A&T Monthly August 2018

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Southeast Asia

Supporting improved breastfeeding policies and practices in China.
At the 2nd Breastfeeding Promotion Forum in Beijing, China, held during World Breastfeeding Week (WBW), Alive & Thrive (A&T) shared information on its successful efforts working with governments in Southeast Asia to improve regulations on the marketing of breastmilk substitutes (BMS), increase maternity protection entitlements, and promote breastfeeding-friendly policies and practices in health facilities. Staff from the Bill & Melinda Gates Foundation presented the latest science on breastfeeding, and the World Health Organization (WHO) Western Pacific Office discussed the role of early essential newborn care (EENC) in increasing early initiation of breastfeeding (EIBF) in health facilities. A new video developed by Save the Children, in collaboration with A&T, called “Don’t Push It – Why we must stop aggressive marketing of formula milk” was launched during the Forum. In the coming months, A&T will continue to provide support to partners working on breastfeeding in China, including facilitating country learning visits and providing technical support for survey analysis and reporting.
Photo credit: Paul Zambrano | Alive & Thrive. Roger Mathisen from A&T presenting at the 2nd Breastfeeding Promotion Forum in Beijing, China, during a session with Anuradha Narayan from UNICEF China, Ellen Piwoz from the Bill & Melinda Gates Foundation, Howard Sobel from WHO, and Elsa Giugliani from the Federal University of Rio Grande do Sul in Brazil.
Four hospitals in Viet Nam recognized as Centers of Excellence for breastfeeding and newborn care.
As part of WBW celebrations, two hospitals in Da Nang City (Cam Le District Hospital and Son Tra District Hospital) and two in Quang Nam province (the Provincial Obstetrics & Gynecology Hospital and Dong Giang District Hospital) received awards from the Department of Health in Viet Nam. With assistance from A&T, maternity and newborn ward staff from all the hospitals in the two provinces received training and coaching on providing EENC and breastfeeding support. Quarterly monitoring data on EENC and EIBF showed that EENC was provided after birth for more than 99 percent of deliveries in Da Nang and 95 percent in Quang Nam, including initiating breastfeeding within 90 minutes of birth.
Myanmar embraces becoming breastfeeding-friendly and launches innovative breastfeeding campaign.
Myanmar is the first country in Asia to complete the Becoming Breastfeeding-Friendly (BBF) Initiative developed by Dr. Rafael Perez Escamilla and the Yale School of Public Health. A&T is a member of the global Technical Advisory Group for the BBF initiative and provides technical assistance via support from Irish Aid. During the ‘Stakeholder Endorsement for Scaling Up Breastfeeding in Myanmar’ meeting, members of the BBF working group presented recommendations for improving the environment for breastfeeding to policy and decisionmakers from Parliament, the Ministry of Health and Sports, and the Attorney General’s Office, as well as to donors, United Nations (UN) agencies, physicians, civil society, and the media. The BBF working group will now meet to develop a Terms of Reference for a National Infant and Young Child Feeding Alliance. This Alliance will develop an action plan for achieving the recommendations.
Photo credit: Save the Children. Collection of images from August 27th launch of the "6 months: Mothers milk is all you need" campaign at the Yangon Gallery, Myanmar.
On August 29, Myanmar’s Ministry of Health and Sports, along with leading child rights and health organizations, celebrities, hospitals, health centers, and businesses, launched a national breastfeeding campaign: “6 months: mothers milk is all you need.” The campaign, which is the first of its kind in Myanmar, is a collective effort of Bridge (creative partner), Koe Koe Tech (technical partner), City Mart Holding Co., Ltd. and KBZ Bank (corporate partners), Shenzhen World Health Foundation (funding), Save the Children, UNICEF, Irish Aid, A&T, GIZ, 3MDG, and LIFT. Over the next three months, 8,000 new mothers in Yangon, Mandalay, and Nay Pyi Taw will receive a personalized mother’s bracelet and informational booklet with monthly markers and developmental and breastfeeding tips, as well as bracelets for her three most important supporters. The campaign will also link mothers to breastfeeding resources via the maymay mobile app.

Bangladesh

A&T supports mobile app on nutrition counselling.
The Maternal and Child Health Division of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), in collaboration with the University of Sydney, is conducting research on the effect of cash transfers and a mobile-based nutrition counselling app on childhood stunting. Five thousand pregnant women are being recruited to participate in a cluster randomized control trial and followed until their children are 2 years old. The icddr,b research team is designing a nutrition focused, interactive, mobile- based application with pictures, videos, messages, and quizzes. A&T is providing technical assistance, reviewing the content, and assessing its appropriateness for pregnant women and mothers of children under 2.
World Food Program and A&T collaborate on integrating nutrition social and behavior change communications with social protection programs.
A&T signed a memorandum of understanding (MoU) with the World Food Program (WFP) to support a social and behavior change (SBC) strategy for the Maternity Allowance and Lactating Mother Allowance program, a social protection program under the Ministry of Women and Child Affairs (MoWCA). A&T is developing a social behavior change communication (SBCC) training module and monitoring checklist to increase nutrition knowledge and capacity among district-level Master Trainers, and an Upazila-level resource pool supported by WFP and MoWCA. Nutrition-sensitive approaches to improving nutrition are the focus of the integrated SBCC training and activities.
On the horizon: A&T framework shared as potential collaboration with WorldFish Bangladesh is explored.
Following a consultation workshop in late July where A&T staff shared key learnings from the previous implementation of its Framework for Implementing Infant and Young Child Feeding Programs at Scale in Bangladesh, a letter of collaboration (LoC) with WorldFish Bangladesh is being developed. WorldFish Bangladesh was recently awarded the Feed the Future Bangladesh Aquaculture and Nutrition Activity (FTF BANA) grant from the US Agency for International Development (USAID) aimed at increasing fish productivity and strengthening the aquaculture market system, while increasing knowledge and awareness of maternal, infant, and young child nutrition (MIYCN) practices. FTF BANA plans to adapt social and behavior change communication (SBCC) materials developed by A&T (i.e. videos, posters, job aids) used in previous phases of the A&T initiative in Bangladesh. The potential partnership will explore other ways that A&T could support FTF BANA objectives.

India

Tools for integrating MIYCN into undergraduate medical curricula reach final stages.
A&T has been providing knowledge leadership and technical support to a range of public medical colleges and universities in Bihar and Uttar Pradesh (UP). In August, A&T facilitated the second technical expert committee meeting in Lucknow, UP to finalize the technical and operational module and service delivery protocols for integrating MIYCN into the undergraduate medical course curriculum. Senior faculty from Obstetrics & Gynaecology and Pediatrics and Preventive and Social Medicine (PSM) departments, and experts from King George Medical University (KGMU) and Era Medical college reviewed and suggested changes to the technical content, assessment methodology, curriculum schedule, and service delivery protocols. The final package will be shared in September/October 2018 with the Directorate General of Medical Education and other key stakeholders. It is expected that the integrated curriculum and service delivery protocols will be rolled out in these public institutions in the next academic year.

Strengthening the medical curricula within private institutions is also underway. A letter of commitment has been signed with the Kurji Holy Family Hospital, a private hospital in Patna, Bihar. The collaboration will focus on: institutionalizing the practice of MIYCN-relevant services based on recommendations from national guidelines; integrating MIYCN into the medical curriculum; and building nutrition capacity of medical officers and in-service nursing staff.
Photo credit: Alive & Thrive. Collection of images from the dissemination workshop organized by the Hamdard Institute of Medical Sciences & Research to present the newly developed MIYCN curriculum for undergraduate medical courses.
Home-Based Care for Young Child (HBYC) program offers opportunity to address undernutrition.
In collaboration with the Child Health Division of the Ministry of Health and Family Welfare (MoHFW) and NITI Aayog, A&T will provide technical assistance in the early implementation stage of HBYC across two selected districts of Bihar (Gaya and Sitamarhi) to ensure quality roll-out of the initiative and the capturing of the early learnings and results to inform the countrywide scale up. The objective of HBYC is to reduce child mortality and morbidity and improve nutrition status, growth, and early childhood development of young children through an additional five home visits by the Accredited Social Health Activist (ASHA), in coordination with the Anganwadi worker. Structured home visits by ASHAs from the third month to the 15th month are proposed in the new program to help improve child nutrition, promote immunizations, stimulate early childhood development, emphasize good hygiene practices, and reduce common childhood illnesses such as diarrhea and pneumonia. Previously, structured visits by ASHAs ended on the 42nd day after birth (about mid-way in the second month). To date, meetings have focused on the HBYC baseline assessment approach and overall research design.
A&T and IPE Global’s “We Collaborate for Nutrition (WECAN)” project sign an agreement.
IPE Global is implementing a multi-sector nutrition project to improve maternal and child nutrition, funded by the Bill & Melinda Gates Foundation, at the national level and in Rajasthan, Odisha and Jharkhand states. The project focuses on strengthening reproductive, maternal, newborn, child, and adolescent health (RMNCH+A) in Jharkhand; Integrated Child Development Services (ICDS) in Rajasthan; and Odisha Livelihood Mission (OLM) in Odisha. The agreement outlines A&T’s support in Rajasthan, which includes helping to develop a terms of reference for formative research to explore and document key motivators and barriers to adopting MIYCN practices in three districts and, based on the results of the research, content for the SBCC materials.

Madagascar

Moving forward on social and behavior change (SBC) to reduce stunting in Madagascar.
Earlier this year, A&T, with the World Bank and partners Tangerine Lab and Agence CAPSULE, conducted formative research to gather data and information to inform an SBC strategy for stunting reduction in Madagascar. The World Bank’s Nutritional Results Improvement Project Project (Projet d’Amelioration de Resultats Nutritionnels/PARN) is supporting implementation of the government’s Unite de Programme National de Nutrition (UPNNC) in four regions with the highest levels of stunting. In August, A&T led a three-day intensive workshop with the Ministry of Health, National Office of Nutrition, UNICEF, WFP, and UPNNC to review available data, as well as new insights from the formative research. The workshop provided a forum to develop an initial design of an SBC strategy to improve MIYCN practices, anticipated to be supported through PARN. A&T documented the meeting outcomes; a report is forthcoming.

Burkina Faso

New policy report released to strengthen MIYCN interventions through RMNCH platforms.
The final report and policy brief on integrating MIYCN into existing reproductive, maternal, newborn and child health (RMNCH) platforms are now available. The report covers: maternal nutrition within antenatal care (ANC); nutrition newborn care practices; and the standards and protocols for monitoring and promoting the growth of children aged 0-59 months during well child care and integrated management of newborn and childhood illness (IMNCI), as well as promotion of infant and young child feeding (IYCF) in the community.
Photo: New brief from Burkina Faso.  Available on aliveandthrive.org.
Gaps in the understanding of how to improve the operational elements of integrating MIYCN, and recommendations for moving forward, are also featured in the report. This policy work is part of broader efforts to revise nutrition policies in Burkina Faso that are supportive of MIYCN, as well as to guide the allocation and use of resources under the World Bank-funded Global Financing Facility (GFF) investment.
A&T and the GFF in Burkina Faso.
The GFF is a multi-stakeholder partnership that provides collective resources to help address health and nutrition issues affecting women, children and adolescents. A recent $20 million GFF investment and an $80 million World Bank grant to Burkina Faso are helping the government strengthen health services in the country. The policy report provided valuable information for the government to help identify key nutrition interventions to be included in the GFF package. In addition, A&T is providing on-the-ground experience to the GFF, recently sponsoring a visit for the GFF communications team to witness what and how RMNCH and nutrition services are delivered by health agents. A&T participates in RMNCH, nutrition, and crosscutting subgroups led by the Ministry of Health and supported by the GFF. A&T is advocating for the integration of MIYCN through antenatal care, birth delivery, and early newborn care (ENC), well child visits, and sick child visits (IMNCI) platforms, as well as for interventions to be delivered through community health agents and women’s support group. Strategies for better multi-sectoral nutrition coordination, and improved health management information system and data-use are being considered in the crosscutting subgroup.
On the horizon: New partnership opportunities for A&T.
Staff from the INSPIRE project—a Bill & Melinda Gates Foundation-funded consortium project led by IntraHealth International to improve nutrition and RMNCH in nine countries in West Africa—and A&T agreed to share resources, collaborate on workshops, and ensure a unified voice on advocacy for priority nutrition interventions. A&T is also exploring partnerships with the Newborn and Child Health unit of UNICEF to scale up nutrition through early newborn care platforms, and with the Food and Agriculture Organization of the United Nations (FAO) and the Ministries of Agriculture and Territory Administration and Decentralization to collaborate on A&T’s proposed complementary feeding implementation research and nutrition sensitive agriculture interventions.

Nigeria

State-level breastfeeding activities reach breastfeeding women in Nigeria.
Throughout the month of August, A&T worked with partners to raise awareness of the benefits of breastfeeding at both the individual and community levels. In Lagos State, a series of health facility-based breastfeeding informational seminars reached mothers who were attending ANC and immunization visits, while a “town hall” style meeting engaged community leaders in how they can protect, promote, and support breastfeeding. Similar efforts were made in Kaduna State through a symposium offered to health facility staff on revitalizing the Baby-Friendly Hospital Initiative (BFHI) and a roundtable dialogue with the Women’s Committee of the Nigerian Labour Congress on “Barriers to Exclusive Breastfeeding among Nursing Mothers in Formal Workplaces.”
Photo: The high-level policy dialogue was featured in several news outlets, including the Premium Times Nigeria.
Dynamic policy dialogue on breastfeeding in Nigeria.
A&T, along with partners Save the Children, UNICEF, and the Civil Society Scaling-Up Nutrition in Nigeria (CS-SUNN) brought together a diverse group of government officials, parliamentarians (including women caucus members), private sector representatives, and the public to celebrate World Breastfeeding Week. More than 200 people attended the event, which was also widely covered in the media. Highlights of the event included an exciting announcement from the Minister of Health, Professor Adewole, that discussions with the Ministry of Labour led to an agreement to extend the National Maternity Leave policy from four to six months for government employees. During the event, the Director General of the National Agency for Food and Drug Administration (NAFDAC), Professor Mojisola Adeyeye, also shared a commitment to strengthen enforcement of the BMS industry to comply with the BMS Code.
Governors’ Forum offers rich opportunity for breastfeeding policy advocacy.
Governors from the 36 states in Nigeria come together biannually to discuss national priorities and plan key actions for the states. A&T participated in the August forum as part of efforts to amplify support for breastfeeding as a national priority. States made commitments to work on creating an enabling environment to enforce the International Code of Marketing of Breast-milk Substitutes (BMS Code) and establishing crèches in the work place (starting with ensuring establishment of a crèche as a minimum standard in the Ministries of Health and Women Affairs). A&T presented a concept note on the cost of setting up crèches and will follow up with additional support as needed.

Ethiopia

Photo credit: Alive & Thrive. Dr. Tadele Bogale, A&T Ethiopia’s Deputy Project Director, presented an overview of A&T's project including the goals, major activities, and outcomes.
Regional launch events for continued A&T efforts in Ethiopia.
Half-day workshops in the regions of Tigray, Southern Nations, Nationalities, and Peoples (SNNP), Amhara, and Oromia officially mark the start of A&T initiative activities in Ethiopia for 2017-2022. The workshop gathered representatives from health and agriculture and livestock bureaus, the Seqota Declaration Program Delivery Units (SD-PDU) teams, nutrition officers from the zonal health and agriculture offices, universities and research institutions, and international and local nongovernmental organizations and UN organizations working on nutrition. Each Regional Health Bureau (RHB) head shared A&T’s shift to providing resources for technical assistance and capacity building rather than direct implementation of programs, as part of the larger effort to promote sustainability of MIYCN services in Ethiopia. They also facilitated question and answer sessions to allow for an open dialogue to establish milestones for achieving program goals. Two more regions, Afar and Somalia, are targeted for A&T support; however, staffing and security issues are delaying the start-up in these regions.

West Africa

“Breastmilk Only, No Water” campaign forthcoming in West Africa.
UNICEF, in partnership with A&T, hosted two web meetings (one in English and one in French) in August to present plans to launch a new campaign targeted at eliminating the practice of giving water to infants 0-6 months of age. A&T is supporting the UNICEF West Africa Regional Office in the development and promotion of SBCC materials and policy advocacy for the campaign. The web meetings served to share the objectives of the campaign, introduce the materials, and stress the importance of country-level input and support. The regional campaign is expected to launch in October.
On the horizon: Regional workshop to build capacity for breastfeeding-friendly health systems.
On September 27 and 28, A&T and UNICEF will host a workshop in Ouagadougou to build momentum and capacity for institutionalizing EIBF into health systems. The workshop will address how to reduce the gap in EIBF at institutional deliveries in the West Africa region and offer knowledge-sharing and capacity- building sessions. The expected audience includes UNICEF and WHO representatives, Ministry of Health delegations from multiple countries in Francophone West Africa, and members of civil society/NGOs.
Identifying areas of collaboration for improving nutrition in Côte d'Ivoire.
A&T hosted a meeting in Abidjan, Côte d'Ivoire with the Permanent Technical Secretariat for nutrition and key stakeholders. The purpose of the meeting was to gain concurrence from the Permanent Technical Secretariat for A&T activities aimed at helping the government scale up breastfeeding practices through institutionalization of WHO's 2018 guidelines on implementation of the BMS Code, and to identify bottlenecks and strengthening breastfeeding counseling in a peri-urban area of Abidjan, including exploring the possibility of using a social franchise model with UNICEF. In addition, the meeting aimed to foster collaboration across other stakeholders’ efforts in Cote d’Ivoire, including Helen Keller International and Action contre la Faim.