)
Dr. Shahnaz Vazir
Dr (Mrs) C Anoma Jayathilaka National Institute of Nutrition
National Project Officer Jamai-Osmania P.O .
Family Health Bureau Hyderabad 500 007
De Saram Place A.P. India
Colombo 10 Tele: 91-40-27008921, Extn. 274
Tele/Fax:0094112696508 Mobile: 91-9849637128
E-mail: [email protected] E-mail: [email protected]

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Institute of Nutrition, Mahidol University Ms Minakshi Singh

(INMU) Project Officer
Child Development and Nutrition
Dr Wantanee Kriengsinyos
UNICEF Jaipur
Institute of Nutrition, Mahidol University
B-9, Bhawani Singh Lane
(INMU)
C-Scheme, Opp. Nehru Sahkar Bhawan
Salaya, Nakhon Pathom
Jaipur-302001
Thailand, 73170 Tele: 0141-2222694; 2222636
Tel: 66-2-889-2168; 66-2-8002380 Fax: 0141-2221510
Fax: 66-2-441-9344 E-mail : [email protected]
[email protected]
Ms Sangita Jacob
Temporary Advisers Project Officer
Child Development and Nutrition
Ms Shashi Prabha Gupta UNICEF Jaipur
Technical Adviser, Room No. 105 B-9, Bhawani Singh Lane
Ministry of Human Resource Development C-Scheme, Opp. Nehru Sahkar Bhawan
(Department of Women & Child Development) Jaipur-302001
Jeevan Deep Building, Parliament Street Tele: 0141-2222694; 2222636
New Delhi-110 001 Fax: 0141-2221510
Tele: 91-11-23362519 E-mail: [email protected]
Fax: 91-11-23362519
E-mail: [email protected] Dr S.N. Methi
Joint Director
Dr Deepika Nayar Chaudhery Department of Women and Child
Technical Specialist (Nutrition) Development
CARE India Government of Rajasthan, Jaipur
27, Hauz Khas Village Tele: 0141-2702481; Fax: 0141-2705632
New Delhi-110 016
Mobile: 9810722787 Mr Sunil Babu
Tele: 91-11-26564101 State Programme Representative
CARE India (Rajasthan)
Fax: 91-11-26529671
Jaipur
E-mail: [email protected]
Tele: 0141-2200480; Fax: 0141-2202975
E-mail: [email protected]
Observers
Dr Zahid Larik UN AGENCIES and Other Partners
Deputy Director General
UNICEF/HQ
Nutrition Wing
Ministry of Health Dr. SM Moazzem Hossain
10-D (West) Taimur Chambers Infant Feeding Advisor
Blue Area, Islamabad UNICEF NYHQ, PD, Nutrition Section
Tele: 051-9202445, 9214976 3 UN Plaza, 44 ST E, Manhattan
Fax: 051-9202445 NY 10017, USA
E-mail: [email protected] Tel: +1 212 326 7765; Fax: + 1 212 735 4405
E-mail: [email protected]
Dr Muhammad Haroon Jehangir Khan
Deputy Director General Health (PHC) Dr. Nuné Mangasaryan
National Coordinator Senior Adviser, Nutrition and Child Growth &
Ministry of Health, Government of Pakistan Development
14-D-West, Feroze Center Nutrition Section, UNICEF
3 United Nations Plaza, New York
Blue Area, Islamabad
NY 10017, USA
Tele: 9202289-9213807
Tel: + 1 212 326 71 59
Fax: 092-51-9215610
Fax: + 1 212 735 4405
E-mail: [email protected]
E-mail: [email protected]

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UNICEF, Bangladesh UNICEF, Indonesia

Ms Harriet Torlesse Dr Anna Winoto
Project Officer Nutrition, Nutrition Project Officer
Health and Nutrition Section, Wisma Metropolitan II, 10th Floor
UNICEF J1. Sudirman Kav. 31 Jakarta 12920
BSL Office Complex Indonesia
1, Minto Road, Tele : +6221 5705816
Dhaka 1000, Bangladesh Fax: +6221 5711326
Tele: 9336701-10; Fax: 9335641-2 E-mail: [email protected]
E-mail: [email protected]
BASICS
UNICEF, India
Dr Sridhar Srikantiah
Dr Werner Schultink Country Team Leader
Chief, Child Development and Nutrition 30, Hauz Khas Village
Section Basement
UNICEF New Delhi – 11 00 16
73, Max Mueller Marg, Tele: 011-55702887; Mobile: 9811516335
Lodhi Estate E-mail: [email protected]
New Delhi – 11 00 03
Tele: 91-11-24606590; 24690401 Mr Manuel Mausiry
E-mail: [email protected] Technical Liaison Officer for Nutrition
TAIS/BASICS
Ms Deepika Shrivastava Exs. Delegacia de Saude
Programme Manager, Dili, East Timor
Child Development and Nutrition Section Tele:+ 670-7256417; Fax: + 670-332-2371
UNICEF E-mail: [email protected]
73, Max Mueller Marg,
Lodhi Estate
CARE India
New Delhi – 11 00 03
Tele: 9811260888 (M) Mr Cedric Finch
E-mail: [email protected] Regional Programme Director
27, Hauz Khas Village
Dr Satish Kumar New Delhi – 11 00 16
State Representative Tele: 09818752299 (M)
UNICEF Rajasthan E-mail: [email protected]
UNICEF Jaipur
B-9, Bhawani Singh Lane
BPNI
C-Scheme, Opp. Nehru Sahkar Bhawan
Jaipur-302001 Dr Raj Bhandari
Tele: 0141-2222694; 2222636 Director, BPNI
Fax: 0141-2221510 7-N-17, Jawahar Nagar
E-mail: [email protected] Jaipur-3-2004
Tele: 094140-48562
UNICEF, ROSA E-mail: [email protected]
Dr Ian Pett
Regional Adviser World Bank
Child Survival and Development Ms Meera Priyadarshi
UNICEF Regional Office for South Asia (ROSA) Senior Nutrition Specialist
PO Box 5815, Leknath Marg Kathmandu, International Bank for Rural Development
Nepal 70, Lodi Estate
Telephone: +(977) 1 441 7082 Ext. 266 New Delhi – 11 00 03
Mobile: +(977) 98510 35244 Tele: 011-41479119 (Direct)
Fax: +(977) 1 441 9479 Fax: 011-24619393
Email: [email protected] E-mail: [email protected]

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 Implementation of the Global Strategy for Infant and Young Child Feeding in the SEA Region

WHO Secretariat Dr Sudhansh Malhotra

Regional Adviser
HQ Child Health & Development
Mrs Randa J. Saadeh WHO/SEARO
Scientist Tele: 011-23370804 Ext. 26317
Nutrition for Health and Development 91-11-2330 9317
WHO/HQ Fax: 91-11-2337 8510
Tele: +41-22-791-3315/3878 E-mail: [email protected]
Fax: +41-22-791-4156
E-mail: [email protected] Country Offices

Dr Rosa Constanza Vallenas Dr Md Abdul Halim

Medical Officer NPO-MPS
CAH/HQ WHO Bangladesh
Tele: +41-22-791-4143 Tele: 861465354
Fax: +41-22-791-4853 Fax: 8807 8613247
E-mail : [email protected] E-mail: [email protected]

Mr Binod Mahanty
SEARO Technical Officer
Dr Dini Latief (Voluntary Counselling & Testing)
Director Office of the WHO Representative to India
Department of Family & Community Health 9, Jor Bagh, New Delhi-110 003
WHO/SEARO Tele: 00-91-11-2464 5817/18
Tele: 91-11-23370804 Fax: 00-91-11-2464 5724
Fax: 91-11-23378510 Mob: 09811401266
E-mail: [email protected] E-mail: [email protected]

Dr Rukhsana Haider Dr Amaya Maw-Naing

Regional Adviser Medical Officer
Nutrition for Health & Development HIV/AIDS
WHO/SEARO WHO Nepal
Tele: 91-11-23370804 Ext: 26313 Tele: +977-1-552 3200
91-11-2330 9313 (Direct) E-mail: [email protected]
Fax: 91-11-2337 8510
E-mail: [email protected]

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Report of a Regional Workshop

Participants of the Regional Workshop on Implementation of the Global Strategy

for Infant and Young Child Feeding in the South-East Asia Region
 Implementation of the Global Strategy for Infant and Young Child Feeding in the SEA Region

Annex 2

Programme

Day 1, Thursday, 27 April 2006

0900–0930 Registration of participants
0930–1000 Inaugural Session
– Welcome – CARE-India (Mr Cedric Finch)
– Inaugural address – Regional Director, WHO-SEARO
(Read by Dr Dini Latief, Director)
– UNICEF - Remarks (Dr Satish Kumar)
– Introduction of participants
– Objectives of the workshop (Dr Rukhsana Haider)
1000–1030 (Group photograph) followed by Tea/Coffee
1030–1115 Update on Infant and Young Child Feeding in the South East Asia Region
(Dr Rukhsana Haider)
Discussion
1115–1145 Progress in implementation of the Global Strategy in other regions
(Mrs Randa J. Saadeh)
1145–1230 IYCF Programme issues: What is working well and barriers to
implementation (VIPP session) – (Ms Deepika Srivastava)
1230–1330 Lunch
1330–1500 Case studies regarding implementation of the national strategies
(IND, NEP, MMR, MAV)
1500–1530 Promoting breastfeeding at community level (Dr Moazzem Hossain)
1530–1600 Tea/Coffee
1600–1700 Country highlights: Poster presentations (5 countries)
1900–2100 Reception

Day 2, Friday, 28 April, 2006

0900–0940 Infant feeding in the context of HIV: Global Strategy, PMTCT
programmes and BFHI (Dr Rosa Constanza Vallenas)
Country feedback

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0940–1015 Infant feeding in difficult circumstances:

Emergencies, severe malnutrition, LBW (Dr Rukhsana Haider)
1015–1100 Technical updates – Tools/documents/courses/guides
(Dr Rosa Constanza Vallenas and Mrs Randa J. Saadeh)
1100–1115 Tea/Coffee
1115–1200 Experiences in improving complementary feeding (Mr Sunil Babu)
Discussion
1200–1330 a) Group work: (Dr Sudhansh Malhotra)
– To develop an operational framework with priority activities for
inclusion/acceleration of implementation of the strategy
Presentation of groups
1330–1415 Lunch
1415–1515 b) Group work on
– Building of monitoring and evaluation system within the
framework
1515–1545 Tea/Coffee
1545–1600 Presentations by groups
1600–1700 Country highlights: Poster presentations (6 countries)

Day 3, Saturday, 29 April, 2006

0900–0930 Summary of previous 2 days
0930–1030 Round Table with partners
– Mechanisms for inter-programmatic and interagency coordination
1030–1100 Tea/Coffee
1100–1300 Draft Recommendations and Next Steps
1300–1400 Lunch
1400–1500 Concluding Session
1500–1515 Tea/Coffee
1515–1700 WHO/UNICEF meeting for planning next steps

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 Implementation of the Global Strategy for Infant and Young Child Feeding in the SEA Region

Annex 3

Tools and materials on infant and

young child feeding

Most of the recently published tools and materials on infant and young
child feeding have been developed by WHO in collaboration with UNICEF
and other partners, and include the following:

(1) Evidence for policy for breastfeeding, which includes optimal

duration of exclusive breastfeeding (2001), risk of death among
non-breastfed children (2000), and long-term effects of
breastfeeding (being finalized).
(2) Evidence and guidelines for complementary feeding which
includes: guiding principles for breastfed (2002) and non-
breastfed children (2005), guidelines for linear programming
(field test).
(3) Evidence, guidelines and job aids for counsellors for HIV and
Infant feeding which includes a Framework for Priority Action
(2003), guidelines for decision-makers (2003), a guide for
health-care managers (2003), a review of available evidence on
transmission through breastfeeding (2004). A set of job aids for
counselling on HIV and infant feeding (2005) includes a
flipchart, a reference guide and take-home flyers.
(4) With regard to feeding in exceptionally difficult circumstances
:For low-birth weight: review of evidence and draft guidelines
¾ For severe malnutrition: guidelines for hospital management
and consensus on community-based managementFor infant
feeding in emergencies: two training modules Tools for
planning and management of IYCF which includes an
assessment tool (2003), a planning guide for national
implementation of the strategy (working draft available on
internet), and indicators for assessing complementary feeding
(draft).

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(6) Infant and Young Child Feeding: An integrated course (5 days),

which includes breastfeeding, and complementary counselling
along with counselling for infant feeding in HIV. The original
courses on breastfeeding counselling, HIV and infant feeding
counselling and/or complementary feeding counselling have
been introduced and/or repeated in more than 100 countries.

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 Implementation of the Global Strategy for Infant and Young Child Feeding in the SEA Region

Annex 4

Group work

Group Work (a): Develop an operational framework with priority

activities for inclusion/ acceleration of implementation of the strategy

The intention was to identify intersectoral activities that will help in

developing a strategy for IYCF or, if one exists, how best to accelerate
action for effective implementation.

Issues
¾ Does the country need a separate Strategy for IYCF or could
elements of the IYCF be positioned in other existing strategies
(e.g. Child Health, Nutrition, etc.)?
¾ Once the strategy is in place what activities in relation to
breastfeeding and complementary feeding would be needed for:
– assessing the existing practices relating to IYCF to identify
issues and gaps;
– designing and implementing a communication strategy; and
– capacity building of health and nutrition workers.
¾ Is there a need to engage professional bodies, parliamentarians
and civil society in efforts for IYCF? How will this be done?
¾ What legal considerations will need to be addressed? How will
these be addressed?
¾ Is there a need for including IYCF in the curriculum in medical,
nursing and other schools? What issues will need to be
addressed e.g. permissions from regulatory authorities, etc.?
¾ What action is needed to formulate a plan for IYCF in
difficult/special circumstances like natural disasters, HIV/AIDS,
management of severe malnutrition?

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¾ What steps will be needed to assist working mothers to practice

appropriate infant and young child feeding practices?
¾ Is a mechanism for identifying and implementing research for
IYCF needed? How will this be done?

Group Work (b): Building of a monitoring and evaluation system

within the framework

¾ What are the critical aspects of IYCF that should be monitored?

¾ How will the agreed set of indicators be collected and analysed?
¾ Are there any other avenues (e.g. DHS) which could be utilized
to collect information about IYCF? What steps are necessary to
ensure that such opportunities are utilized effectively for
monitoring IYCF-related activities?
¾ What steps are necessary to ensure that the
monitoring/evaluation process feeds into policy change(s)?

Group I

The recommendations made by the group were as follows:

Policy and plan

Examine existing country policies related to IYCF; revise/develop policy

(country specific); revise/develop strategy (country specific); develop time-
bound action plan for IYCF linked to MDGs and national goals at national
levels and sub-national levels (country specific).

Partners

Set up a high level inter-sectoral group, with other partners, professional

bodies and assign specific responsibilities with resources; there should be a
national focal point for IYCF. Use every opportunity to highlight the need to
prioritize IYCF, with parliamentarians, civil society, also piggy backing on
other programmes e.g. Child Survival, Nutrition, HIV/AIDS; address the
Parliamentarian’s Forum for Children – for longer-term engagement
(country specific).

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 Implementation of the Global Strategy for Infant and Young Child Feeding in the SEA Region

Legal aspects

An inter-ministerial group is needed to ensure protection; strengthen code

implementation, and to safeguard against repealing by new integrated food
laws. Maternity Protection needs more work especially for women in the
unorganized sector

Training

Undertake needs assessment to identify the structure and resources for

inclusion; IYCF must be included in the medical and nursing curriculum;
institutions such as medical councils, nursing councils to be brought into
intersectoral coordination group; constitute a training sub-group which
should be linked to the intersectoral group; use short modules or country-
specific innovations based on needs and structures; core training module
on IYCF to be included in all relevant training courses.

Exceptionally difficult circumstances

There should be a separate section within the action plan, and specific
activities planned.Community support

Community-based, mother-and-child-care support should be planned,

especially in the unorganized sectors; may include creches which must be
baby-and child-friendly.

This group did not make specific recommendations with regard to

monitoring and evaluation and neither did it develop an operational
framework. It was pointed out that there was very little that was
new/different that was being proposed by the group. The response to this
comment was that as the strategy was in a very nascent stage of
implementation in these countries, therefore basic activities have been
proposed and emphasized to set the ball rolling.

Group II The group developed an operational framework in which it

prioritized the following areas:

Policy and legislation; Advocacy and communication; Planning,

coordination and resource mobilization; Training; Baby Friendly Hospital
Initiative; Community support; Infant feeding in difficult circumstances.

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The indicators proposed included:

(1) Exclusive breastfeeding among children less than 6 months

(2) Percentage receiving complementary feeding at: 6 months; 6-9
months; and family foods at one year of age
(3) BFHI: number of facilities (hospitals and PHCs) meeting BFHI
criteria
(4) Prevalence of underweight, stunting, wasting
(5) Code monitoring – mechanism and frequency

Methods of collection would include routine Health Management

Information Systems, sentinel sites and large surveys (e.g. Demographic
Health Survey).

Key comments on the group work included:

¾ Use standard Demographic Health Survey indicators. Collect

information which stimulates action.Indicators related to IYCF
should be integrated in Health Monitoring Information Systems,
a monthly compilation of which will facilitate a district team to
support monitoring and action. Group III

The group developed an operational framework in which it prioritized the

following areas:

Generating political commitment; setting up a network of multi-

sectoral organizations; capacity building both pre-service and in-service;
and building community support groups. The group also did not make
specific recommendations with regard to monitoring and evaluation.

Overall, the recommendations made by the group were:

¾ An integrated course on IYCF should be implemented

¾ IYCF should be introduced in the pre-service training curriculum
as a separate chapter
¾ Advocacy with local NGOs for getting involved with IYCF
activities should be strengthened.

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