INFANT AND YOUNG CHILD FEEDING

PROGRAMMING STATUS

Results of 2010 - 2011 assessment of key

actions for comprehensive infant and young child feeding programmes in 65 countries

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© United Nations Children’s Fund (UNICEF) April 2012 Cover photo: Ghana: © UNICEF/HQ02-0570/Pirozzi Permission to reproduce or extract any part of this document is required. Requests may be sent to C. Rudert, Nutrition Section, UNICEF New York, crudert@unicef.org

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Acknowledgements

Nutrition staff from UNICEF country offices compiled the information on IYCF programmes in each of the 65 countries which completed the matrices, and in many countries Government staff and partners were also involved in the exercise.

UNICEF consultant Avril Armstrong collected and inputted the data and drafted the report. Adebayo Ogunlade conducted additional analysis and editing of the report and produced country profiles for 22 countries with poor IYCF practices and large burdens of children sub-optimally fed and undernourished. From UNICEF headquarters, Christiane Rudert (Nutrition Specialist Infant Feeding) conceptualized the assessment matrix and prepared the first draft; she was also responsible for overseeing the assessment, managing the consultancies and finalizing the report. Mandana Arabi (formerly Nutrition Specialist Complementary Feeding) oversaw the development of the final version of the matrix and contributed to following up on the conducting of the assessment. The assessment was supported by Nune Mangasaryan (Senior Advisor Infant and Young Child Nutrition).

Any questions or comments should be addressed to Christiane Rudert, crudert@unicef.org

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Table of Contents

Acronyms and abbreviations……………………………………………………………………...

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Executive summary………………………………………………………………………………….

1

1.0 Introduction…………………………………………………………………………………... 7

1.1 Objectives………………………………………………………….…………………………..

7

2.0 Methodology……………………………………………………….…………………………. 7

2.1 Data collection ………………………………..………………………………………………. 7

2.2 Data analysis procedure…………………..………………………………………………….

8

3.0 Results………………………………………………………………………………………...... 10

3.1 Response rates……………………………………………………………………………….… 10

3.2 National level IYCF actions…………………………………………………………..……….. 10

3.3 Health service level IYCF actions………………………………………………………..…… 16

3.4 Community-based IYCF actions…………………..……………………………………..…… 23

3.5 Communication on IYCF……………………………………...…………………………..…… 27

3.6 Complementary feeding interventions/components……………………….…………..…… 31

3.7 IYCF in difficult circumstances………………….………………………………………..…… 34

3.7.1 HIV and infant feeding ……….………………….………………………………………..…… 34

3.7.2 Infant feeding in emergencies………………….………………………………………..…… 35

3.8 IYCF monitoring and evaluation…………………………………………………..……..…… 39

3.9 Conclusions and recommendations…….…...……...…………………..……………..……. 41

References………………………………………………………..………………………..…………... 50

Section 4: IYCF profiles: 22 countries with poor IYCF practices and large burdens of

undernutrition among children under five years…………….…………..………………………

51

ANGOLA…………………………………………………..……………………………..…..………….. 52

BANGLADESH…………………………………………………..…………………………..………….. 54

BURKINA FASO…………………………………………………..………………..………..…………. 56

COTE D’IVOIRE…………………………………………………..………………...………..………… 58

DEMOCRATIC REPUBLIC OF THE CONGO………………………………..……………..………. 60

ETHIOPIA…………………………………………………..……………………..…………..………… 62

INDIA…………………………………………………..………………………..………………….……. 64

INDONESIA…………………………………………………..………………………..……………….. 66

KENYA…………………………………………………..………………………..……………………... 68

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MALAWI………………………………………………………………………………………………….. 70

MALI………………………………………………………………………………………………………. 72

MOZAMBIQUE…………………………………………………………………………………………... 74

NIGER…………………………………………………..………………………..………………………. 76

NIGERIA…………………………………………………..………………………..……………………. 78

NORTH SUDAN…………………………………………………..………………………..…………… 80

PHILIPPINES…………………………………………………..………………………..………………. 82

SIERRA LEONE…………………………………………………..………………………..…………… 84

SOMALIA…………………………………………………..………………………..………………..….. 86

SOUTH SUDAN…………………………………………………..………………………..………….… 88

UGANDA…………………………………………………..………………………..………………….… 90

UNITED REPUBLIC OF TANZANIA…………………………………………………..……………… 92

YEMEN…………………………………………………..………………………..……………………… 94

ANNEXES………………………………………………………………………..………………………. 96

ANNEX 1: Assessment matrix questionnaire ………………………….……………..……………... 97

ANNEX 2: Completion of assessment matrix and response rate…….……………..…………….. 104

ANNEX 3: Key IYCF interventions and indicators ………….……………..………………………... 105

ANNEX 4: Country descriptions………………………….……………..……………………………... 107

ANNEX 5a: IYCF policy, strategy and plan of actions………………….……………..…………… 111

ANNEX 5b: IYCF legislation and law………………………….……………..……………………….. 114

ANNEX 5c: National level IYCF action score ………………………….……………..……………... 116

ANNEX 5d: IYCF health service training curricula……………………….……………..………….. 118

ANNEX 5e: IYCF health workers capacity development……………….……………..……………. 121

ANNEX 5f: Training of health providers on IYCF counseling…………….……………..………….. 123

ANNEX 5g: IYCF health system counseling………………………….……………..………………. 125

ANNEX 5h: Baby-Friendly Hospital Initiative………………………….……………..………………. 127

ANNEX 5i: Health system level IYCF actions score…………………….……………..……………. 129

ANNEX 5j: Community-based IYCF actions………………………….……………..……………….. 132

ANNEX 5k: Capacity development and coverage of community-based IYCF actions………….. 135

ANNEX 5l: IYCF community activity implementor………..…………….……………..…………….. 137

ANNEX 5m: Communication on IYCF…...……….……………………….……………..………….… 138

ANNEX 5n: Communication on IYCF: Strategy, materials and monitoring/evaluation…………. 141

ANNEX 5o: Communication on IYCF action scores…..……………….……………..……………… 144

ANNEX 5p: Complementary feeding components / interventions….….……………..……………. 147

ANNEX 5q: IYCF in difficult circumstances (HIV and infant feeding)….……………..……………. 149

ANNEX 5r: IYCF in difficult circumstances (Infant feeding in emergencies)……………………….. 152

ANNEX 5s: Overall IYCF in difficult circumstances……….………………………….……………... 155

ANNEX 5t: IYCF monitoring and evaluation……….………………………………..…………………. 157

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Acronyms and abbreviations

ANC ante-natal care

BCC behaviour change communication

BFHI Baby Friendly Hospital Initiative

BMS breast-milk substitutes

CAR Central African Republic

CEE/CIS Central and Eastern Europe/Commonwealth of Independent States

CF complementary feeding

CHW community health worker

Code International Code of Marketing of Breastmilk Substitutes and subsequent relevant

World Health Assembly Resolutions

DRC Democratic Republic of Congo

EAPR East Asia and the Pacific and South Asia Region

ESAR Eastern and Southern Africa Region

GMP growth monitoring and promotion

GSIYCF Global Strategy for Infant and Young Child Feeding

HIV human immunodeficiency virus

HMIS health management information system

HW health worker

IF infant feeding

ILO International Labour Organization

IMCI integrated management of childhood illness

IYCF infant and young child feeding

IYCN infant and young child nutrition

KAP knowledge, attitudes and practices

LAM lactation amenorrhea method

LBW low birth weight

LNS lipid nutrient supplements

LQAS lot quality assurance sampling

MAM moderate acute malnutrition

MICS multiple indicator cluster survey

M&E monitoring and evaluation

PMTCT prevention of mother to child transmission

ROSA Regional Office for South Asia

SOWC State of the World’s Children

TBA traditional birth attendant

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

U5MR under-five mortality rate

WCAR Western and Central African Region

WHO World Health Organization

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Executive summary This comprehensive infant and young child feeding (IYCF) situation assessment was conducted with the primary objective of providing an up-to-date overview of the scope and scale of IYCF programming and implementation status globally, which will enable gaps and constraints as well as areas of achievement to be highlighted and actions to strengthen the programmes identified. Since 2010, the equity-focused approach has emerged as a pivotal priority for UNICEF as an organization [1]. The present report is highly relevant to this effort. It presents the detailed IYCF profile for 22 nutritionally vulnerable countries, “countries with the poorest IYCF practices and largest burden of undernutrition among children less than five years”

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Furthermore, optimal IYCF practices play an important role in reducing early childhood morbidity and mortality, as well as in improving early child growth and development. WHO/UNICEF recommend exclusive breastfeeding from birth to first six months of life, with the introduction of complementary foods thereafter, and continued breastfeeding until two years of age [2].

Guidance on IYCF actions

In support of country-level actions in strengthening IYCF programmes, UNICEF has recently developed a programming guide on IYCF [3] for country level managers and public health/nutrition staff. The programming guide is based on scientific evidence, lessons learned, best practices and presents the “how” of programming at all levels. Key IYCF action areas at the national, health service and community levels for a comprehensive, at-scale IYCF strategy, including the design and implementation steps are outlined.

IYCF assessment matrix

Accompanying the IYCF Programming Guide is an assessment matrix. The matrix is structured around the components of the Guide. This tool is intended for use by UNICEF’s country offices, in close collaboration with governments and other partners involved in IYCF programming, to regularly monitor and assess the scope and scale of recommended IYCF in-country actions and identify areas for improvement. The matrix can be used periodically to assess whether progress is being made to address identified gaps. The aggregated information is also helpful for regional and headquarters staff to prioritize support and additional guidance on the areas most commonly reflected as problematic.

Methodology Between 2010 and 2011, the UNICEF Nutrition Section at HQ requested its country offices to complete the IYCF assessment matrix. In most cases the exercise was undertaken in collaboration with Government counterparts and other partners. The data collected were compiled, analyzed and will be used as baseline data for the scope and scale of IYCF programming globally. This report summarizes the results of the analysis. In total, the assessment matrix was sent to 86 (including 22 designated nutritionally vulnerable countries) country offices in 6 regions [East and South Asia region (ESAR), West and Central African region (WCAR), Region of South Asia (ROSA), Middle East and North African region (MENA) and East Asia and Pacific region (EAPR)] for completion. IYCF action score was calculated for each country on each of the action areas. Scores were then scaled from 0 to 10 and rated based on a colour scale

2. It is emphasized that the results are principally qualitative and

are based on the responses received from the countries. Overall, approximately 65 countries (76%) responded within the stipulated timeframe and returned completed assessment matrices.

1 It is noted that these 22 countres do not represent the entire set of countries with poor nutrition indicators, but a selection.

2 Colour scale interpreted as follows: Red = 0-3 [“Poor” – very low number of key IYCF actions implemented]; Orange = 4-6 [“Fair” – low

number of key IYCF actions implemented; Green = 7-8 [“Good” - average number of key IYCF actions implemented]; Purple = 9-10 [“Very good” – High number of key IYCF actions implemented].

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Key findings National level IYCF actions Overall more countries had IYCF policies than strategies and plans

of actions. Approximately 84% of the countries (n=51) had policies (stand-alone or integrated), 60% (n=38) had strategies and only 48% (n=30) had plans of action.

An estimated 62% of the countries (n=39) had national legal frameworks related to the Code of Marketing of Breastmilk Substitutes in place and only 19 countries (50%) had a Code monitoring or enforcement system in place. Paid maternity leave existed in most of the countries [92% (n=56)] but only about 52% of the countries (n=32) provided paid nursing breaks for mothers after they returned to work.

On average, countries were rated “fair” on their national level IYCF actions, indicating implementation of low number of key IYCF actions at the national level.

Overall, 12% of the countries were rated “Very good”, 28% “Good”, 40% “Fair” and 20% “Poor” on the national IYCF actions.

Health service IYCF actions Pre-service trainings for nurses and other health professionals on

IYCF were more likely to occur than training for medical doctors. Only 51% of the countries (n=33) conducted IYCF-focused pre-service trainings for medical doctors, and about 88% (n=38) conducted pre-service trainings for nurses and other health professionals.

In-service trainings occurred in about 37 countries (60%). About 69% of the countries (n=44) had job aids and counselling cards available for health professionals (medical doctors, nurses and other health professionals).

Although about 43 countries indicated that health workers were trained on IYCF counselling since 2006, none of the countries were able to report on the geographic scale and target population coverage of counselling activities taking place within the maternal and child health centres.

Among the 55 countries that indicated that at least one hospital/maternity facility was ever-certified as “Baby-Friendly”, the average proportion ever-certified was 23% (ranging from 1 to 100%). Among the 22 countries that indicated that at least one hospital/maternity facility was ever re-certified as “Baby-Friendly”, the average proportion ever re-certified is extremely low at 5.6% (ranging from 1 to 76%).

On average, countries were rated “fair” on their health service IYCF actions, indicating the implementation of low number of key IYCF actions at the health service level.

Overall, 12% of the countries were rated “Good”, 57% “Fair” and 31% “Poor” on the health service IYCF actions.

Community level IYCF actions Eighty-four percent of the countries (n=53) had established

community-based IYCF activities either as stand-alone and/or integrated within other programmes.

Only 11 countries reported having stand-alone IYCF activities within the community. Some countries indicated integrating activities within other programmes [such as Integrated Management of Childhood Illnesses (n=12), ante-natal care (n=9), growth monitoring and promotion (n=7)].

About 66% of the countries (n=39) indicated training of community health workers on community IYCF counselling had occurred since

Health service level IYCF action

scores in 65 countries

Community level IYCF action scores in

65 countries

National level IYCF action scores in

65 countries

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2006, while 27 countries (60%) conducted specific capacity building on communication skills for community health workers. The average proportion of community health workers trained on IYCF counselling since 2006 was 26 % (ranging from ≈1 to 73%).

Only 13 countries routinely monitored the counselling skills of the community health workers and very few monitored the counselling quality

On average, countries were rated “Poor” on their community-based IYCF actions, indicating the implementation of very low number of key IYCF actions at the community level.

Overall, only 8% of the countries were rated “Good”, 31% “Fair” and 61% “Poor” on the community-based IYCF actions.

Communication on IYCF Only 36 countries (55%) conducted communication on IYCF

through five or more communication channels. Countries also indicated having communication strategies at the national (n=33), health service (n=54) and community (n=50) levels.

Behavioural change and communication materials were available in most [95% (n=61)] of the countries.

However, few countries had monitoring and evaluation systems for communication on IYCF. Only 16 countries (28%) routinely monitored on-going communication on IYCF activities.

Additionally, about 20% of the countries (n=9) routinely monitored the number of people reached through media messages. As a result, only a few countries were able to report on the coverage of communication on IYCF activities in their country.

On average, countries were rated “Fair” on their communication on IYCF actions, indicating the implementation of low number of key communication on IYCF actions.

Overall, 12% of the countries were rated “Good”, 62% “Fair” and 26% “Poor” on the communication on IYCF actions.

Complementary feeding interventions/components About 60% of the countries (n=37) indicated that

caregivers/mothers were counselled on home preparation of complementary foods for children 6-24 months. Countries d a variety of counselling channels, such as counselling cards (at the health service and community level), cooking classes, published recipe guides for mothers and broadcast food preparation demonstrations on TV.

Micronutrient supplements (multiple/single) were provided to improve complementary feeding for children 6-24 months in about 79% of the countries (n=51). Furthermore, 58% of the countries (n=19) provided fortified industrially blended complementary foods, while only 26% of the countries (n=10) provided fortified local complementary foods.

On average, countries were rated “Fair” on their complementary feeding interventions/components.

Overall, 11% of the countries were rated “Very good”, 4% “Good”, 36% “Fair” and 49% “Poor” on the complementary feeding interventions/components.

IYCF in exceptionally difficult circumstances HIV and infant feeding

HIV and infant feeding policy and guidance were available in about 84% of the countries (n=54).

Approximately 72% of the countries (n=47) d infant feeding counselling for HIV positive mothers, while about 83% countries (n=45) trained health workers on infant feeding and HIV. However, only about 67% (n=38) of the countries provided support on infant feeding for HIV positive mothers.

Communication on IYCF action scores

in 65 countries

Complementary feeding interventions/

components scores in 65 countries

HIV and infant feeding action scores in

65 countries

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Infant feeding and HIV training materials and job aids/counselling cards were updated with the WHO 2010 recommendation in approximately 76% (n=31) and 74% (n=23) of the countries, respectively.

Only 27.4% (n=17) of the countries had a monitoring system on infant feeding practices among HIV positive mothers in place.

On average, the countries were rated “‘fair’” on their actions related to HIV and infant feeding interventions.

Overall, 12% of the countries were rated “Very good”, 38% “Good”, 25% “Fair” and 25% ‘Poor”. Infant feeding in emergencies

Only 41% (n=26) of the countries indicated that their national IYCF policy included infant feeding in emergencies. Similarly, 24 countries (41%) also reported having a national emergency preparedness plan which included IYCF in emergencies.

About 24% (n=14) countries provided training for health providers or IYCF counsellors on infant feeding in emergencies.

Fifteen (15) countries (25%) indicated that they provide breastmilk substitutes in emergencies.

On average the countries are rated “poor” on their actions related to infant feeding in emergencies.

Overall, 4% of the countries were rated “Good”, 17% “Fair” and 78% “Poor”.

IYCF monitoring and evaluation

Routine monitoring and evaluation of ongoing IYCF activities and the monitoring of process indicators took place in about half of the countries

Evaluation or review of the IYCF situation only occurred in about two thirds of the countries. At the same time, monitoring of national IYCF programmes only took place in 39 countries (64%).

Almost none of the countries were able to report on the geographic scale and population coverage of IYCF counselling services, either in the health system or at community level. Coverage of communication activities was also not reported.

On average, countries were rated “Fair” on the IYCF monitoring and evaluation action score.

Overall, 4% of the countries were rated “Very good”, 11% “Good”, 37% “Fair” and 48% “Poor”.

Summary of recommendations These recommendations represent a summary of major lines of action that are suggested by the results of the assessment; they are not meant to be all-encompassing or detailed. For detailed guidance see the UNICEF IYCF Programming Guide, which covers all the steps to design, plan and monitor comprehensive IYCF interventions that will be required to strengthen the various components and address constraints and gaps. National level IYCF actions i. Gaps at the policy level still need to be addressed. Although most countries had some form of

IYCF policy (stand-alone/integrated), very few countries had a combination of policy, strategy and plan of action to operationalize the policy and strategy.

ii. IYCF policy comprehensiveness should be reviewed. National IYCF policies still did not reflect certain key IYCF practices or components.

iii. National IYCF policies should be comprehensive to ensure that all relevant health and community services protect, promote and support breastfeeding and ensure timely, safe and age-appropriate

Infant feeding in emergencies action

scores in 65 countries

IYCF monitoring and evaluation action

scores in 65 countries

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complementary feeding at 6-24 months as well as guidelines on ensuring appropriate IYCF in exceptionally difficult circumstances.

iv. More countries need to establish national legislation on the Code of Marketing of Breast milk Substitutes and continually check the status of their Code.

v. Gaps existed with monitoring and enforcement systems for the Code, even for those countries with a law already in place. Regular independent monitoring is needed, which is free from commercial interests using standard protocols to document violations.

vi. Maternity leave was provided in many countries but a large percentage of countries do not provide nursing breaks for mothers.

Health service level IYCF actions i. In-service training and pre-service education gaps in countries need to be comprehensively

addressed. The standard pre-service and in-service training curricula in countries should be based on the WHO 2009 IYCF model chapter for textbooks for medical students and allied professionals – noting that the HIV and infant feeding chapter needs to be updated in line with the 2010 WHO recommendations on HIV and infant feeding.

ii. It is also vital to ensure that the capacities of health professionals are substantially strengthened in providing recommended IYCF counseling and support.

iii. Appropriate systems and structures to routinely deliver IYCF counselling services within the health system need to be developed as well as supervision and performance monitoring mechanisms need to be in place to ensure sustained implementation and documentation of performance. IYCF indicators need to be integrated within the health management information systems (HMIS), especially in countries where these systems function relatively well. Rapid assessment tools such as lot quality assurance sampling (LQAS), SMART and other nutrition surveys, health facility assessment tools and qualitative assessments can be used to measure coverage and quality of IYCF counseling, and established assessment and survey instruments need to integrate appropriate IYCF indicators.

iv. Given that the Baby-Friendly Hospital Initiative was reported as having extremely low coverage of re-certification of facilities, it must be properly institutionalized within the national health system in order to ensure continuity and sustainability. The Ten Steps and the tools to assess compliance with them need to be fully integrated within the standard operating procedures of health facilities and the supervisory, monitoring, quality assurance, accreditation systems.

Community level IYCF actions i. Community-based initiatives can extend the delivery of interventions, particularly important in

countries that have a weak health infrastructure or low health facility delivery rates. However, current IYCF actions at the community level in most countries appear to be not as well-developed as the health service level.

ii. More effort is required to strengthen and scale up community level IYCF actions and ensure that IYCF is promoted and supported in communities. Community-based IYCF activities and programmes should build upon existing health and nutrition programmes at community level to the extent possible.

iii. Training community health workers in community-based IYCF counseling and communication skills should be intensified in countries and large-scale coverage pursued. The distinction between promotive actions/communication and counselling and skilled support needs to be more clearly made, and the importance and complementarity of both underscored, as many countries do not yet pursue large-scale actions related to counselling and support at the community level.

iv. Monitoring and evaluation of community-based IYCF activities should be strengthened to include supportive supervision and a recognition mechanism for well-performing workers in more countries. Additionally, monitoring systems should be comprehensive enough to be able to provide sufficient detail on the coverage, quality of training and counseling activities among others. A combination of routine data and rapid assessment and survey tools should be used to monitor coverage and quality of community IYCF interventions (see recommendation iii) in the section on the health system above).

Communication on IYCF i. Comprehensive communication strategies on IYCF based on formative research and using

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multiple channels to reach priority participant groups with age and context-specific messages should be an integral part of in-country IYCF intervention.

ii. Gaps exist with respect to routine monitoring of ongoing communication on IYCF activities. Countries need to strengthen or develop appropriate system to monitor and evaluate communication activities, outcomes and impact on behaviour.

Complementary feeding additional interventions/components i. Counseling mothers or caregivers on optimal complementary feeding practices and using multiple

communication channels will be crucial for improving mothers/caregivers knowledge and skills on home preparation of nutrient-rich complementary foods for children 6-24 months.

ii. For some countries provision of complementary food supplements may be needed to fill the nutrient gap when locally available foods alone cannot satisfy nutrition requirements. Appropriate decision-making processes are needed to determine whether, when and for whom supplements are needed, and where implemented, monitoring systems are needed to be able to report on coverage.

IYCF in difficult circumstances HIV and infant feeding i. HIV and infant feeding recommendations, based on the latest 2010 guideline, need to be fully

integrated within all the in-country IYCF guidelines, materials, training sessions and counselling contacts.

ii. These revised materials need to be thoroughly disseminated to all relevant health and community workers across the whole country, and systematic follow up and mentoring on quality and appropriate application is needed

iii. More emphasis on the importance of providing support and follow-up for HIV positive mothers is required.

Infant feeding in emergencies i. National policies should be updated to include infant feeding in emergencies and not wait until after

an emergency strikes before prioritizing infant feeding in emergencies. ii. Capacities for the design, planning, management and monitoring of IYCF interventions in

emergencies need to be strengthened among Governments, partners, NGOs and other institutions.

iii. Free breast milk substitutes were still provided in some of the countries. Actions should be taken to inform governments in advance (as part of emergency preparedness and planning) in these countries about the negative impact of accepting donations of these products on IYCF practices, and to ensure effective systems are in place to prevent, block and handle donations in case an emergency occurs. In situations where breast milk substitutes are necessary for eligible children then close control and monitoring is necessary.

Monitoring and evaluation system for IYCF i. Monitoring and evaluation systems need to be substantially strengthened as evidenced by the low

proportion of countries that were able to report on geographical scale, target population coverage and quality of IYCF interventions in the health services, at community level, on complementary feeding supplements and related to communication currently taking place in their countries. Steps to strengthen this aspect will involve a number of initiatives, for example to include IYCF indicators within HMIS systems where these systems are functioning well; to improve community-based tallying and reporting by CHWs; to integrate IYCF indicators of outcome (IYCF practices) and programme performance (e.g. coverage of counselling and communication, coverage of complementary feeding supplements or social protection schemes; training received, counselling services provided, etc., within rapid assessment tools such as LQAS-based small household surveys, CHW surveys and health facility surveys; and systematically integrating all IYCF indicators within household surveys such as SMART and MICS.

ii. The monitoring and evaluation system needs to be carefully designed from the outset to ensure that it comprehensively captures relevant information for the key IYCF action areas.

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1. INTRODUCTION Supported by unequivocal evidence of its impact on child survival and health, key IYCF actions are an integral part of UNICEF programmes that seek to improve early childhood survival, growth and development. Optimal IYCF entails the initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months of a child’s life and continued breastfeeding up to two years or beyond, together with safe, age-appropriate complementary foods starting at 6 months of age [2].

Several countries, including those with high burden of undernutrition and sub-optimal IYCF practices, are beginning to strengthen and enhance the scope and scale of their programmes. In support of these country-level IYCF actions, UNICEF’s Nutrition Section in New York HQ has recently developed a comprehensive programming guide on IYCF [3] for programme managers and public health/nutrition staff. The programming guide is based on scientific evidence, lessons learned, best practices and presents the “how” of programming at all levels. Key IYCF action areas at the national, health system and community levels for a comprehensive, at-scale IYCF strategy are outlined, including the design and implementation steps. The guide offers a number of benefits, including opportunity to assess the current scale, scope and status of IYCF programmes compared to the recommended approach.

An IYCF assessment matrix is included as an adjunct to the programme guide. This matrix is intended for use by UNICEF country offices, in collaboration with governments and IYCF partners, to regularly monitor and assess the scope and scale of recommended IYCF actions in each country. As country offices engage in the design and implementation of IYCF interventions, this matrix is meant to be applied in assessing the status of in-country existing programmes and ultimately identifying gaps in recommended key IYCF action areas. Between 2010 and 2011, the UNICEF Nutrition Section at HQ requested its country offices to complete the assessment matrix. The data collected were compiled and analysed and will be used as the baseline data of the scope, scale and status of IYCF programming globally. This report summarizes the results of the analysis. Structure of the document This document is divided into five main sections. Sections 1 and 2 contain the background information, objective and the detailed methodology as well as the data analysis procedure employed. Section 3 is the result section which contains the key findings of the 2010 – 2011 assessment of key IYCF actions in 65 countries. Section 4 contains the IYCF profile for 22 selected countries with poor IYCF practices and large burdens of undernutrition among children less than five years. Section 5 of the document contains the annexes with the assessment matrix questionnaire, tables with detailed results for each of the action areas, responses received, contacts etc.

1.1 OBJECTIVE The main objective of this analysis was to provide an overview of the scope, scale and status of comprehensive IYCF programmes, encompassing all of the recommended key IYCF action areas [3] at the country-level. Special emphasis was placed on the 22 nutritionally vulnerable countries.

2. METHODOLOGY

2.1 DATA COLLECTION A version of the 2009 IYCF matrix is included in Annex 1. There are two versions of the IYCF assessment matrix. Annex 2 shows the different completion phases of the matrix and the countries that responded at each phase. Version 1: In 2008, the first version of the assessment matrix was pilot-tested in 10 countries. Version 2: In 2009, the assessment matrix was revised and more detailed questions were added, including detailed questions on the International Code of Marketing of Breast-milk Substitutes, maternity protection laws, IYCF partners, UNICEF and government IYCF specific activity budgets, availability of job aids and counseling cards for health professionals, community and health system level monitoring and evaluation and monitoring and training on IYCF in difficult circumstances. In

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addition, the new matrix was updated in 2009 to reflect current available guidelines and reference documents on IYCF. Twenty-three countries in ROSA, EAPR and CEE/CIS completed this 2009 matrix between 2009 and 2010 (Annex 2). The 2009 matrix was then sent to a new group of countries for completion in January 2011. Between January and April 2011, 33 countries completed the 2009 assessment matrix (Vietnam completed the matrix in 2009 and 2011); only the 2011 responses were included in this analysis. In total between 2009 and 2011 the new 2009 assessment matrix was sent to 86 (including 22 nutritionally vulnerable countries) country offices in six world regions (ESAR, WCAR, ROSA, MENA and EAPR) for completion. All responses were compiled and the data cleaned and managed using File Maker Pro 11, and analyzed using Microsoft Excel. For two countries, Liberia and Cote d’Ivoire, the completed 2008 version of the matrix was used. These countries did not complete the 2009 version of the matrix.

2.2 DATA ANALYSIS PROCEDURE

Country scores and ratings Indicators were developed based on selected key IYCF action areas outlined in the programming guide (Tables 2a – 2m). These indicators were used to guide the analysis procedure and only the questions on the assessment matrix related to these indicators were included in this analysis. From these indicators, an IYCF action score was calculated for each country for each IYCF action area. Each country’s score represented its performance on a particular IYCF action area. Scores at each action level were combined to calculate a total overall score for each country as well. Scores were then scaled from 0 to 10 and rated based on the colour scale as shown in Table 1. Country scores were grouped and analyzed regionally and as a whole. At the end of the analysis each country had a score that represented its performance on each IYCF action level.

Table 1: IYCF action score and rating keys

Score Colour Rating

0 – 3 POOR (very low number of the key IYCF actions or interventions implemented)

4 – 6 FAIR (low number of the key IYCF actions or interventions implemented)

7 – 8 GOOD (average number of the key IYCF actions or interventions implemented)

9 – 10 VERY GOOD (high number or all of the key IYCF actions or interventions implemented

Calculation of country scores and sub scores

The scores are calculated based on the average of the sub-scores for each of the components that are considered to be required for that action area. For example, the national level IYCF action score is calculated by determining the mean between the two sub-scores for i) the national policy, strategy and plan of action sub-score and (ii) national legislation action sub-score, which make up the aggregate score. These sub-scores are derived from country’s responses to the questionnaire (each of the questions that were selected was awarded a score of “1” for positive response and “0” for negative response). The detailed composition of each of the two sub scores are as shown in Annexes 5a to 5c; (i) Policy, strategy and plan of action sub-score is composed and derived based on response on key national IYCF policy actions areas, including key IYCF practices reflected in the national IYCF policy (initiation of breastfeeding within the first hour, exclusive breastfeeding, complementary feeding from 6 to 24 months and beyond); the national IYCF strategy and plan of action, as well as other components (including Baby-Friendly Hospital Initiative (BFHI), international Code for Marketing of

9

Breastmilk Substitutes, behaviour change and communication, IYCF in emergencies and HIV and infant feeding). (ii) The legislation sub-score is composed and derived from the response from key IYCF legislation action areas including the Code law, maternity protection law, maternity leave, paid nursing break. The detailed composition for each of the other IYCF action areas are as shown in the respective tables in annex 5d – 5t, including health service level IYCF actions (Annexes 5d to 5i), community level IYCF actions (Annexes 5j to 5k), communication on IYCF (Annexes 5m to 5o), the complementary feeding components/interventions (Annex 5p), IYCF in exceptionally difficult circumstances (Annexes 5q to 5r) and IYCF monitoring and evaluation action (Annex 5t).

Limitations

The result of the present assessment should be interpreted within the context of a qualitative assessment and its inherent limitations. The results are based on the assessment and judgement of UNICEF country-level representatives (in close collaboration with governments and other partners involved in IYCF programming). However in few instances the results might not reflect an absolute picture of a country’s overall IYCF programme, as there may be some elements of subjectivity inherent with this type of assessment. For example, in some cases a particular component may appear to be scored highly based on the reported status, when in fact the reality may be less positive. In addition, it was apparent that the majority of countries were unable to report on the component of “scale” as information systems do not exist to record the geographic and population coverage of IYCF interventions. Nevertheless, efforts were undertaken to ensure that the assessment results reflect the best possible, up-to-date in-country IYCF programming status.

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3. RESULTS

3.1 RESPONSE RATES The UNICEF nutrition specialists and managers, in many cases in collaboration with country government officials and other partners completed the matrices (See annex 4). Of the 86 countries that received the matrix between 2009 and 2011, 65 responded (22 designated as nutritionally vulnerable countries and 43 others). Pakistan and Cote d’Ivoire were the only two nutritionally vulnerable countries that did not respond during the above timeframe. For Cote d’Ivoire, the 2008 version of the matrix was used. Based on this, the overall response rate was 76% (96% for which profiles were developed) (Annex 2). Responses varied across regions. Response rates regionally were 100% for MENA, 93% for EAPR, 86% for ROSA, 80% for ESAR, 77 % for WCAR, and 42% in CEE/CIS. The majority (79%) were completed by UNICEF country officers (including nutrition and health professionals) alone or in collaboration with the MOH, but with 14% solely by the Ministry of Health (MOH) or other government bodies responsible for nutrition.

3.2 NATIONAL LEVEL IYCF ACTIONS NATIONAL IYCF POLICY, STRATEGY AND PLAN OF ACTION A national IYCF policy is usually a formal document setting out the position of the government on recommended IYCF practices and the principles of action to achieve national goals, such as legislative and systems frameworks, main areas of intervention and accountabilities [4]. The IYCF programming guide highlights what an IYCF should include and emphasizes that it should be up to date and reflect all the key practices and major areas of action. An IYCF strategy involves high-level national strategic thinking that defines why the issue of IYCF is being addressed, the overarching goals and specific objectives, the interventions and major lines of action to achieve the objectives and by whom. The strategy document is a broad outline considering and choosing between possible choices of IYCF interventions and actions, while focusing on the most critical needs [3]. The recommended contents and structure of an IYCF strategy are outlined in the programming guide.

National IYCF policy Approximately 31% of the countries (n=19) had a stand-alone IYCF policy. IYCF was integrated into either a nutrition or health policy in 32 countries (53%) that did not have a stand-alone policy. Botswana and Zimbabwe had draft policies; Somalia’s IYCF policy was included in its nutrition strategy and in Southern Sudan it was mentioned in the draft nutrition and health policy. The key IYCF practices (Table 2) that are reflected in most country’s national IYCF policy were exclusive breastfeeding [85% (n=51)] and complementary feeding of 6-24 month old children [83% (n=48)] while early initiation of breastfeeding appeared in only 68% (n=40) of the countries. In less than half (n=32) countries were all three practices reflected in the national policies. Regionally, in CEE/CIS only Uzbekistan and Turkmenistan had stand-alone IYCF policies (25% of countries). Although these countries had stand-alone IYCF policies, in Turkmenistan, the policy did not reflect key IYCF practices related to complementary feeding for 6-24 month olds, while Uzbekistan’s policy lacked the key practice related to early initiation of breastfeeding. Although Kyrgyzstan and Kazakhstan did not have stand-alone IYCF policies, their policies were integrated into their child health policies and contained all the key practices

3 of a comprehensive IYCF policy as well

as over 6 additional components (Annex 5a).

3 The three key IYCF practices reflected in the national policy as captured by the assessment matrix, included (i) initiation of breastfeeding within

one hour of birth, (ii) exclusive breastfeeding and (iii) appropriate and adequate complementary feeding with continued breastfeeding from 6 to 24 months and beyond

11

Four countries (29%) in EAPR had a stand-alone IYCF policy. These countries were Vanuatu, Cambodia, China and the Philippines. Three countries (Korea, Indonesia and Thailand) were not specific regarding whether IYCF was included in another national policy; however, Thailand’s IYCF policy reflected all the key components (Annex 5a). The other country with a comprehensive national IYCF policy was Vietnam. In the ESAR, (Angola, Burundi, Ethiopia, Kenya, Madagascar, Namibia, Rwanda, Uganda, Zambia, Malawi, Somalia and South Africa] 71% had IYCF policies. Mozambique had no officially approved IYCF policy, only a draft, but had other planning or policy documents where IYCF featured prominently. These were listed on the assessment matrix as: the Communication and Social Mobilization Strategy for Protection, Promotion and Support of Breastfeeding 2009-2013.

Zimbabwe was in the process of drafting an IYCF policy; however, all key practices and components were integrated into its nutrition policy. South Africa planned to update its policy. In the MENA region, only three countries (Yemen, Sudan and South Sudan) were assessed. Yemen and Sudan (67%) indicated having IYCF policy. In South Sudan, IYCF was included in the drafted nutrition and health policy and key practices reflected included exclusive breastfeeding, and complementary feeding. In Sudan, IYCF was integrated in the nutrition policy and it reflected all the key IYCF practices. Five countries (83%) in ROSA reported having a national IYCF policy. Two of the countries (33%), Nepal and Bhutan had stand-alone IYCF policies, while India, Sri Lanka and Afghanistan have their IYCF policies as part of the nutrition/health policies. Bangladesh’s policy reflected all key components with the exception of initiation of breastfeeding, while India had only the initiation of breastfeeding reflected in its national IYCF policy. In WCAR, all the countries had IYCF policies either as a stand-

Table 2a: Key practices and indicators at the national IYCF policy level (all regions)

National level actions

Selected Indicators

Results, n (%)

National IYCF Policy

Countries with national IYCF policy (stand-alone/integrated)

51 (83.6%)

Countries with stand-alone IYCF policy

19 (31.0%)

Countries with integrated IYCF policy

32 (52.5%)

National strategy and plan of action

Countries with national IYCF strategy

38 (60.3%)

Countries with national plan of action

30 (47.6%)

Key IYCF practices* reflected in the national IYCF policy

Countries with all key IYCF practices* reflected in the national IYCF policy

32 (49.2%)

Countries with initiation of breastfeeding in the first hour of birth reflected in the national IYCF policy

40 (67.8%)

Countries with exclusive breastfeeding reflected in the national policy

51 (85.0%)

Countries with appropriate and adequate complementary feeding from 6 to 24 months and beyond reflected in the national IYCF policy

48 (82.8%)

*Key IYCF practices reflected in the policy, (i) included initiation of breastfeeding within one hour of birth, (ii) exclusive breastfeeding and (iii) appropriate and adequate complementary feeding with continued breastfeeding from 6 to 24 months and beyond

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alone [4 countries (24%)] or as part of nutrition/health policies in 13 countries (77%). Data were not available for Liberia regarding the key practices and components of its IYCF policies.

National IYCF Strategy and plan of action About 60% of countries (n=38) that responded had an IYCF national strategy but only 48% (n=30) had a national action plan. Only Uzbekistan in the CEE/CIS region had a strategy and two countries (Uzbekistan and Tajikistan) had a plan of action. Uzbekistan had policy, strategy and plan of action. In the EAPR region, 36% of the countries (n=5) had a strategy and plan of action. Vanuatu, China, Myanmar, Philippines and Thailand had strategies. Countries with plan of action were Korea, Vanuatu, Timor-Leste, Vietnam and Thailand. Only Vanuatu and Thailand had both a strategy and a plan of action. In the ESAR, 65% of the countries (n=11) had a strategy and 47% a plan of action. Half of the countries Madagascar, Zambia, Tanzania, South Africa, Swaziland, Uganda, Kenya and Ethiopia had both a plan of action and strategy. South Africa, Uganda and Kenya had a policy, strategy and plan of action. In the MENA region, 2 (Yemen and North Sudan) of the 3 countries had both an IYCF

strategy and plan of action. Yemen was the only country with all three: policy, strategy and plan of action. In the ROSA region, all countries had a strategy but India and Nepal reported having no plan of action. Afghanistan, Bhutan and Sri Lanka all had policy, strategy and plan of action. In the WCAR region most of the countries that responded [87% (n=13)] had a strategy but only 60% of these countries (n=13) had a plan of action. Mauritania, Nigeria, CAR, Gambia, Ghana, Gabon, Togo and Senegal reported having both a strategy and a plan of action and DRC had neither a strategy nor a plan of action. Gambia, CAR, Gabon, Ghana, Mauritania, Senegal, Togo and Nigeria had policy, strategy and plan of action.

NATIONAL IYCF LEGISLATION The International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly Resolutions need to be translated into national legislation and regulations, integrated into the legislative and regulatory frameworks of the country. The code, adopted by the World Health Assembly in 1981, provides guidelines for the marketing of breast milk substitutes, bottles, and teats [5].

International code of marketing of breast milk substitutes law / regulation About 62% of the countries (n=39) reported having an existing international code of marketing of breast-milk substitutes law or regulation but only 50% (n=19) had systems of Code monitoring or enforcement in place (Table 2b, Annex 5b). The entire CEE/CIS region responded that their country had an existing international code of marketing of breast-milk substitute law. Romania and Kyrgyzstan had a system of Code monitoring and enforcement in place.

Box 1: Summary of national IYCF policies, strategies and plan of actions in the 65 countries assessed

Overall, more countries had IYCF policies than strategies and plan of action. Approximately 84% of the countries had national IYCF policies (stand-alone or integrated), 60% had strategies and 48% had plan of action. Having a stand-alone policy was not a requirement for having a comprehensive IYCF policy. Some stand-alone IYCF policies were not comprehensive and several of the integrated IYCF policies were comprehensive in all key IYCF practices or components.

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In the EAPR, 71% of the countries (n=10) that responded reported having a law or regulation in place; only 5 countries (55.6%) had a system of monitoring or enforcement in place. Korea, Indonesia, Myanmar, Timor-Leste had no laws or regulation. In the ESAR, 41% of the countries (n=7) had laws or regulation in place and these countries are Zimbabwe, Uganda, Tanzania, Botswana, Mozambique, Malawi and Zambia. Almost all of these countries except Mozambique had a system of monitoring and enforcement in place. Only Yemen in the MENA region had a national Code law/regulation but with no system of enforcement. In the ROSA region 83.3% of the countries (n=5) had laws or regulations on the Code (all except Bhutan). India and Sri Lanka were the only two with systems of monitoring or enforcement. In the WCAR region, 9 (60%) of the 15 countries that responded, had a Code related law / regulation. These include Mauritania, Nigeria, Ghana, Burkina Faso, Gambia, Gabon, Benin, Congo and Senegal. Only 4 of these countries had a system of monitoring and enforcement in place (Senegal, Nigeria, Gambia, and Ghana).

Maternity Protection Laws and Nursing breaks Overall, 50 countries (79%) out of those that responded had maternity protection laws, about 92% (n=56) provided paid maternity leave for women and 52% (n=32) provided paid nursing breaks for mothers after they returned to work. In the CEE/CIS region, 50% of the countries (n=4) Bosnia, Turkmenistan and Romania and Kazakhstan had maternity protection laws and all of the countries provided paid maternity leave for mothers but only Romania, Kyrgyzstan and Kazakhstan provided paid nursing breaks for mothers.

In the EAPR region, Timor-Leste and Fiji were the only two countries without maternity protection laws (14%). All EAPR countries except Timor-Leste provided paid maternity leave for mothers and 64% of the countries (n=9) provided paid nursing breaks. Among those who did not provide paid nursing breaks were Timor Leste, Fiji, Korea, Myanmar, Indonesia and Thailand.

About 14 countries (82%) in ESAR regions had a maternity protection law in place. Only Rwanda and Somalia did not provide maternity

Table 2b. Key components and indicators at the national level on IYCF legislation

National action level Indicators Results, n (%)

Development & enforcement of national legislation on the marketing of breast milk substitute

Countries with existing international code of marketing of breast milk substitute law/regulation

39 (61.9%)

Countries with Code monitoring and enforcement system in place

19 (50.0%)

Development & enforcement of national legislation on maternity protection

Countries with maternity protection laws or regulations in place 50 (79.4%)

Countries with paid maternity leave 56 (91.8%)

Countries with paid nursing breaks provided for mothers after they return to work

32 (51.6%)

Box 2. Summary of national IYCF legislations/regulations in the 65 countries assessed

Generally, countries performed slightly better on IYCF legislative actions than on IYCF policy (Annex 5b); however, there were still gaps in the monitoring and enforcement of the International Code of Marketing of Breast-milk Substitutes and the provision of nursing breaks for mothers after they return to work. Thirty-nine countries (62%) had International Code of Marketing of Breast-milk Substitutes laws or regulations in place, 19 countries had code monitoring or enforcement in place. Nevertheless, 56 countries (92%) have paid maternity leave in place but only 32 countries (52%) provided paid nursing breaks for mothers after they returned to work.

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leave for women and 41% of the countries (n=7) provided paid nursing breaks for mothers. All the 6 countries in the ROSA had maternity protection laws. Nepal was the only country without paid maternity leave for mothers and only Bhutan and Afghanistan provided paid nursing breaks for mothers.

Most of the countries [93% (n=14)] in WCAR that responded had maternity protection law in place with the exception on Mali. Furthermore, all the countries [100% (n=15)] that responded had paid maternity leave for women. However, the DRC, Benin, Congo Brazzaville, Sierra Leone and Gambia had no paid nursing breaks for mothers returning to work. North Sudan was the only country in the MENA region with a maternity protection law and this country provided paid maternity leave for women and paid nursing breaks as well as Yemen (although Yemen had no maternity protection law

or regulation).

NATIONAL LEVEL IYCF ACTIONS SCORE The national level IYCF action score was calculated for each country based on performance in the key action areas related to IYCF policy and legislation. National level IYCF action scores and how countries performed are shown in figure 1. The average national IYCF action score was 6 out of 10. MENA had the lowest score (4) and ROSA the highest (7). The other four regions had averages of 5 (ESAR and CEE/CIS) and 6 (WCAR and EAPR). Countries with a score between 0 - 3 ‘poor’ had, at the time of the survey, very few or none of the key national level actions related to IYCF policy, strategy, plan of action and legislation. Twenty per cent of the countries (n=13) fell in this category and had many gaps in their national IYCF policy and legislative actions. Countries with a score between 4 and 6 were still below average and were rated as having a low ‘fair’ national IYCF action level; 26 countries (40%) fell in this category. These countries need to intensify efforts to strengthen their national IYCF actions. Countries with scores between 7 and 8 were categorized as ‘good’ regarding the status of national level IYCF action in their countries. About 28% of the countries (n=18) fell into this category. A score between 9 and10 indicated a high level of actions at the national level. Senegal and Gambia WCAR, Zimbabwe, and Botswana in ESAR, Vietnam and the Philippines in EAPR, Afghanistan and Sri Lanka in ROSA all had scores ≥ 9.

15

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

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Figure 1: National level IYCF actions score*

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

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3.3 HEALTH SERVICE LEVEL IYCF ACTIONS

Health service interventions for IYCF are one of the key pillars of the overall IYCF policy and strategy, and are crucial even if service coverage and utilization are not high for all of the maternal and child health services. Even if the health system is weak or access is poor, IYCF actions should still be an important part of it, for a number of reasons: health professionals are influential; they are often the trainers and supervisors of community cadres; the advice and messages provided at health facility and community level, as well as through communication channels, should be harmonized, and health professionals should be able to deal with problematic cases referred by community health workers or lay counsellors.

IYCF HEALTH SERVICE CURRICULA Incorporating IYCF topics in the basic curriculum of medical and para-medical health professionals is most likely to be the most feasible and sustainable way to address the current knowledge gaps. The standard pre-service curricula should be based on the recent WHO Model Chapter for Medical Textbooks on IYCF [6]. A number of other WHO reference documents on IYCF also inform curricula

4.

Only Mauritania, Sri Lanka and Togo (7% out of the 41 countries that provided a response) used all four references/documents (Table 2c) to update both their pre-service IYCF packages for medical doctors, nurses and health professionals. The reference used by the largest percentage of countries to update pre-service curricula for medical doctors was the revised Baby Friendly Hospital Initiative (BFHI) material 2009 [7] [66% (n= 27)]. The other references, including the Global Strategy on IYCF [2] or the Guiding Principles for Complementary Feeding of the Breastfed Child [8], were the key IYCF documents/references used in 24 countries (59%).

4 The four key IYCF documents/references used in updating/developing health professionals’ pre-/in-service curricula as

captured by the assessment matrix, included (i) Global strategy for IYCF 2003; (ii) Revised BFHI material 2009; (iii) Guiding principles for complementary feeding of breastfed child 2001; and (iv) Guiding principles for feeding non-breastfed children 6 to 24 months WHO 2005

Table 2c. Health service level actions: IYCF training curricula for health professionals

Health system actions Selected indicators

Results, n (%)

Pre

-serv

ice

cu

rric

ulu

m Development/updating of

IYCF integrated curriculum for health providers’ pre-service education (Medical doctors only)

Countries that used the global strategy on IYCF* to develop/update their medical curriculum

24 (58.5%)

Countries that used the revised BFHI material 2009* to develop/update their medical curriculum

27 (65.9%)

Development/updating of IYCF integrated curriculum for health providers’ pre-service education (Nurses and other health professionals only)

Countries that used the global strategy on IYCF* to update/develop the curriculum for nurses and other health professionals

14 (30.4%)

Countries that used the revised BFHI material 2009* to update /develop the curriculum for nurses and other health professionals

18 (39.1%)

In-s

erv

ice

cu

rric

ulu

m Development/updating of

IYCF integrated curriculum for health providers’ in-service training (for all health professionals)

Countries that used the global strategy on IYCF* to update/develop the curriculum for of all health professionals

11 (100%)

Countries that used the revised BFHI material 2009* to update /develop their medical curriculum

3 (27.3)

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The WHO 2005 Guiding Principles for Feeding Non-Breastfed Children 6 to 24 months [9] was used in approximately 56% of the countries (n=23) to update their medical curricula. For nurses and other health professionals, most of the countries [83% (n=38)] used WHO/PAHO 2001 Guiding Principles for Complementary Feeding of the Breastfed Child to update their pre-service training curricula

4.

Furthermore, about 14 countries (30%) used the Global Strategy for IYCF [2] for updating nurses and other health professional curricula. Furthermore, all the countries that responded (11), indicated updating their in-service IYCF training package for their health professionals using the global strategy for IYCF [2] document (Table 2c). “Baby-friendly practices” was the element

5 that was least likely [70% (n=39)] to be included in medical

curricula and “Appropriate breastfeeding practices” was the most likely [84% (n=47)] element to be included in medical training curricula. Similarly, for nurses and other health professionals; pre-service curricula, “Appropriate complementary feeding” was the element least likely [70% (n=38)] and “Appropriate breastfeeding [85% (n=46)] was the most likely to be reflected in the curricula. About 57% of the countries (n=32) had pre-service curricula for medical doctors that were comprehensive, that is, contains all three key IYCF elements and 52% (n=28) had comprehensive curricula for nurses and other health professionals. Regionally for medical curricula, CEE/CIS [71% (n=5)], EAPR [64% (n=7)] and WCAR [67% (n=10)] had the highest percentage of countries reporting that their pre-service medical curricula contained a comprehensive IYCF package. ESAR [(47% (n=8)], MENA [33% (n=)] and ROSA [40.0% (n=2)] were all below 50%. Turkmenistan noted that the elements were only partially developed and Benin that there were no specific IYCF elements but only elements on nutrition. Additionally, the IYCF training packages for nurses and other health professionals were comprehensive among 10 countries (59%) in ESAR; 3 (60%) in ROSA, 4 (67%) in CEE/CIS, 7 (54%) in WCAR and 4 countries (36%) in EAPR. No countries in MENA had a comprehensive IYCF package for their pre-service curricula for nurses and other health professionals.

CAPACITY DEVELOPMENT ON IYCF FOR HEALTH PROVIDERS Building the capacity of health providers whether through in-service training or pre-service education is critical for ensuring optimal IYCF practices. Fewer countries [51% (n=33)] conducted IYCF-focused pre-service trainings for their medical doctors than the IYCF-focused in-service trainings for nurses and other health professionals [88% (n=38)]. This was a similar trend across regions except in MENA where the training conducted was for medical doctors (Annex 5e). Only the countries in MENA and Benin and CAR in WCAR responded that there was no IYCF pre-service training for nurses and other health professionals. Approximately 60% of countries (n=37) indicated that stand-alone IYCF in-service trainings were conducted for health professionals (medical doctors, nurses and other health professionals). The regions with the lowest percentage of countries that had in-service training were ROSA [50% (n=3)] and WCAR [56% (n=9)]. The other regions had between 62% (n=8) [ESAR] and 67% (n=10) [ESAR] of countries conducting in-service IYCF trainings. Sixty-nine per cent of the countries (n=44) indicated having IYCF job aids and counselling cards for health professionals. CEE/CIS (50%) and WCAR (56%) had fewer countries with job aids, compared to MENA (67%), EAPR (71%), ESAR (82%) and ROSA (83%). Training on IYCF counseling took place in 55 countries (85%). Additionally, training of

5 The three key IYCF elements reflected in the training package as captured by the assessment matrix, included (i) the Baby-

Friendly practices to support early initiation of breastfeeding, (ii) appropriate breastfeeding practices and (iii) appropriate complementary feeding practices

Box 3. Summary of training/capacity development on IYCF for health providers in the 65 countries assessed

Pre-service IYCF trainings for nurses and other health professionals were more likely to occur than training for medical doctors. About half of the countries conducted pre-service trainings for medical doctors and a little over four-fifths pre-service IYCF training for nurses. In-service trainings occurred in roughly two-third of the countries (All health professionals).

18

health workers on stand-alone IYCF counseling since 2006 occurred in 94% (n=43) out of the 46 countries that responded. Only 54% of the countries were able to report on the proportion of health workers trained. Where countries were able to estimate this, the average proportion of health workers trained on IYCF counseling since 2006 is 10%, with a range of 0.2% to 82%. Also, most countries were not able to report on the coverage of the training on IYCF counselling by district. Among the few which did report, the average proportion districts in which IYCF training took place was 47 %, ranging from 2% to 100% coverage. Regionally, only Bosnia and Romania in CEE/CIS did not have IYCF training since 2006; however, the other countries in the region (Kosovo, Bosnia, Uzbekistan, Kyrgyzstan, Kazakhstan and Tajikistan) that conducted IYCF training also indicated training of their health workers in standalone IYCF counselling. In EAPR 82% of the countries (n=9) which responded that they had conducted trainings since 2006 indicated training their health workers in stand-alone IYCF counselling. One country, Vanuatu, did not conduct any IYCF trainings since 2006. All of the countries (n=6) in ROSA had some form of training since 2006 and only 4 countries responded that health workers were trained in stand-alone IYCF counselling. For India and Nepal, data were not available. Both ESAR and WCAR had 14 countries in each region that trained health workers in IYCF since 2006. All of those countries in WCAR and only 12 in ESAR indicated training health workers in IYCF counseling.

IYCF COUNSELING AT THE HEALTH SERVICE LEVEL IYCF counseling and support in health services is important for establishment and sustaining of good infant and young child feeding practices, as well as for solving problems at relevant health care contacts. Most countries [91% (n=59)] indicated that IYCF counselling occur at the health service level. Countries that did not have IYCF counselling activities were Romania in CEE/CIS, Mongolia in EAPR, and Somalia in ESAR, South Sudan in MENA and Sierra Leone and Liberia in WCAR. Mongolia reported that the country had just begun the process of training its health workers on IYCF counselling. The assessment aimed to determine the major programmes and services within which IYCF was integrated in countries. Of the countries who reported that IYCF counselling took place in their health system, 56% (n=33) of the counselling took place during ante-natal care (ANC), 76% (n=44) in prevention of mother to child transmission (PMTCT) services, 58% (n=34) in growth monitoring and

Table 2d. Health service level actions: IYCF capacity development

Health system actions Selected indicators Results, n (%)

Pre- and in-service capacity development on IYCF for health providers/lactation counsellors

Countries with IYCF-focused pre-service trainings for health professionals (medical doctors only)

33 (50.8%)

Countries with IYCF-focused pre-service trainings for nurses and other health professionals.

38 (88.4%)

Countries with IYCF-focused in-service trainings for all health professionals (medical doctors, nurses and other health professionals)

37 (59.7%)

Training of health workers on stand-alone IYCF training since 2006

Countries in which health workers are trained on IYCF counseling since 2006

43 (93.5%)

Average proportion of health workers trained on IYCF counseling since 2006

10% [range 0.2% – 82%]

Average proportion of district covered by the training on IYCF counseling

47% [range 2.0% – 100%]

19

promotion (GMP) services, 78% (n=46) in the integrated management of childhood illness (IMCI) programme and only 25% (n=15) of the countries had IYCF counselling taking place through the essential nutrition action (ENA) programme. A few countries mentioned other services such as the Baby-Friendly Hospital Initiative, maternal and child health clinic, expanded programme on immunization (EPI) clinics, child health days and community-based management of acute malnutrition (CMAM), although only 3 countries (Madagascar, Ghana and Mauritania) indicated CMAM. Countries that have IYCF counseling taking place within in the top five maternal and child health contacts

6 (Table 2c) included, Turkmenistan

(CEE/CIS), Mozambique (ESAR), Sudan (MENA), Niger, Senegal and Nigeria (WCAR).

6 The top five maternal and child health programme where counseling on IYCF takes place the most frequently included ante-

natal care, prevention of mother to child transmission of HIV, growth monitoring and promotion, integrated management of childhood illness and essential nutrition action programmes

Table 2e. Health system level action: IYCF health service counseling

Health system actions Selected indicators Results, n (%)

Esta

bli

sh

men

t o

f in

teg

rate

d IY

CF

co

un

selin

g

serv

ice

s w

ith

in h

ealt

h s

yste

m

IYCF counseling activities within the health facilities at relevant maternal and child health contacts

Countries with IYCF counseling currently taking place within the health service level

59 (90.8%)

Countries with IYCF counseling taking place within the top five maternal and child health contacts

#

6 (9.2%)

System integration: IYCF counseling within the top five maternal and child health contacts

Countries in which IYCF counseling is currently taking place within the IMCI

Countries in which IYCF counseling is currently taking place within the PMTCT

Countries in which IYCF counseling is currently taking place within the GMP

Countries in which IYCF counseling is currently taking place within the ANC

Countries in which IYCF counseling is currently taking place within the ENA

46 (78.0%)

44 (75.9%)

34 (57.6%)

33 (55.9%)

15 (25.4%)

Mo

nit

ori

ng

an

d e

valu

ati

on

of

IYC

F

co

un

selin

g s

erv

ice

s w

ith

in t

he

healt

h s

yste

m

Development & implementation of supervision/quality assurance system for IYCF services in the health system

Countries with routine monitoring of health workers skills

18 (34.6%)

Countries with routine monitoring of quality of counselling

10 (19%)

% of countries with regular supportive supervision provided by managers

24 (44.0%)

Countries that routinely monitor the or conducted routine monitoring of other process indicators

20 (35.1%)

# Top five maternal and child health contacts identified included, Antenatal care, Prevention of mother to child transmission of HIV/AIDS,

Growth monitoring and promotion, Integrated management of childhood illnesses and essential nutrition action programmes

20

The assessment included a question on the proportion of the target population reached with IYCF counselling services in the health system, and the proportion of districts where IYCF counseling services are provided, but no countries were able to provide a response. This represents a major gap in programme monitoring, as it is not possible to determine whether IYCF counselling is actually being provided and the scale of services.

BABY-FRIENDLY HOSPITAL INITIATIVE The BFHI was launched by WHO and UNICEF in 1991, following the joint WHO/UNICEF statement on breastfeeding in the maternity services in 1989 and the adoption of the Innocenti Declaration in 1990 [10]. The BFHI promotes the implementation of the “Ten Steps to successful breastfeeding” practices with the primary objective of creating an environment conducive for breastfeeding [11]. Maternal and infant experience in health care services exerts a strong influence on breastfeeding initiation and later infant feeding behaviour.

Based on the responses from 65 countries, 55 countries (85%) had “ever-certified” at least one hospital or maternity facility as baby-friendly, but only 22 countries (34%) had re-certified at least one hospital or maternity facility. The average proportion of hospitals/maternity facilities ever certified was reported to be 22.7%, with a range of 1.0% to 100%. This is in line with the global reported average of around 27% at the time. And the average proportion of hospitals/maternity facilities ever re-certified was extremely low at 5.6%, with a range of 1.0% to 76%. The low rate of certification, in particular re-certification, highlights the difficulty of rapidly scaling up the BFHI in the traditional vertical manner and of sustaining the intervention. At the regional level, all of the countries (n=8) in CEE/CIS had ever-certified at least one hospital/maternity facility, while only 63% of the countries (n=5) had at least one hospital/maternity facility re-certified baby-friendly. Although the average proportion of maternity facilities ever-certified is 49%, with a range of 1% (in Tajikistan) to 100% (in Kosovo). In EAPR region, only Vanuatu had no hospitals ever certified baby-friendly and only 4 countries (29%) [Vietnam, Papua New Guinea, Fiji and Thailand] had re-certified baby-friendly hospitals. Not all countries reported the number of facilities in their countries, however, of

Table 2f. Health system level action: Baby-friendly Hospital Initiative

Health system actions Indicators Results, n (%)

Insti

tuti

on

alizin

g t

he “

Ten

ste

ps t

o

su

cce

ssfu

l b

reastf

eed

ing

" in

all

mate

rnit

y f

acilit

ies/H

osp

itals

Certification of

hospitals/ maternity

facilities “Baby-

Friendly”

Countries with at least one hospital/

maternity facility ever certified as “Baby

Friendly”

55 (84.6%)

Average proportion* of hospitals /

maternity facilities ever certified “Baby-

Friendly”

22.7% (range 1.0% - 100%)

Re-certification of

hospital/ maternity

facilities “Baby-

friendly”

Countries with at least one hospital /

maternity facility ever re-certified as

“Baby-Friendly” since 2006

22 (33.9%)

Average proportion* of hospitals/

maternity facilities ever re-certified “Baby-

Friendly” since 2006

5.6% (range 1.0% - 76%)

Box 6. Summary of BFHI status in the 65

countries assessed

The average proportion of hospitals/maternity facilities ever certified Baby-Friendly was 22.7%, with a range of 1.0% to 100%. And the average proportion of hospitals/maternity facilities ever re-certified Baby-Friendly was 5.6%, with a range of 1.0% to 76%. The low rate of certification, in particular re-certification highlights the difficulty of scaling up rapidly the BFHI in the traditional vertical manner. A sustainable option might be to institutionalize the BFHI principles within the health services.

21

those who did, only Fiji (100%) Philippines (83%) and Thailand (67%) certification rates were above 50%. Over half (52%) of baby-friendly designated hospitals in Fiji were re-certified, about 10% for Thailand and 0% for Philippines. ESAR (16%), ROSA (15%) and WCAR (16%) regions had similar average proportion of hospitals/maternity facilities certified. However, re-certification was only 0% (in ROSA), while ESAR (87.5%) of its countries hospitals/maternity facilities certified baby-friendly. However, recertification rate was even lower, as none of the facilities in ROSA were re-certified, 5.6% in WCAR and 4.3% in ESAR.

MONITORING AND EVALUATION OF IYCF COUNSELING ACTIVITIES As noted above, there is generally a serious problem of low reporting with respect to the coverage of IYCF counseling activities taking place within the maternal and child health contacts. The absence of routine and mandatory monitoring/reporting system on IYCF counselling is a major constraint. Inclusion of questions in household surveys or rapid assessments that would enable coverage to be determined is also generally assumed not to happen. Only 35% (n=18) of countries health system routinely monitored health worker skills. Only 10 (19%) had routine monitoring of the quality of counselling taking place in their health system. Forty-four per cent (n=24) had managers that provided regular supportive supervision. None of the countries in MENA monitored health workers skills or quality of counselling routinely. In CEE/CIS, neither Kazakhstan nor Tajikistan conducted routine monitoring of health worker performance. Only Cambodia in EAPR conducted both performance monitoring activities and was the only country that conducted managerial supportive supervision.

In ESAR, only Malawi and Rwanda conducted regular monitoring of health worker skills. In ROSA only Sri Lanka, Bangladesh and India did and in WCAR six countries (Nigeria, DRC, Togo, Senegal, CAR and Gabon routinely monitored health workers skills. Among these countries only Tajikistan, Rwanda, India, Sri Lanka, Gabon, Togo, DRC and Nigeria carried out regular support supervision. Approximately 35.1% (20) of the countries reported conducting monitoring of other process indicators. Those mentioned included number of health workers trained, number of trainings conducted and

number of facilities carrying out IYCF counselling activities.

HEALTH SERVICE LEVEL IYCF ACTIONS SCORE

The average IYCF health service level IYCF action score was approximately 5 indicating a low level of IYCF action at the health system level for countries as a whole (Figure 2). Regional averages were mostly 5 (CEE/CIS, WCAR, EAPR and ESAR) or 4 (ROSA and MENA) (See Annex 5i). Romania and Bosnia Herzegovina. in CEE/CIS, Myanmar, Indonesia, Korea, Vietnam and Timor-Leste in EAPR, Botswana and Somalia in ESAR, Yemen and South Sudan in MENA, Afghanistan, Nepal and Bangladesh in ROSA and Congo, Cote d’Ivoire, Gabon, Liberia and Sierra Leone in WCAR had very low IYCF health service level activity scores and were rated as having very ‘poor’ IYCF health system actions. Overall, 12% of the countries were rated “Good”, 57% “Fair” and 31% “Poor” on the health service IYCF actions.

Box 5. Summary of IYCF counseling / monitoring within the health service in the 65 countries assessed

Almost all of the countries that responded (43) had an IYCF stand-alone counseling training in-country during 2006-2009. Very few countries monitored health workers skills routinely or monitored the quality of counseling taking place within the health service level.

22

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

7 7 7

6 6

5

3

1

7

6 6 6

5 5

4 4 4

3 3

2 2 2

7 7

6 6 6 6

5 5 5 5

4 4 4 4

3

2 2

6

3

2

6

5 5

3 3 3

7 7

6 6 6 6

5 5 5

4 4 4

3 3

2 2

0

0

1

2

3

4

5

6

7

8

9

10

Kyrg

yzsta

n

Ta

jikis

tan

Tu

rkm

en

ista

n

Kazakhsta

n

Uzb

ekis

tan

Kosovo

Bosnia

Herz

.

Ro

ma

nia

Fiji

La

o P

.De

m. R

ep

.

P.N

.Gu

inea

Th

aila

nd

Ca

mb

od

ia

Mo

ngo

lia

Ch

ina

Phili

pp

ine

s

Van

ua

tu

Kore

a

Vie

tna

m

Ind

one

sia

Mya

nm

ar

Tim

or-

Le

ste

Sou

th A

fric

a

Ta

nza

nia

Ken

ya

Rw

an

da

Za

mb

ia

Zim

ba

bw

e

Eth

iop

ia

Ma

law

i

Mo

za

mb

iqu

e

Ug

and

a

Ang

ola

Ma

dag

asca

r

Na

mib

ia

Sw

azila

nd

Buru

nd

i

Bots

wa

na

Som

alia

No

rth

Su

da

n

Yem

en

Sou

th S

ud

an

Sri L

an

ka

Bhu

tan

Ind

ia

Afg

han

ista

n

Ban

gla

de

sh

Ne

pal

Nig

eria

To

go

D.R

ep

.Con

go

Gha

na

Nig

er

Sen

eg

al

Burk

ina

Fa

so

Ma

li

Ma

urita

nia

Ben

in

C. A

fr. R

ep

.

Gam

bia

Co

ngo

Bra

zza

vill

e

Gab

on

Co

te d

'Ivoire

Sie

rra

Le

on

e

Lib

eria

Sc

ore

Figure 2: Health service IYCF actions score*

CEE/CIS EAPR ESAR ROSA WCAR CEE/CIS EAPR ESAR MENA WCAR

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

23

3.4 COMMUNITY LEVEL IYCF ACTIONS

Community-based IYCF programmes and activities should build upon existing health and nutrition programmes to the extent possible. Community level breastfeeding and complementary feeding promotion and support can be effective in improving optimal infant and young child feeding, particularly for those disadvantaged and vulnerable groups with low access to health services.

COMMUNITY LEVEL IYCF ACTIVITIES Based on the responses received, established community-based IYCF activities were carried out in 53 countries (84%). Countries without established community-based IYCF activities were Kazakhstan, Romania and Uzbekistan in CEE/CIS; Mongolia and Myanmar in EAPR; Angola, Botswana and Burundi in ESAR, Bhutan in ROSA and Congo in WCAR.

Korea and Thailand in EAPR provided no response. About 20% of the countries (n=11) indicated that the community-based IYCF activities was stand-alone. One country in MENA (Sudan), ROSA (Afghanistan), and WCAR (Niger); two countries in CEE/CIS (Bosnia and Herzegovina and Turkmenistan) and EAPR (China and Vanuatu) and four in ESAR (Madagascar, Mozambique, Somalia and Uganda) had stand-alone IYCF activities. Countries without stand-alone IYCF community-based activities indicated in which package IYCF was included. Some countries had stand-alone community-based IYCF activities; however, they also indicated that IYCF was also included in other community activity packages. Twelve countries (30%) had IYCF within the community IMCI programme, 23% of the countries (n=9) had it included in ANC, 18% (n=7) in GMP, 13% (n=5) in ENA, 13% (n=5) in mother to mother programmes and 3% (n=1) in PMTCT programme. Only one country (Afghanistan) reported that IYCF activities were included within the CMAM programme.

Table 2g. IYCF actions at the community service level: Community-based IYCF activities

Health system actions Selected indicators Results, n (%)

Esta

bli

sh

men

t o

f in

teg

rate

d

IYC

F

Co

un

se

lin

g s

erv

ice

s a

t th

e

co

mm

un

ity

-leve

l

IYCF counseling activities at the community level

Countries with established community-based IYCF counseling activities

53 (84.1%)

Countries with stand-alone community-based IYCF activities

11 (20.3%)

System integration: IYCF counseling taking place within other relevant selected community-based programmes

Countries in which IYCF counseling is currently taking place within C-IMCI

Countries in which IYCF counseling is currently taking place within the ANC

Countries in which IYCF counseling is currently taking place within the GMP

12 (30.0%)

9 (22.5%)

7 (17.5%)

Imp

lem

en

tati

on

of

co

mm

un

ity

-based

IY

CF

co

un

selin

g s

erv

ice

s

Development and implementation of community-based programmes

Countries in which IYCF activities are carried out by multipurpose community health workers

34 (62.9%)

Countries in which IYCF activities are carried out by dedicated community health workers

29 (53.7%)

Countries in which IYCF activities are carried out by mother support groups

26 (47.3%)

24

The majority of IYCF community activities were being carried out by multi-purpose community health workers [63% (n=34)] who conducted group education sessions as a part of child survival packages. Dedicated IYCF community health workers or counsellors who provided group counselling/promotion and individual counselling and support to mothers were reported in about 54% of the countries (n=29), with 47% of the countries (n=26) mentioning mother support groups. Only 17% of the countries’ IYCF community activities were conducted by traditional birth attendants (TBAs) or traditional health practitioners (THPs). Other groups listed as IYCF activity implementers were volunteers; secular and community groups (see Annex 5l for a complete list). About 68% of the countries (n=44) had data available to calculate the coverage of the IYCF

community-based activities. The average coverage was 65.3%, ranging from 3% to 100%. Thirteen countries had less than 25% of their districts covered with IYCF activities. 38 countries (59%) were not able to report the proportion of the population targeted by the IYCF activities. However, the proportion ranges from 7% to 100% among countries that were able to report on the proportion of the population living in the target districts (See Annex 5k which provides the coverage details as provided by the countries).

Capacity development and routine monitoring of community health worker skills Not all countries had information on the community-based IYCF trainings that took place in their

Box 7. Summary of community level IYCF activities in the 65 countries assessed

Almost 84% of the countries (n=53) indicated carrying out community-based IYCF activities, but only 11 countries (20%) indicated had an established stand-alone IYCF activities. Approximately 60% of the countries (n=27) had a community-based IYCF training and specific communication skills capacity building. Of the countries that responded, only 13 routinely monitored their community health workers skills and very few countries [13% (n=6)] monitored the quality of community health workers’ counselling skills. The monitoring systems need to be substantially strengthened. None of the countries responded on the proportion of districts implementing community IYCF interventions.

Table 2h. IYCF at the community system level: Capacity development of community health workers skills Community-based actions

Selected indicators Results, n (%)

Training of community health workers on community-based IYCF counseling

Countries in which community health workers are trained on community-based IYCF counseling since 2006

39 (66.1%)

Countries in which the capacity building on communication skills are conducted for community health workers

27 (60.0%)

Average proportion of community health workers trained on IYCF counseling since 2006

25.6% [<1% - 73%]

Average proportion of district covered by the training on IYCF counseling

No information

Community level monitoring system

Countries in which community IYCF activities are routinely monitored

15.0 (31%)

Countries in which community health workers’ counselling skills are routinely monitored

13 (27.1%)

Countries in which community health workers’ counselling qualities are routinely monitored

6 (13.0%)

Countries with supportive supervision of community health workers

23 (50.0%)

Countries with recognition mechanism for well-performing workers

5 (19.2%)

25

countries since 2006. Approximately 66% of the countries (n=39) had a community-based IYCF training while about 60% (n=27) out of the 45 countries that responded had capacity building on communication skills for community health workers (see Annex 5j). Regionally, WCAR [81% (n=39)], ESAR [77% (n=13)] and EAPR [67% (n=8)] had the most countries that conducted community based IYCF trainings. IYCF Trainings occurred in two countries in MENA (Yemen and Sudan). Only Sri Lanka in ROSA, Turkmenistan and Kyrgyzstan in CEE/CIS had training on IYCF. About 60% of the countries (n=27) acknowledged that community health workers participated in specific communication skill capacity building, with WCAR region having the highest number of countries [86% (n=12)] that had specific skill-building capacity development for their community health workers. Only 17 countries (26%) were able to report on the proportion of community health workers trained since 2006. The average proportion of community health workers trained on community-based IYCF counseling since 2006 is 26%, with a range of <1% (in Indonesia) to 73% (in South Africa) [See Annex 5k]. None of the countries responded on the questions related to the proportion of districts implementing community IYCF interventions. This reveals a major gap in information about geographic coverage – and indeed the question was a very general one, not even about the proportion of the population that has access to IYCF services at community level. The assessment tool did not attempt to assess coverage for the target population of community-based IYCF interventions, as it was assumed that this information would not be available. Neverthess, this represents a key area of work: to develop or strengthen community information systems to be able to measure performance, quality and coverage of IYCF interventions and to explore feasible assessment modalities including small surveys (e.g. through LQAS) and qualitative methods to complement the information systems.

Monitoring community-based IYCF activities

Only 15 countries (31%) indicated that that routine monitoring of IYCF community-based activities was being conducted. Neither of CEE/CIS or MENA regions conducted routine monitoring of IYCF activities in their region. Only Cambodia in EAPR and Somalia, Rwanda, Madagascar, South Africa and Kenya in ESAR; as well as Afghanistan in ROSA and 8 countries in WCAR reportedly conduct routine monitoring of IYCF community activities (based only on countries that responded). Furthermore, only 13 countries (27%) indicated that the counseling skills of community health workers were routinely monitored and only 6 countries (13%) routinely monitored the quality of counselling conducted by Community health workers. However, more countries [23 (50%)] conducted supportive supervision of the community health workers. Only Kyrgyzstan, Fiji, Kenya, CAR and Nigeria indicated that there was a recognition mechanism for well performing community health workers in their countries. Taken together, the monitoring systems of community-based IYCF activities in most countries need to be substantially strengthened.

Community level IYCF actions score The average community-based IYCF actions score was very low: 3 (Annex 5j); all of the regions were either rated very low (CEE/CIS, EAPR, ROSA) or low (ESAR) for their performance on community-based IYCF activities. Eight countries had a score of 0: Romania and Uzbekistan (CEE/CIS); Myanmar, Mongolia, Indonesia, Thailand (EAPR); Angola (ESAR) and Bhutan (ROSA). All of these countries responded that no community-based IYCF activities existed in-country. Four countries (Senegal, Togo, Cote I’voire, Nigeria and CAR), all in the WCAR region had scores of 7 or 8, based on how they completed the assessment matrix. They all received a rating of ‘good’ for their community-based IYCF activity level. However, in some cases this status reported in the matrix may reflect a more positive picture than the actual situation on the ground, based on other sources, reports and experience. All other countries were either "Poor – 1-3” or "Fair 4-6” regarding in-country community-based IYCF actions. Comparatively, WCAR was the only region with a score of 5 (denoting a medium level of community-based IYCF activities). Overall, only 8% of the countries were rated “Good”, 31% ‘Fair” and 61% “Poor” on the community-based IYCF actions.

26

.

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

5

3 3

2

1

0 0 0

6

5

4 4 4

3 3

2

1 1

0 0 0 0

6

5 5 5

4

3 3 3 3 3 3

2 2 2

1 1

0

3 3

2

5 5

3

1 1

0

8

7 7 7 7

6 6 6

5

4 4 4

3

2

1 1 1

0

1

2

3

4

5

6

7

8

9

10K

yrg

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Bo

snia

an

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tan

Tu

rkm

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Kaz

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stan

Ko

sov

oR

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ania

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bo

dia

Vie

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inea Fij

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iger

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Figure 3: Community level IYCF actions score*

CEE/CIS EAPR ESAR MENA ROSA WCAR

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

27

3.5 COMMUNICATION ON IYCF Communication broadly encompasses advocacy, social mobilization, social marketing, and behaviour and social change communication. Communication on IYCF is a research-based consultative process of addressing the knowledge, attitudes and practices that are intrinsically linked to programme goals on IYCF. Formative research identifies both positive and problematic behaviours and motivators related to IYCF. It also identifies, analyses, and segments so-called “participant groups” who influence infant and young child feeding behaviours and practices, as well as the communication channels which particular communities and groups are most likely to use to receive information and to dialogue on IYCF. An effective communication strategy uses a wide mix of channels appropriate to the identified participant groups, which may include interpersonal, group and mass media channels, as well as participatory methods and social marketing [3]. It also includes plan to implement communication activities at scale and on a continuous basis, rather than just focusing on a one-off event such as World Breastfeeding Week alone.

National level communication strategy on IYCF About 52% of the countries (n=33) had a stand-alone national IYCF communication strategy, while 47 countries (78%) had elements

7 of communication on IYCF included in the overall national IYCF or

nutrition strategy. The elements included in most strategies were World Breastfeeding Week (WBW) [90% (n=37)], while child health days [63% (n=26)] and national campaigns [54% (n=22)] were present to a lesser extent in countries.

In some instances, countries that indicated that despite not having a national IYCF communication strategy, their country still participated in certain IYCF communication activities. For example, Kosovo did not have an IYCF strategy but celebrated WBW under their national plan of action for nutrition.

7 The key elements of communication on IYCF included in most national level communication strategy as captured by the

assessment matrix, included World Breastfeeding Week, National campaigns and health days

Table 2i. Communication on IYCF

Key actions Selected indicators Results, n (%)

Imp

lem

en

tati

on

of

co

mp

reh

en

siv

e c

om

mu

nic

ati

on

str

ate

gy o

n I

YC

F

National level communication strategy on IYCF

Countries with national level communication strategy on IYCF

33 (52.3%)

Communication on IYCF at the health service level

Countries with on-going health service level behavioural change communication activities

54 (91.5%)

Communication on IYCF at the community level

Countries with on-going community-based behavioural change communication activities

50 (84.7%)

IYCF communication channels*

Countries in which behavioural change and communication activities are implemented through five or more communication channels

36 (55.4%)

Countries in which behavioural change and communication activities are implemented through eight communication channels

5 (7.7%)

Monitoring system for communication on IYCF

Countries that routinely monitor on-going communication on IYCF activities

16 (28.1%)

Countries that routinely monitor the number of people reached through media messages

9 (19.6%)

Countries that routinely monitor the quality of group messages

8 (18.2%)

*The 8 most important IYCF communication channels used among the countries, included national TV, radio, campaigns and poster, interpersonal communication, and mobile phone messages as well as communication through indigenous leaders and community leader

28

Although 23 countries indicated that there was no national coordination mechanism present in-country, almost all (except Angola and Botswana) listed an implementing agency. In 13% of the countries, the national coordination mechanism was implemented by non-governmental organisations and 11% by the government and 76% by both.

Communication on IYCF at the health service level At the health system level, most of the countries [92% (n=54)] that responded had on-going behaviour change and communication activities occurring in their health system. The three behaviour change and communication activities that occurred in most countries were distribution of posters and leaflets on IYCF [83% (n=47)] with coverage rates ranging from 20% to 100% (as reported in only 24 countries); health workers conducting IYCF group sessions [73% (n=44)] with coverage rates ranging from 2% to 100% (as reported in only 10 countries) and videos on IYCF [37% (n=22)] for communication on IYCF with coverage rates ranging from 20% to 100% (as reported in 13 countries).

Communication on IYCF at the community level8 About 85% of the countries (n=50) indicated that there were ongoing behaviour change and communication activities at community level. Countries that did not indicate having ongoing behaviour change and communication activities at community level were Thailand, Papua New Guinea, Vanuatu, Philippines, Zambia, Tanzania, Somalia, Afghanistan and Cote d’Ivoire. Approximately 85% of the countries (n=40) who responded indicated that community-based health workers conducted group sessions to promote IYCF, 80% (n=39) had mother support groups or other group sessions to promote IYCF but only 34% (n=15) were aware of traditional health practitioners conducting sessions on IYCF. Other examples of special groups that conducted IYCF sessions in communities were community volunteers in Uzbekistan, Myanmar, Yemen, Sri Lanka; community resource persons in Mali; community health nurses and dieticians in Fiji and associations and NGOs in Benin.

IYCF communication channels, materials and monitoring and evaluation Behaviour change and communication channels The 8 most important IYCF communication channels used, included National TV, radio, campaigns, and posters, interpersonal communication, mobile phone messages, as well as communication through indigenous leaders and community leader. Only five countries (Cambodia, Senegal, Zambia, Tanzania and Mauritania) out of the ones that that responded indicated implemented behaviour change and communication through 8 or more multiple channels. The average number of channels used was 5 and roughly 60% of the countries used 5 or more communication channels. The messages were most often communicated through national television [88% (n=52)], national campaigns [81% (n=48)], interpersonal communication [81% (n=48)], community leaders [71% (n=42)] and religious leaders [58% (n=34)]. The least used behaviour change and communication methods were mobile phones [12% (n=7)] (Annex 5m). Behaviour change and communication materials Behaviour change and communication materials were available in most [95% (n=61)] of the countries Posters and leaflets on breastfeeding [90% (n=52)] and on complementary feeding [83% (n=48)] were the most common materials used. Participatory materials on IYCF were the least used behaviour change and communication materials [29% (n=17)]. Zimbabwe, Botswana, Gabon and the CAR had

8 The assessment matrix did capture information on the coverage of communication activities at the community level.

Box 8. Summary of IYCF communication channels/ methods in the 65 countries assessed

Roughly two-thirds of the countries conducted behaviour change and communication (BCC) through 5 or more communication channels and at multiple levels in-country: national, health system and community levels. Almost all of the countries had BCC materials available in country. However, only about 30% of the countries conducted regular monitoring of IYCF communication activities.

29

no behaviour change and communication material available and Ethiopia’s only materials were family health cards. Monitoring and evaluation of communication strategy About 16 countries (28%) routine monitored IYCF communication activities. Few countries [20% (n=9)] had system in place for monitoring the number of people reached through media messages as well as to monitor the quality of the group sessions [18% (n=8)]. This represents a significant gap. As described for the monitoring of community based activities, there is a need to develop feasible approaches for monitoring and evaluation of communication strategies to measure whether coverage and quality is being achieved and the activities are appropriate and effective.

Communication on IYCF action scores

This communication score took into account all actions or activity related to IYCF behaviour change and communication including communication on IYCF at the national, health service and community level in each country as well as the communication on IYCF monitoring system. The average Communication on IYCF score was 5 (See annex 5o). The highest scores were in WCAR (Burkina Faso, Mauritania, and Senegal) with a score of 8 (Figure 4). Seventeen countries’ communication on IYCF actions were rated as ‘poor: 0-3”. These countries were Romania and Tajikistan in CEE/CIS; Timor Leste, Philippines and Indonesia in EAPR; Ethiopia, Madagascar, Somalia, South Africa, Zimbabwe and Botswana in ESAR; Nepal in ROSA and DRC, Gabon, Cote d’Ivoire, Liberia and CAR in WCAR. Furthermore, all of these countries except Zimbabwe and Timor Leste scored 0 on BCC monitoring actions. Overall, 12% of the countries were rated “Good”, 62% ‘Fair” and 26% “Poor” on the communication on IYCF actions.

30

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

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Figure 4: Communication on IYCF actions score*

CEE/CIS EAPR ESAR MENA ROSA WCAR

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

31

3.6 COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

Quality counseling of mothers/caregivers and appropriate behavioural change and communication are essential for improving complementary feeding practices among children 6 to 24 months and beyond. In addition, provision of complementary food supplements (e.g. industrially and locally produced fortified foods, micronutrient powders or lipid-based nutrient supplements) may be needed to fill nutrient gaps when locally available foods alone cannot satisfy nutritional requirements. Strategies to improve complementary feeding in different contexts may also encompass various social protection measures such as cash transfers or vouchers, and nutrition-sensitive measures in the agriculture sector.

Counseling of mothers/caregivers on home preparation of complementary foods About 59.7% of the countries (n=37) indicated that counseling of caregivers/mothers in home preparation of complementary foods was provided to improve complementary feeding practices of children 6 – 24 months. More countries counsel mothers through food preparation demonstration on TV [60% (n=22)] and health system counseling cards [57% (n=21]. Very few countries provide food preparation demonstrations on TV or radio [8% (n=3)] or cooking classes [15% (n=5)]. Regionally, counseling of mothers/caregivers on home preparation of complementary foods was similar for ESAR [69% (n=11)], ROSA [67% (n=4)], WCAR [65% (n=11)]; but less than two-thirds for EAPR [58% (n=7)] and CEE/CIS [25% (n=2)].

Provision of complementary food supplements It must be noted that the assessment of the use of supplements was intended to be a general overview, and a much more detailed survey was undertaken by UNICEF and CDC on the use of various types of products

9.

9 This section is not intended to be comprehensive. In 2011 CDC and UNICEF conducted a detailed assessment of

programmatic interventions related to home fortification in 162 countries (the survey covers the coverage and scale of use among young children).

Table 2j. Complementary feeding interventions

Key components Selected indicators Results, n (%)

IYCF counseling of mothers/care-givers in relation to home preparation of complementary foods

Countries in with caregivers/mothers are counselled on home preparation of complementary foods

37 (59.7%)

Countries that counsel mothers through counseling cards on food preparation (for health system)

21 (56.8%)

Countries that counsel mothers through counseling cards on food preparation (for community base)

15 (44.1%)

Provision of complementary feeding supplements

Countries providing micronutrient supplements to improve complementary foods of children 6 to 24 months

51 (78.5%)

Countries providing targeted food supplements to improve complementary foods of children 6 to 24 months

40 (61.5%)

32

Fifty-one (79%) countries reported that micronutrient supplements10

were provided to improve complementary feeding of children 6-24 months old. Approximately two-thirds of these countries provided both single micronutrients [68% (n=34)] and multiple micronutrients [62% (n=31)]. Supplements were most often available in non-emergency settings [73% (n=38)] with about 33% of the countries (n=17) provided them during emergencies. Targeted food supplements were provided in 62% (n=40) of the countries to improve the nutritional quality of complementary foods for children 6 to 24 months. Specifically, unfortified and fortified local complementary foods are available in 41% (n=16) and 26% (n=10) of the countries, respectively; while unfortified and fortified industrially-blended complementary foods were provided in 21% (n=7) and 58% (n=19), respectively. In addition, only few countries [19% (n=6)] provided lipid-based nutrient supplements to improve complementary feeding of children 6 to 24 months. The matrix contained questions aiming to assess how targeting of complementary feeding supplements was undertaken and the coverage achieved, but none of the countries responded on these aspects. Regionally, all countries (n=6) in ROSA had some type of micronutrient supplements available followed by CEE/CIS region [88% (n=7)], WCAR [82% (n=14)], EAPR [71% (n=10)], ESAR [71% (n=12)] and MENA (66.7%). Countries that indicated that multiple or single micronutrients were not provided/available for children 6 to 24 months, included Tajikistan in CEE/CIS, Fiji, Papua New Guinea, Timor-Leste and Myanmar in EAPR, Botswana, Ethiopia, Zimbabwe, Angola and Rwanda in ESAR, South Sudan in MENA and Mali, DRC and Sierra Leone in WCAR. Not all countries were aware if social protection programmes with food security component are available in their country; however, 40% (n=22) of those that responded did have such programmes.

Complementary feeding interventions/components score The average complementary feeding component/interventions action score was 4. This score is ranked as ‘fair’ and is indicative that actions to strengthen complementary feeding through counselling to caregivers/mothers as well as provision of complementary food supplements are low across countries (Figure 5 & Annex 5p). One of the regions had an average complementary feeding action score of 6 (EAPR) and ROSA had 4. Three regions (ESAR, MENA and WCAR) had an average of 3 and CEE/CIS average of 2; these regions are ranked as poor. The complementary feeding components/interventions actions score for 36 countries (55%) were ranked as ‘poor’. Overall, 11% of the countries were rated “Very good”, 4% “Good”, 36% “Fair”, and 49% “Poor” on the complementary feeding interventions/components.

10

The limitation of the assessment matrix pertaining to the reported use of micronutrient supplements is that it was difficult to differentiate countries that use micronutrient supplements added to complementary foods from other supplements that are taken directly (e.g. Vitamin A or Zinc supplements) because of the way the assessment matrix questionnaire was framed.

Box 9. Summary of the complementary feeding interventions status in the 65 countries assessed

Only about 60% of the countries counsel mothers/caregivers in home preparation of complementary foods for children 6 to 24 months. 42 countries responded that targeted food supplements were provided. Most countries did not have coverage estimates for supplement distribution in their countries.

33

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

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Figure 5: Complementary feeding components/interventions score*

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

34

3.7 IYCF IN DIFFICULT CIRCUMSTANCES

3.7.1 HIV and infant feeding IYCF in the context of HIV poses significant challenges. Updated HIV and infant feeding guidance was issued by WHO in 2010. These new guidelines fundamentally transforms the landscape in which decisions on infant feeding are made by mothers and caregivers, health providers and national health authorities. The latter establish a single national public health recommendation: either breastfeeding and ARVs or replacement feeding. With the provision of ARVs for HIV-positive mothers and their infants, the standard breastfeeding practices can be recommended for the entire population and different recommendations for HIV-exposed infants are no longer needed. Counseling on individual choice of feeding options is also no longer necessary – unless the mother chooses to opt out of the national policy that has been set. The challenge countries face is to ensure the updated guidelines are widely disseminated and properly understood. Fifty-four (84%) countries had a policy or guidance on HIV and infant feeding and 89% of those countries (n=48) had HIV and infant feeding policy or guidance included in their national IYCF policies (Table 2k & Annex 5q). Almost all of countries [93% (n=53)] had guidance on HIV and infant feeding included in their PMTCT policy but only 74% of the countries (n=42) had their infant feeding policy based on the WHO 2010 recommendation on HIV and infant feeding [12]. Regionally, in the CEE/CIS, Kosovo, Bosnia, Romania, Kazakhstan reported having no policy or guidance on HIV and infant feeding in place. In the other regions, countries without guidance were Korea and Timor Leste in EAPR, Botswana in ESAR, and Yemen in MENA, India in ROSA and DRC and Liberia in WCAR. Counselling of HIV positive mothers on appropriate infant feeding is reported to be in place in 48 countries (72%). All the countries in MENA and one-thirds of the countries (n=4) in the ROSA region (Nepal, Sri Lanka, Afghanistan and Bangladesh) had no infant feeding counselling activities for HIV+ mothers. Approximately 87% (n=40) of the countries that had counseling activities for mothers in place also had IYCF counselling materials that included HIV and IF and only 31 countries (76%) had training materials updated based on the most recent HIV and infant feeding guidance.

Table 2k. IYCF in difficult circumstances: HIV and infant feeding

Action area Selected indicators

Results, n (%)

Infa

nt

feed

ing

pro

gra

mm

ing

wit

hin

th

e c

on

text

of

HIV

Policy on HIV and infant feeding

Countries with policy or guidance on HIV and infant feeding

54 (84.4%)

Countries in which the national IYCF policy include guidance on HIV and infant feeding

47 (88.7%)

Countries in with the prevention of mother to child transmission of HIV policy include guidance on HIV and infant feeding

53 (93.0%)

Capacity development

Countries with established training activities for health workers on HIV and infant feeding

45 (83.3%)

Countries in which health workers are trained on HIV and infant feeding counselling

44 (74.6%)

Counseling activities for HIV+ mothers

Countries with established counseling activities for HIV positive mothers on infant feeding

47 (72.3%)

Countries with follow-up and continuous support for HIV + mothers on infant feeding in place

38 (66.7%)

35

Almost all of the countries [90% (n=55)] that responded had PMTCT training materials that included infant feeding and 76% (n=38) of these were updated. The exceptions were Cote d’Ivoire, South Sudan, Mongolia, Korea, Sierra Leone, Sri Lanka and Indonesia. HIV and infant feeding job aids and counselling cards were available in 63% (n=36) of the countries that responded and 74% (n=23) of these had their materials updated based on the recent HIV and infant feeding guidance. Approximately 83% (n=45) of the countries that responded had training for health workers on HIV and infant feeding and 44 countries (75%) trained health workers on HIV and infant feeding counselling.

Infant feeding counseling was integrated into the PMTCT services in 86% of the countries (n=50). Countries without their infant feeding counselling services integrated within the PMTCT programme were Mongolia, Indonesia and Timor Leste and Philippines in EAPR, Botswana in ESAR, North Sudan and South Sudan in MENA, Sri Lanka and Bangladesh in ROSA. Thirty-eight countries (67%) indicated that they provided support or follow-up for HIV+ mothers. Free infant formula was provided to HIV+ mothers in about 58% (n=35) of the countries that responded to the question. In general, formula was provided by most countries in CEE/CIS [88% (n=7)] except Kazakhstan, 60% of the countries (n=3) in ROSA region, 64% (n=9) in EAPR, 47% (n=7) in ESAR and only Yemen in MENA. Furthermore, based on the countries that responded, 42% (n=14) of the free formula came from the government and 64% (n=21) from non-governmental organizations. Uzbekistan and Vietnam indicated that both entities distributed formula. Overall, only 27% (n=17) of the countries have a system in place for monitoring infant feeding practices among HIV+ mothers.

3.7.2 Infant feeding in emergencies The protection, promotion and support of good IYCF practices is essential in emergencies, when child mortality and malnutrition rates escalate and the risks of sub-optimal IYCF practices are amplified. The response in terms of IYCF in emergencies is often less than adequate, starting from the preparedness, policy and planning aspects to the actual execution of the activities. An important starting point for an effective IYCF response in emergencies is the presence of a strong programme prior to the emergency, with high coverage of services and interventions and good availability of trained and skilled personnel, including those responsible for design, planning, management and decision-making. Approximately 41.3% of the countries (n=26) had a national IYCF policy which includes Infant feeding in emergencies. Additionally, 24 countries (40.7%) had national emergency preparedness plan which includes IYCF in emergencies and only 25.4% (n=15) of these were updated based on the latest edition of the guideline on infant feeding in emergencies [13].

Countries with system in place for monitoring infant feeding practices among HIV+ mothers

17 (27.4%)

Countries that provide free breast-milk substitute to HIV+ mothers

35 (58.3%)

Table 2l. IYCF in difficult circumstances: infant feeding and emergencies

Action area Selected indicators

Results, n (%)

Infa

nt

an

d y

ou

ng

ch

ild

feed

ing

in

em

erg

en

cy c

on

texts

Policy on infant feeding in emergencies

Countries in which the national IYCF policy includes infant feeding in emergencies

26 (41%)

Countries in which the national emergency preparedness plan include IYCF in emergencies

24 (41%)

Capacity Countries in which health providers and IYCF counsellors 14 (24%)

36

Regionally, in the CEE/CIS only Tajikistan has a national IYCF policy which includes IYCF in emergencies. In the other regions, 13 countries (46%) have a national policy in EAPR, 41% (n=7) in ESAR, 83% (n=6) in ROSA and 75% of the countries (n=12) in WCAR. Only few countries [33% (n=9)] indicated that an up-to-date guideline or training materials on IYCF in emergencies are available. Additionally, only 24% of the countries (n=14) indicated that health workers or IYCF counsellors are trained on IYCF in emergencies.

Overall IYCF in difficult circumstances score

Similar to other IYCF action levels, the mean IYCF in difficult circumstances action score was 4 (Figures 6 and 7; Table 10c in Annex 2). This was indicative of a ‘fair’ level of activity occurring in countries in this area. The overall score among all the countries was ‘fair’, only 2 countries (Ghana and Congo) received a rating of (7) ‘good’; the rest have a score of 6 or lower. Regionally, WCAR scored 5; both ESAR and EAPR, scored 4; While CEE/CIS, MENA and ROSA had the lowest score of 3. Overall, about 78% of the countries assessed (n=51) were rated poor on the Infant feeding in emergency action scores. While only few countries were rated fair [17% (n=11) or good [5% (n=3). For IYCF within the context of HIV, 12% of the countries were rated “Very good”, 38% “Good”, 25% fair and 25% “Poor”.

development are trained on infant feeding in emergencies

Countries with up-to-date training material on counseling on IYCF in emergencies

9 (33%)

Provision of breast-milk substitute

Countries in which breast-milk substitutes are provided during emergencies

15 (25%)

Countries in which the national government procures and distribute breast-milk substitutes during emergencies

4 (13.8%)

37

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

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Figure 7a: HIV and Infant Feeding score*

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

38

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

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ia

Buru

ndi

Ang

ola

Som

alia

S. S

uda

n

Yem

en

N.

Su

da

n

Sri L

an

ka

Ne

pa

l

Afg

ha

nis

tan

Ban

gla

de

sh

Bhu

tan

India

Nig

eria

Sen

eg

al

Tog

o

Mali

Co

ng

o B

.

Gh

an

a

Mau

rita

nia

B. F

aso

CA

R

DR

C

Ga

mb

ia

Ga

bo

n

Nig

er

S. L

eo

ne

Ben

in

Co

te D

'Ivo

ire

Lib

eri

a

Sc

ore

CEE/CIS EAPR ESAR MENA ROSA WCAR

Figure 7b: Infant Feeding in emergencies score*

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

39

3.8 IYCF monitoring and evaluation In a broad sense, monitoring is assesses ongoing implementation and evaluation centres on taking stock of a programme or intervention. Quality monitoring is an ongoing programmed activity which helps to orient required adjustments at any stage of the programme cycle, and programme evaluation attempts to determine systematically and objectively (as much as possible) the worth or significance of a policy, strategy or intervention [14].

At the national level, monitoring and evaluation for IYCF was undertaken in about 64% of the countries (n=39). Regionally, countries that do not have a monitoring and evaluation strategy in place included; 5 countries (63%) in CEE/CIS [Bosnia, Romania, Kazakhstan, Turkmenistan and Kosovo]; 3 countries (27%) in EAPR [Fiji, Papua New Guinea Vanuatu]; 4 countries (24%) in ESAR [Angola, Swaziland, Tanzania and Burundi]; Yemen and South Sudan in MENA; 27% of the countries (Gabon, Cote d’Ivoire, Benin and Niger) in WCAR.

Only 31 countries (50%) routinely monitor ongoing IYCF activities and 56% (n=34) reported that there has been an overall evaluation or review of IYCF situation in the countries.

IYCF monitoring and evaluation actions score The average monitoring and evaluation IYCF actions score for countries was low: 4 (Annex 5t). All the regions were either rated very low (0-3) [CEE/CIS, MENA] or low (4-6) [EAPR, ESAR, ROSA, WCAR) on their performance on monitoring and evaluation IYCF activities. In general, most of the countries were rated poor [31 countries (48%)] or fair [24 countries (37%)]. Only few countries were rated good [11% (7)] or very good [4% (3)]. The monitoring and evaluation system of most countries appears to be weak requiring substantial strengthening or reinforcement.

Table 2m: Selected indicators on monitoring and evaluation of IYCF actions

National level action

Selected indicators

Results, n (%)

Monitoring, review and evaluation

Countries with monitoring and evaluation for IYCF actions in place at the national level

39 (63.9%)

Countries that routinely monitor on-going IYCF activities

31 (50.0%)

Countries in which there has been an overall evaluation or review of IYCF situation

34 (55.7%)

40

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

7

5

3 3 3

1 1

0

7 7

5

4 4 4 4

3 3 3 3 3

2

1

9

7

6

5 5 5 5

4

3 3 3 3 3 3 3

2 2

5

2

1

6 6

5

4

3 3

9 9

7 7 7

6 6 6

5 5 5

4

3 3 3

2

0 0

1

2

3

4

5

6

7

8

9

10

Ta

jikis

tan

Kyrg

yzsta

n

Bosnia

& H

erz

.

Tu

rke

mn

ista

n

Uzb

ekis

tan

Kazakhsta

n

Kosovo

Ro

ma

nia

Ca

mb

od

ia

Vie

tna

m

Mo

ngo

lia

Ind

one

sia

Mya

nm

ar

Phill

ipin

es

Tim

or-

Le

ste

Ch

ina

La

o P

DR

Pap

ua

Ne

w G

uin

ea

Th

aila

nd

Van

ua

tu Fiji

Kore

a

Rw

an

da

Som

alia

Ma

law

i

Ken

ya

Ma

dag

asca

r

Mo

za

mb

iqu

e

Za

mb

ia

Sou

th A

fric

a

Bots

wa

na

Buru

nd

i

Eth

iop

ia

Sw

azila

nd

Ta

nza

nia

Ug

and

a

Zim

ba

bw

e

Ang

ola

Na

mib

ia

No

rth

Su

da

n

Sou

th S

ud

an

Yem

en

Ind

ia

Sri L

an

ka

Ban

gla

de

sh

Afg

han

ista

n

Bhu

tan

ne

pa

l

Nig

eria

To

go

DR

C

Gha

na

Ma

urita

nia

G

am

bia

Burk

ina

Fa

so

Sen

eg

al

CA

R

Gab

on

Ma

li

Sie

rra

Le

on

e

Ben

in

Lib

eria

Nig

er

Co

ngo

Bra

za

vill

e

Co

te d

'Ivoire

Sco

re

CEE/CIS EAPR ESAR MENA ROSA WCAR

Figure 8: IYCF monitoring and evaluation actions score*

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

41

3.9. CONCLUSIONS AND RECOMMENDATIONS The purpose of this assessment was to review the current scope, scale and status of IYCF key actions in 65 countries (Table 3; figure 9); with special focus on some 22 nutritionally vulnerable countries (see pages 48 to 92).

As a whole, countries were rated “Fair” on average, indicating low implementation of comprehensive IYCF packages (Table 3). Individual countries performed strongly in some areas while they also had gaps in some other key action areas.

In order to achieve the goal of having a comprehensive IYCF strategy at scale, countries will have to act in synergy by building upon or maintaining progress in areas where IYCF actions are already established while at the same time working to strengthen areas where actions are weak or non-existent.

National level IYCF actions Conclusions On average, countries were rated “fair” on their national level IYCF actions, indicating

implementation of low number of key IYCF actions at the national level.

Overall, 12% of the countries were rated “Very good”, 28% “Good”, 40% “Fair” and 20% “Poor” on the national IYCF actions.

On the whole, more countries had IYCF policies than strategies and plan of action.

An estimated 62% of the countries had national laws or regulations in place related to the International Code of Marketing of Breastmilk Substitutes and only 19 countries had the code monitoring or enforcement in place. Paid maternity leave existed in most of the countries (92%), but only about 52% of the countries provided paid nursing breaks for mothers after they returned to work.

Recommendations Gaps at the policy level still need to be addressed. Although most countries had some form of IYCF

policy (stand-alone/integrated), very few countries had a combination of policy, strategy and plan of action.

IYCF policy comprehensiveness should be reviewed. National IYCF policies still did not reflect certain key IYCF practices or components.

National IYCF policies should be comprehensive to ensure that all relevant health and community services protect, promote and support breastfeeding and ensure timely, safe and age-appropriate complementary feeding at 6-24 months as well as include guideline on ensuring appropriate IYCF in exceptionally difficult circumstances.

More countries need to establish national legislation on the Code of Marketing of Breast milk Substitutes.

Gaps existed with monitoring and enforcement systems for the Code, even for those countries with a law already in place. Regular independent monitoring is needed, which is free from commercial interests using standard protocols to document violations. Effective regulations and systems for enforcement are also needed.

Maternity leave was provided in many countries but a large percentage of countries do not provide nursing breaks for mothers.

Health service level IYCF actions Conclusions On average, countries were rated “fair” on their health service IYCF actions, indicating the

implementation of low number of key IYCF actions at the health service level.

Overall, 12% of the countries were rated “Good”, 57% “Fair” and 31% “Poor” on the health service IYCF actions.

Pre-service trainings for nurses and other health professionals on IYCF were more likely to occur than training for medical doctors. Only 51% of the countries conducted IYCF-focused pre-service

42

trainings for medical doctors, and about 88% conducted pre-service trainings for nurses and other health professionals.

In-service trainings occurred in about 60% of the countries. Further, an estimated 69% had job aids and counselling cards available for health professionals (medical doctors, nurses and other health professionals).

Although 43 countries indicated that health workers were trained on IYCF counselling since 2006, only a few countries were able to report on the scale and coverage of counselling activities taking place within the maternal and child health centres.

Among the 55 countries that indicated that at least one hospital/maternity facility ever certified as “Baby-Friendly”, the average proportion ever-certified is 23% (ranging from 1 to 100%). Among the 22 countries that indicated that at least one hospital/maternity facility ever re-certified as “Baby-Friendly”, the average proportion ever re-certified is very low at 5.6% (ranging from 1 to 76%).

Recommendations In-service training and pre-service education gaps in countries need to be comprehensively

addressed. The standard pre-service and in-service training curricula in countries should be based on the WHO 2009 IYCF model chapter for textbooks for medical students and allied professionals – noting that the HIV and infant feeding chapter needs to be updated in line with the 2010 WHO recommendations on HIV and infant feeding.

It is also vital to ensure that the capacities of health professionals are substantially strengthened in providing recommended IYCF counseling and support.

Appropriate systems and structures to routinely deliver IYCF counselling services within the health system need to be developed. Supervision and performance monitoring mechanisms need to be in place to ensure sustained implementation, quality delivery and documentation of performance

Given that the Baby-Friendly Hospital Initiative was reported as having extremely low coverage of re-certification of facilities, it must be properly institutionalized within the national health system in order to ensure continuity and sustainability. The Ten Steps and the tools to assess compliance with them need to be fully integrated within the standard operating procedures of health facilities and the supervisory, monitoring, quality assurance, accreditation systems.

Monitoring of IYCF activities and outcomes in the health system needs to be substantially strengthened, based on the principle that “what is monitored is more likely to be done”. IYCF indicators need to be integrated within the health management information systems (HMIS), especially in countries where these systems function relatively well. Rapid assessment tools such as lot quality assurance sampling (LQAS), SMART and other nutrition surveys, health facility assessment tools and qualitative assessments can be used to measure coverage and quality of IYCF counseling, and established assessment and survey instruments need to integrate appropriate IYCF indicators.

Community level IYCF actions Conclusions On average, countries were rated “Poor” on their community-based IYCF actions, indicating the

implementation of very low number of key IYCF actions at the community level.

Overall, only 8% of the countries were rated “Good”, 31% “Fair” and 61% “Poor” on the community-based IYCF actions.

Eighty-four per cent of the countries (n=53) had established community-based IYCF activities either as standalone and/or integrated within other programmes.

Only 11 countries reported having stand-alone IYCF activities within the community. Some countries indicated integrating activities within other programmes [such as Integrated management of childhood illnesses (n=12), ante natal care (n=9), growth monitoring and promotion (n=7)].

About 66% of the countries indicated training community health workers on community IYCF counselling since 2006 and only 27 countries conducted specific capacity building on communication skills for community health workers. The average proportion of community health workers trained on IYCF counselling since 2006 is 26 % (ranging from ≈1 to 73%).

Only 13 countries routinely monitored the counselling skills of the community health workers and very few monitored the counselling quality.

43

Recommendations Community-based initiatives can extend the delivery of interventions, particularly important in

countries that have a weak health infrastructure or low health facility delivery rates. However, current IYCF actions at the community level in most countries appear to be not as well-developed as the health service level.

More effort is required to strengthen and scale up community level IYCF actions and ensure that IYCF is promoted and supported in communities. Community-based IYCF activities and programmes should build upon existing health and nutrition programmes at community level to the extent possible.

Training community health workers in community-based IYCF counseling and communication skills should be intensified in countries and large-scale coverage pursued. The distinction between promotive actions/communication and counselling and skilled support needs to be more clearly made, and the importance and complementarity of both underscored, as many countries do not yet pursue large-scale actions related to counselling and support at the community level.

Monitoring and evaluation of community-based IYCF activities should be strengthened to include supportive supervision and a recognition mechanism for well-performing workers in more countries. Additionally, monitoring systems should be comprehensive enough to be able to provide sufficient detail on the coverage, quality of training and counseling activities among others. A combination of routine data and rapid assessment and survey tools should be used to monitor coverage and quality of community IYCF interventions.

Communication on IYCF Conclusions On average, countries were rated “Fair” on their communication on IYCF actions, indicating the

implementation of low number of key communication on IYCF actions.

Overall, 12% of the countries were rated “Good”, 62% “Fair” and 26% “Poor” on the communication on IYCF actions.

Only 36 countries (55%) conducted communication on IYCF through five or more communication channels. Countries also indicated having communication strategies at the National (n=33), health service (n=54) and community (n=50) levels.

Behavioural change and communication materials were available in most [95% (n=61)] of the countries. However, few countries have monitoring and evaluation system for communication on IYCF in place.

Recommendations A comprehensive communication strategy on IYCF using multiple channels to reach priority

audience with age and context-specific messages should an integral part of any IYCF intervention.

Gaps exist with respect to routine monitoring of ongoing communication on IYCF activities. Countries need to strengthen or develop appropriate system to monitor and evaluate communication activities, outcomes and impact on behaviour.

Complementary feeding interventions/components Conclusions On average, countries were rated “Fair” on their complementary feeding interventions/components.

Overall, 11% of the countries were rated “Very good”, 4% “Good”, 36% “Fair” and 49% “Poor” on the complementary feeding interventions/components.

About 60% of the countries (n=37) indicated that caregivers/mothers were counselled on home preparation of complementary foods for children 6-24 months. Countries use varieties of counselling channels, such as counselling cards (at the health service and community level), cooking classes, published recipe guides for mothers and food preparation demonstration on TV.

Micronutrient supplements (multiple/single) were provided to improve complementary feeding for children 6-24 months in about 79% of the countries (n=51). Furthermore, 58% of the countries (n=19) provided fortified industrially blended complementary foods, while only 26% of the countries (n=10) provided fortified local complementary foods.

44

Recommendations Counseling mothers or caregivers on optimal complementary feeding practices and using multiple

communication channels will be crucial for improving mothers/caregivers knowledge and skills on home preparation of complementary foods for children 6-24 months.

For some countries provision of complementary food supplements may be needed to fill the nutrient gap when locally available foods alone cannot satisfy nutrition requirement. Appropriate decision-making processes are needed to determine whether, when and for whom supplements are needed. Countries need to establish effective monitoring systems so the coverage and programmatic aspects of these products and the outcomes can be measured.

The use of nutrition-sensitive social protection schemes needs to be more widely tested and applied, as well as strengthened linkages with agriculture for the implementation of nutrition-sensitive interventions to increase the availability of locally produced nutrient dense quality foods.

IYCF in difficult circumstances HIV and infant feeding

Conclusions On average, the countries were rated “‘fair’” on their actions related to HIV and infant feeding

interventions.

Overall, 12% of the countries were rated “Very good”, 38% “Good”, 25% “Fair” and 25% ‘Poor”.

HIV and infant feeding policy and guidance was available in about 84% of the countries (n=54).

Approximately, 72% of the countries (n=47) provide infant feeding counselling for HIV positive mothers, while about 83% countries (n=45) train health workers on infant feeding and HIV. However, only about 67% (n=38) of the countries provided support on infant feeding for HIV positive mothers.

Infant feeding and HIV training materials and job aids or counselling cards were updated with the WHO 2010 recommendations in approximately 76% (n=31), and 74% (n=23) of the countries, respectively.

Only 27% (n=17) of the countries have a monitoring system on infant feeding practices among HIV positive mothers in place.

Recommendations HIV and infant feeding recommendations, based on the latest 2010 guideline, need to be fully

integrated within all the in-country IYCF guidelines, materials, training sessions and counselling contacts.

These revised materials need to be thoroughly disseminated to all relevant health and community workers across the whole country, and systematic follow up and mentoring on quality and appropriate application is needed.

More emphasis on the importance of providing support and follow-up for HIV positive mothers is required.

Infant feeding in emergencies Conclusions On average the countries are rated “poor” on their actions related to infant feeding in emergencies.

Overall, 4% of the countries were rated “Good”, 17% “Fair” and 78% “Poor”.

Only 41% (n=26) of the countries indicated that their National IYCF policy includes infant feeding in emergencies. Similarly, just 24 countries (41%) also reported having a national emergency preparedness plan which includes IYCF in emergencies.

About 24% of the countries (n=14) provide training for health providers or IYCF counsellors on infant feeding in emergency.

Fifteen countries (25%) indicated that they provide breast-milk substitutes in emergencies.

45

Recommendations National policies should be updated to include infant feeding in emergencies and not wait until after

emergency strikes before prioritizing infant feeding in emergencies in the national IYCF strategies.

Capacities for the design, planning, management and monitoring of IYCF interventions in emergencies need to be strengthened among Governments, partners, NGOs and other institutions.

Free breast milk substitutes were still provided in some of the countries. Actions should be taken to inform governments in advance (as part of emergency preparedness and planning) in these countries about the negative impact of accepting donations of these products on IYCF practices, and to ensure effective systems are in place to prevent, block and handle donations in case an emergency occurs. In situations where breast milk substitutes are necessary for eligible children then close control and monitoring is necessary.

IYCF Monitoring and evaluation Conclusions On average, countries were rated “Fair” on the IYCF monitoring and evaluation action score.

Overall, 4% of the countries were rated “Very good”, 11% “Good”, 37% “Fair” and 48% “Poor”.

Evaluation or review of the IYCF situation only occurred in about two thirds of the countries. At the same time, monitoring and evaluation of national IYCF only occur in 39 countries (64%).

Recommendations Routine monitoring and evaluation of ongoing IYCF activities and the monitoring of process

indicators took place in about half of the countries. However, none of the countries were able to report on coverage of the health services, community-based interventions and communication currently taking place in their countries.

Monitoring and evaluation systems need to be substantially strengthened as evidenced by the low proportion of countries that were able to report on geographical scale, target population coverage and quality of IYCF interventions in the health services, at community level, on complementary feeding supplements and related to communication currently taking place in their countries. Steps to strengthen this aspect will involve a number of initiatives, for example to include IYCF indicators within HMIS systems where these systems are functioning well; to improve community-based tallying and reporting by CHWs; to integrate IYCF indicators of outcome (IYCF practices) and programme performance (e.g. coverage of counselling and communication, coverage of complementary feeding supplements or social protection schemes; training received, counselling services provided, etc., within rapid assessment tools such as LQAS-based small household surveys, CHW surveys and health facility surveys; and systematically integrating all IYCF indicators within household surveys such as SMART and MICS.

The monitoring and evaluation system needs to be carefully designed from the on-set to ensure that it comprehensively captures relevant information at key IYCF action areas.

46

Table 3: IYCF comprehensive action score (All countries)

Region Country National level

IYCF score Health

services score

Community-based system

score

Communication on IYCF score

IYCF in Difficult

circumstances score

CF Component SCORE

Monitoring & evaluation

score

Overall IYCF Comprehensive actions score

CEE/CIS Romania 5 3 0 3 3 2 0 2

CEE/CIS Kosovo 2 5 0 4 2 4 1 3

CEE/CIS Uzbekistan 3 7 0 5 5 1 3 3

CEE/CIS Bosnia and Herz. 5 4 3 4 2 4 3 4

CEE/CIS Kazakhstan 7 8 1 6 1 3 1 4

CEE/CIS Turkmenistan 5 7 2 4 4 4 3 4

CEE/CIS Tajikistan 5 8 3 3 4 0 7 4

CEE/CIS Kyrgyzstan 8 8 5 5 4 2 5 5

MEAN 5 6 2 4 3 2 3 4

EAPR Timor-Leste 0 3 1 3 2 1 4 2

EAPR Indonesia 2 4 0 3 3 4 4 3

EAPR Myanmar 4 3 0 4 4 3 4 3

EAPR Korea 5 5 2 7 1 3 1 3

EAPR Fiji 3 8 4 4 4 1 2 4

EAPR Thailand 8 7 0 4 5 1 3 4

EAPR Vanuatu 8 4 1 6 5 1 3 4

EAPR China 5 5 4 4 6 4 3 4

EAPR Lao D. Rep. 8 6 3 6 4 1 3 4

EAPR Mongolia 6 7 0 6 1 7 5 5

EAPR P. New Guinea 6 8 4 5 4 3 3 5

EAPR Philippines 9 4 3 3 6 4 4 5

EAPR Cambodia 8 6 6 6 5 5 7 6

EAPR Vietnam 9 6 5 5 5 6 7 6

MEAN 6 5 2 5 4 3 4 4

ESAR Angola 4 5 0 4 1 0 2 2

ESAR Burundi 2 6 1 4 1 1 3 3

ESAR Ethiopia 2 5 2 3 3 0 3 3

ESAR Botswana 9 2 1 1 2 2 3 3

ESAR Namibia 4 4 2 5 3 3 2 3

ESAR Swaziland 3 6 2 4 5 3 3 4

ESAR Somalia 3 3 5 3 3 3 7 4

ESAR Zambia 5 7 3 4 4 3 5 4

ESAR Mozambique 4 5 3 7 4 4 5 5

ESAR Madagascar 7 5 5 3 4 4 5 5

ESAR South Africa 5 9 3 3 4 5 4 5

ESAR Uganda 7 6 3 5 5 4 3 5

ESAR Zimbabwe 9 9 3 2 5 4 3 5

ESAR Rwanda 4 8 6 5 5 0 9 5

ESAR Tanzania 6 9 4 6 5 4 3 5

ESAR Kenya 6 8 5 7 4 3 5 5

ESAR Malawi 8 8 3 5 4 5 6 6

MEAN 5 6 3 4 4 3 4 4

MENA South Sudan 1 2 2 4 3 2 2 2

MENA Yemen 5 3 3 4 3 2 1 3

MENA North Sudan 6 8 3 5 3 4 5 5

MEAN 4 4 3 4 3 3 3 4

ROSA Nepal 6 4 1 3 3 3 3 3

ROSA Bhutan 7 6 0 4 4 3 3 4

ROSA Bangladesh 7 3 3 5 3 4 5 4

ROSA Afghanistan 9 3 5 4 4 3 4 5

ROSA India 5 6 1 6 1 7 6 5

ROSA Sri Lanka 9 7 5 6 4 6 6 6

MEAN 7 5 3 5 3 4 5 5

WCAR Liberia 0 0 6 2 2 4 3 2

WCAR D. Rep. Congo 4 8 3 2 4 0 0 3

WCAR Cote d'Ivoire 2 4 7 2 4 4 2 4

WCAR Gabon 8 4 1 2 3 1 7 4

WCAR Congo Brazzaville 5 4 2 6 7 2 5 4

WCAR Sierra Leone 6 2 6 6 5 2 4 4

WCAR Benin 4 6 4 4 5 4 6 5

WCAR Mali 3 8 1 5 6 5 5 5

WCAR Niger 6 7 5 6 3 3 3 5

WCAR Cen.Afr.Rep. 7 5 7 2 5 2 6 5

WCAR Gambia 9 4 4 5 5 3 5 5

WCAR Burkina Faso 7 6 4 8 4 6 3 5

WCAR Ghana 8 8 1 7 7 4 7 6

WCAR Mauritania 8 8 6 8 5 3 7 6

WCAR Senegal 10 7 7 8 2 8 6 7

WCAR Togo 8 8 7 6 5 5 9 7

WCAR Nigeria 8 8 8 7 6 5 9 7

MEAN 6 6 5 5 5 3 5 5

Colour key

High / Very good

Medium / Good

Low / Fair

Very Low / Poor

47

*The scores were measured on a scale of 0 to 10 The countries for which profiles were developed are indicated with the striped bars (see page 45)

2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6

7 7 7

0 1 2 3 4 5 6 7 8

South Sudan

Burundi

Angola

Liberia

Timor-Liste

Kosovo

Romania

Bosnia and Herz.

Botswana

Cote d'Ivoire

D. Rep. Congo

Ethiopia

Fiji

Indonesia

Kazakhstan

Korea

Myanmar

Namibia

Nepal

Swaziland

Yemen

Bhutan

Cen.Afr.Rep.

China

Gabon

Lao D. Rep.

Madagascar

P. New Guinea

Sierra Leone

Somalia

Thailand

Turkmenistan

Uzbekistan

Vanuatu

Afghanistan

Bangladesh

Benin

Burkina Faso

Congo Brazzaville

Gambia

India

Kenya

Mali

Mongolia

Mozambique

Niger

North Sudan

Rwanda

South Africa

Tajikistan

Tanzania

Uganda

Zambia

Zimbabwe

Cambodia

Ghana

Kyrgyzstan

Malawi

Mauritania

Philippines

Sri Lanka

Vietnam

Togo

Nigeria

Senegal

Figure 9: Overall IYCF Comprehensive actions score

COLOUR KEY

VERY GOOD High number of key IYCF actions or intervention implemented

GOOD Medium number of key IYCF actions or intervention implemented

FAIR Low number of key IYCF actions or intervention implemented

POOR Very Low number of key IYCF actions or intervention implemented

48

Table 4b: Nutritionally vulnerable country statistics

Table 4b: Under-five mortality rankings in nutritionally vulnerable countries

Country Under-5 mortality rate

(2009)

Value Rank

Democratic Republic of the Congo 199 2

Sierra Leone 192 5

Mali 191 6

Somalia 180 7

Burkina Faso 166 9

Angola 161 11

Niger 160 12

Mozambique 142 15

Nigeria 138 18

Uganda 128 19

Côte d'Ivoire 119 21

Liberia 112 24

Malawi 110 26

Sudan 108 27

United Republic of Tanzania 108 27

Ethiopia 104 29

Kenya 84 39

India 66 48

Yemen 66 48

Bangladesh 52 57

Indonesia 39 66

Philippines 33 77

The above list ranks countries and territories in descending order of their estimated 2009 under-five mortality rate (U5MR), a critical indicator of the well-being of children. Source: UNICEF, Progress for Children: Achieving the MDGs with Equity, No, 9 New York, 2010.

49

Table 4c: Nutrition statistics: Nutritionally vulnerable countries

Countries and

territories

Early initiation of

breastfeeding (%)

% of children (2005–2009*) who are: % of under–fives (2003 –2009*) suffering from:

exclusively breastfed

breastfed with complementary

food

still breastfeeding

underweight (NCHS/WHO)

underweight (WHO) wasting (WHO)

stunting (WHO)

moderate & severe

moderate & severe

severe moderate & severe

moderate & severe 2005–2009* (<6 months) (6–9 months)

(20–23 months)

Angola 55 11 x 77 x 37 x – 16 y 7 y 8 y 29 y

Bangladesh 43 43 74 91 46 41 12 17 43 Burkina Faso

20 16 – – 31 26 7 11 35

Côte d'Ivoire 25 4 54 37 20 16 5 8 40 Democratic Republic of the Congo

48 36 82 64 31 25 8 10 46

Ethiopia 69 49 54 88 y 38 33 11 12 51

India 41 46 57 77 48 43 16 20 48

Indonesia 44 32 75 50 – 18 5 14 37

Kenya 58 32 83 54 20 16 4 7 35

Malawi 58 57 89 72 21 15 3 4 53

Mali 46 38 30 56 32 27 10 15 38

Mozambique 63 37 84 54 18 18 5 4 44

Niger 40 10 52 – 41 y 34 y 11 y 12 y 46 y

Nigeria 38 13 75 32 29 24 9 11 43

Philippines 54 34 58 34 26 22 – 7 32

Sierra Leone 51 11 73 50 25 21 7 10 36

Somalia 26 9 15 35 36 32 12 13 42

Sudan – 34 56 35 31 27 10 16 40

Thailand 50 5 43 19 9 7 1 5 16

Uganda 42 60 80 54 20 16 4 6 38 United Republic of Tanzania

67 41 x 91 x 55 x 22 17 4 4 44

Yemen 30 12 x 76 x – 46 43 19 15 58

Average

45.9

30 66.7 54.2 30.6 25.0 8.5 10.7 41.8

SUMMARY INDICATORS BY REGION/GLOBAL

Africa# 49 34 69 49 24 20 6 9 40 Sub-Saharan Africa#

49 33 70 51 27 22 7 9 42

Eastern and Southern Africa

61 47 72 64 25 21 6 7 44

West and Central Africa

39 23 70 43 28 23 8 10 40

Middle East and North Africa

47 32 57 35 14 14 5 10 31

Asia# 41 38 54 68 31 27 13 17 35

South Asia 39 45 56 75 47 42 15 19 48 East Asia and Pacific

44 28 52 – 11 11 – – 22

Developing countries§

44 36 59 56 26 22 9 12 34

Least developed countries§

50 42 69 68 33 28 9 11 44

World 44 36 59 56 26 22 9 12 34

Source: UNICEF, Progress for Children: Achieving the MDGs with Equity, No, 9 New York, 2010.

50

References

1. UNICEF, 2010. Achieving the MDGs with equity: Progress for children, challenges and disparities. UNICEF: New York.

2. WHO/UNICEF, 2003. Global strategy for IYCF 2003 WHO/UNICEF Global Strategy for Infant and Young Child Feeding. World Health Organization: Switzerland, Geneva.

3. UNICEF, 2011. Programming guide: Infant and young child feeding. UNICEF: New York.

4. WHO & UNICEF. 2007. Planning guide for national implementation of the global strategy for infant and young child feeding. World Health Organization: Switzerland, Geneva.

5. WHO. 1981. International Code of Marketing of Breast-Milk Substitutes. World Health Organization: Switzerland, Geneva.

6. WHO 2009. Infant and young child feeding: Model chapter for textbooks for medical students and allied professionals.

7. UNICEF. 2009. Revised BFHI material

8. WHO/PAHO. 2001. Guiding principles for complementary feeding of breastfeed child.

9. WHO. 2005. Guiding principles for feeding non-breastfed children 6 to 24 months.

10. WHO & UNICEF 1990. Innocenti declaration on the Protection, Promotion and Support for

Breastfeeding. Online at: http://www.unicef.org/programme/breastfeeding/innocenti.htm.

11. WHO & UNICEF, 1991. The Baby-Friendly Hospital Initiative. Online at: http://www.unicef.org/programme/breastfeeding/baby.htm#10.

12. WHO, UNICEF, UNAIDS, UNFPA. 2010. Guidelines on HIV and infant feeding 2010. Principles and recommendation for infant feeding in the context of HIV and a summary of evidence.

13. IFE Core Group 2007. Infant and young child feeding in emergencies: Operational guidance.

14. UNICEF. 2007. Programme policy and procedure manual: Programme operations

51

Section 4: IYCF PROFILES 22 countries*, with poor infant and young child feeding practices and large burdens

of undernutrition among children less than five years, designated nutritionally

vulnerable countries

* IYCF and nutrition data reflects countries’ status for the year 2010. Source: UNICEF, Progress for Children:

Achieving the MDGs with Equity, No, 9 New York, 2010.

52

ANGOLA Angola has a stunting prevalence rate of 29% among children under 5 years of age;

while 16% and 8% are underweight and wasted, respectively. Recent reports on

IYCF status indicate that the rate of early initiation of breastfeeding is currently at

55%, exclusive breastfeeding (< 6 months) at 11% and continued breastfeeding (20

- 23 months) at 37%. About 77% of children 6 to 9 months are breastfed with

complementary food; the nutritional quality of complementary foods from most

developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Angola’s overall national policy, strategy

and plan of actions status appears to be

“poor”. The country has very few of the

building blocks for a comprehensive

IYCF strategy and continued work on

IYCF is required. At present the policy

on IYCF reflected none of the key

practices and only few of the key

components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the key

components, including maternity protection law, maternity leave and paid nursing leave.

However, more work is needed with respect to the CODE law, its monitoring and

enforcement.

HEALTH SYSTEM LEVEL ACTIONS

The health system level actions appear to be “fair”. Although, the country seems

to have adequate IYCF health service counseling, several other key components,

including the BFHI, the pre- and in-service training curricula and health workers

capacity development activities need to be reinforced.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Key components, such as

community system integration,

community capacity development

and training, as well as monitoring

and evaluation require extensive

attention.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy Status

Overall national IYCF policy, strategy and plan of actions

Poor

Key practices reflected in the policy

Early initiation of breastfeeding

× Exclusive breastfeeding

× Continued breastfeeding

× Complementary feeding ×

Selected key components reflected in the national IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding

IYCF in emergency × National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Fair

Key action areas

CODE law × CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Fair

IYCF health workers capacity development Fair

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): < 2

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional delivery in the country (%) 42

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 0

Coverage of the training on IYCF counseling among health workers (%) 0

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Poor

Community monitoring and evaluation

Poor

Selected key components of the IYCF community

system level actions

Status

Community capacity development

Training on community IYCF counseling since 2006

× Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

0

Coverage of community health workers providing IYCF counseling activities as part of other community-based programme (%)

10

Proportion of the population living in the target area

26%

53

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems to

“fair”. Several other key components are judged to be

weak and may require extensive work, including the

national IYCF behaviour change and communication

strategy and the monitoring and evaluation of the effect of

communication on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “poor” and may require extensive attention. Additionally, more

work is needed to strengthen the broader monitoring and

evaluation system within the national legislation, community and

health system levels as well as communication on IYCF and IYCF

in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication strategy Poor

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Selected key interventions in relation to provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months

×

Micronutrients supplements (single/multiple) provided in emergencies

-

Micronutrients supplements provided in non- emergencies

-

Targeted food supplements are provided to improve CF for children 6-24 months

×

Fortified local complementary foods are provided -

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided -

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

×

Provision of complementary food supplements score

×

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

×

Infant feeding counseling for HIV+ mothers ×

IYCF training materials include HIV and infant feeding -

IYCF counseling materials which include HIV and infant feeding are updated

- Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on HIV and infant feeding Poor

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

×

HIV and infant feeding in PMTCT policy

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency ×

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes ×

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF

×

Routine monitoring of ongoing IYCF ×

Overall evaluation/review of IYCF situation ×

54

BANGLADESH Bangladesh has a stunting prevalence rate of 43% among children under 5 years

of age; while 41% and 17% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 43%, exclusive breastfeeding (< 6 months) at 43% and continued

breastfeeding (20 - 23 months) at 91%. About 74% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Bangladesh’s overall national policy,

strategy and plan of actions status

appears to be “good”. The country

seems to have adequate number of the

building blocks for a comprehensive

IYCF strategy. However, more work

may be required to ensure that early

initiation of breastfeeding is reflected in

the national policy.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including CODE law, maternity protection law, and maternity leave.

However, more work may be needed with respect to the CODE monitoring and

enforcement and provision paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Several key components,

including the BFHI, health workers capacity development and the IYCF health

service counseling activities may require strengthening.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

seem “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Key components, such as IYCF

community system integration,

community health workers capacity

development, as well as monitoring

and evaluation may require

extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Good

Key practices reflected in the policy

Early initiation of breastfeeding

× Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication HIV and infant feeding

IYCF in emergency

National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Fair Key action areas

CODE law

CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Poor

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula

-

IYCF health workers capacity development Fair

IYCF health service counseling Poor

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 50

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional delivery in the country (%) 18

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%)

< 1

Coverage of the training on IYCF counseling among health workers (%)

3

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration

Poor

IYCF community health workers capacity development Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

× Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities

×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) 3

Coverage of community health workers providing IYCF counseling activities as part of other community-based programme (%) 25

Proportion of the population living in the target area 7%

55

COMMUNICATION ON IYCF Overall national level communication on IYCF seems

“fair”. Some key components are judged to be weak and

may require extensive work, including the IYCF

behaviour change and communication channels and the

monitoring and evaluation of the effect of communication

on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “fair” and may require additional attention. Weaker aspects of

the comprehensive IYCF monitoring and evaluation system

should be strengthened, particularly at the national legislation,

community and health system levels as well as communication on

IYCF and IYCF in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication Good

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months

Micronutrients supplements provided in emergencies

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months

Fortified local complementary foods are provided ×

Fortified industrially-blended complementary foods are provided

×

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers ×

IYCF training materials include HIV and infant feeding -

IYCF counseling materials which include HIV and infant feeding are updated regularly

- Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency

Government procures/distribute breast milk substitutes ×

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

×

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation

56

BURKINA FASO Burkina Faso has a stunting prevalence rate of 35% among children under 5 years of age; while 26% and 11% are underweight and wasted, respectively. Recent reports on IYCF status indicate that the rate of early initiation of breastfeeding is currently at 20% and exclusive breastfeeding (< 6 months) at 16%. The nutritional quality of complementary foods from most developing countries is usually poor or inadequate. Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Burkina Faso’s overall national policy,

strategy and plan of actions status

appears to be “good”. The country

seems to have most of the building

blocks for a comprehensive IYCF

strategy. At present some of the key

components are not reflected in the

national IYCF policy and thus may

require continued work in this area.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has some of the

key components, including CODE law, maternity protection law, maternity leave and

paid nursing leave. However, more work is needed with respect to the CODE

monitoring and enforcement.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country

seems to have adequate IYCF health workers capacity development

component, several other key components, including the BFHI, the pre- and in-

service training curricula and the IYCF health service counseling activities may

need strengthening.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “fair”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Key components, such as

community system integration,

community capacity development

and training, as well as monitoring

and evaluation require extensive

attention

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Good

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the national IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication HIV and infant feeding - IYCF in emergency × National IYCF strategy × National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Good Key action areas

CODE law

CODE monitoring and enforcement

×

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Fair

IYCF health workers capacity development Good

IYCF health service counseling Fair

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): < 2

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 76

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 10

Coverage of the training on IYCF counseling among health workers (%) 100

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Fair

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Fair

Selected key components of the IYCF community

system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities

Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

66

Coverage of community health workers providing IYCF counseling activities as part of other community-based programme (%)

100

Proportion of the population living in the target area (%)

100

57

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“good”, However, to take advantage of the adequate

communication on IYCF, other weaker aspects of the

comprehensive IYCF programming should be reinforced,

particularly at the health system and community levels, as

well as IYCF monitoring and evaluation.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation

appears to be “fair” and may require extensive attention.

Additionally, more work is needed to strengthen the broader

monitoring and evaluation system within the national

legislation, community and health system levels as well as

communication on IYCF and IYCF in exceptionally difficult

circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Good

Key action areas or component

National IYCF behaviour change and communication Good

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Very Good

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements

Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months

Micronutrients supplements (single/multiple) provided in emergencies

×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months

Fortified local complementary foods are provided

Fortified industrially-blended complementary foods are provided

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency ×

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency -

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF ×

Overall evaluation/review of IYCF situation ×

58

COTE D’IVOIRE Cote d’Ivoire has a stunting prevalence rate of 40% among children under 5 years

of age; while 16% and 8% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 25%, exclusive breastfeeding (< 6 months) at 4% and continued

breastfeeding (20 - 23 months) at 37%. About 54% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Cote d’Ivoire’s overall national policy,

strategy and plan of actions status

appears to be “fair”. The country has

some of the building blocks for a

comprehensive IYCF strategy and

continued work on IYCF is required. At

present, there is no information on

some of the key components as

reflected in the national IYCF policy.

IYCF LEGISLATION AND LAW There is no information on the current status of the overall national IYCF legislation

and law status. Additionally, there is no information on the current status of the key

action areas or components including, CODE law, CODE monitoring and enforcement,

maternity protection law, maternity leave and paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country

seems to have adequate IYCF counseling service at the health system level,

several other key components, including the BFHI, the pre- and in-service

training curricula and health workers capacity development activities may need

to be reinforced.

\

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “good”. Key components,

such as community system

integration as well as, monitoring

and evaluation may require further

strengthening. The community

health workers capacity

development and training activities

may be adequate.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication - HIV and infant feeding

IYCF in emergency

National IYCF strategy - National IYCF plan of action - Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation - Key action areas

CODE law -

CODE monitoring and enforcement

-

Maternity protection law -Maternity leave -

Paid nursing breaks -

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Poor

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Poor

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 9

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country -

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) -

Coverage of the training on IYCF counseling among health workers (%) -

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Good

Key action areas or components

IYCF community system integration

Fair

IYCF community health workers capacity development

Very Good

Community monitoring and evaluation

Fair

Selected key components of the IYCF community

system level actions

Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities

Routine monitoring of skills of community health workers

Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

-

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

-

Proportion of the population living in the target area

35%

59

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“poor”. Several other key components are judged to be

weak and may require extensive work, including the

national IYCF behaviour change and communication

strategy and channels, as well as the monitoring and

evaluation of the effect of communication on IYCF

behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION Overall national level IYCF monitoring and evaluation

appears to be “poor” and may require extensive attention.

Additionally, more work is needed to strengthen the broader

monitoring and evaluation system within the national

legislation, community and health system levels as well as

communication on IYCF and IYCF in exceptionally difficult

circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Poor

Key action areas or component

National IYCF behaviour change and communication strategy Poor

IYCF behaviour change and communication channels Poor

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements

Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies

Micronutrients supplements provided in non- emergencies

-

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided -

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

×

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

-

Status

Overall national standing on Infant feeding in emergencies

- Selected key action areas

National IYCF policy include IYCF in emergency -

National emergency preparedness plan includes IYCF in emergency

-

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

-

Breast milk substitutes are provided during emergency -

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF

×

Routine monitoring of ongoing IYCF ×

Overall evaluation/review of IYCF situation -

60

DEMOCRATIC REPUBLIC OF THE CONGO The Democratic Republic of the Congo (DRC) has a stunting prevalence rate of

46% among children under 5 years of age; while 25% and 10% are underweight

and wasted, respectively. Recent reports on IYCF status indicate that the rate of

early initiation of breastfeeding is currently at 48%, exclusive breastfeeding (< 6

months) at 36% and continued breastfeeding (20 - 23 months) at 64%. About

82% of children 6 to 9 months are breastfed with complementary food; the

nutritional quality of complementary foods from most developing countries is

usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS The DRC’s overall national policy,

strategy and plan of actions status

appears to be “very good”. The

country seems to have most of the

building blocks for a comprehensive

IYCF strategy in place. Nevertheless,

more work may be needed in

developing a comprehensive national

IYCF strategy and plan of actions.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including CODE law, maternity protection law, and maternity leave.

However, there are still gaps with respect to provision of paid nursing breaks and the

CODE monitoring and enforcement.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Several key components,

including the pre- and in-service training curricula and health workers capacity

development and health service counseling activities may be adequate.

However, the BFHI need to be reinforced to take advantage of the good health

system, particularly important with the percentage of institutional births currently

at 64%.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

are judged to be “poor”.

Strengthening IYCF activities within

the communities should be a high

priority action area. Key

components, such as community

system integration, capacity

development, as well as monitoring

and evaluation require extensive

attention.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Very Good

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the national IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication HIV and infant feeding

IYCF in emergency

National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Fair Key action areas

CODE law

CODE monitoring and enforcement

×

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Very Good

IYCF health workers capacity development Very Good

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 4

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 75

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) -

Coverage of the training on IYCF counseling among health workers (%) 5

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) < 1

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 5

Proportion of the population living in the target area 8%

61

COMMUNICATION ON IYCF Overall national level communication on IYCF may be

“poor”. All the key components are judged to be weak

and may require extensive work, including the national

IYCF behaviour change and communication strategy,

channels and materials, as well as the monitoring and

evaluation of the effect of communication on IYCF

behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “good”. However, to take advantage of the current adequate

IYCF monitoring and evaluation, other weaker aspects of the

comprehensive IYCF monitoring and evaluation system should be

strengthened, particularly at the national legislation, community

and health system levels as well as communication on IYCF and

IYCF in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Poor

Key action areas or component

National IYCF behaviour change and communication strategy Poor

IYCF behaviour change and communication channels Poor

Behaviour change and communication materials on IYCF Fair

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months

×

Micronutrients supplements (single/multiple) provided in emergencies

-

Micronutrients supplements provided in non- emergencies

-

Targeted food supplements are provided to improve CF for children 6-24 months

×

Fortified local complementary foods are provided -

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding ×

National IYCF policy include guidance on HIV and infant feeding

-

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

-

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

×

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency

Government procures/distribute breast milk substitutes ×

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation

Status

Overall IYCF monitoring and evaluation score Good

Selected key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation

62

ETHIOPIA Ethiopia has a stunting prevalence rate of 51% among children under 5 years of

age; while 33% and 12% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 69%, exclusive breastfeeding (< 6 months) at 49% and continued

breastfeeding (20 - 23 months) at 88%. About 54% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Ethiopia’s overall national policy,

strategy and plan of actions status

appears to be “poor”. The country has

very few of the building blocks for a

comprehensive IYCF strategy and

continued work on IYCF is needed. At

present the policy on IYCF reflected

none of the key practices and there is

no information on the status of most of

the key components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including maternity protection law, maternity leave. However, more

work is needed with respect to the CODE law, its monitoring and enforcement and

provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. The country seems to be

adequate in some of its key IYCF components. However, it may be essential to

reinforce it weak BFHI.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Key components, such as

community system integration,

community capacity development

and training, as well as monitoring

and evaluation require extensive

attention.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Poor

Key practices reflected in the policy

Early initiation of breastfeeding

× Exclusive breastfeeding

×

Continued breastfeeding

× Complementary feeding ×

Selected key components reflected in the national IYCF policy

Status

Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Fair Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Good

IYCF health workers capacity development Good

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 0

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 18

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 15

Coverage of the training on IYCF counseling among health workers (%) 21

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community

system level actions

Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

53

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

21

Proportion of the population living in the target area

25,500,000

63

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“poor”. Several key action areas are judged to be weak

and may require extensive work, including the IYCF

behaviour change and communication channels and

materials, as well as the monitoring and evaluation of the

effect of communication on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “poor” and may require extensive attention. Additionally,

more work is needed to strengthen the broader monitoring and

evaluation system within the national legislation, community and

health system levels as well as communication on IYCF and IYCF

in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Poor

Key action areas or component

National IYCF behaviour change and communication strategy Good

IYCF behaviour change and communication channels Poor

Behaviour change and communication materials on IYCF Poor

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months

×

Micronutrients supplements (single/multiple) provided in emergencies

-

Micronutrients supplements provided in non- emergencies

-

Targeted food supplements are provided to improve CF for children 6-24 months

×

Fortified local complementary foods are provided -

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

×

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

×Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF ×

Overall evaluation/review of IYCF situation ×

64

INDIA India has a stunting prevalence rate of 48% among children under 5 years of age;

while 43% and 20% are underweight and wasted, respectively. Recent reports on

IYCF status indicate that the rate of early initiation of breastfeeding is currently at

41%, exclusive breastfeeding (< 6 months) at 46% and continued breastfeeding

(20 - 23 months) at 77%. About 57% of children 6 to 9 months are breastfed with

complementary food; the nutritional quality of complementary foods from most

developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS India’s overall national policy, strategy

and plan of actions status appears to be

“poor”. The country has very few of the

building blocks for a comprehensive

IYCF strategy and continued work on

IYCF is required. At present the policy

on IYCF did not reflect most of the key

practices and components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has most of the

key components, including the CODE law, its monitoring and enforcement, maternity

protection law, maternity leave. However, more work is needed with respect to the

provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country

seems to have adequate IYCF counseling service and capacity development

components at the health system level, other key components, including the

BFHI, may need to be reinforced with institutional births currently at 41%.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

seem “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Currently, it seems that all the key

components require extensive

attention.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions Poor

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

×

Continued breastfeeding

×

Complementary feeding ×

Selected key components reflected in the national IYCF policy

Status

Baby-friendly hospital initiative ×International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy

National IYCF plan of action ×

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Good Key action areas

CODE law

CODE monitoring and enforcement

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Good

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 10

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 41

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 12

Coverage of the training on IYCF counseling among health workers (%) -

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Poor

Community monitoring and evaluation

Poor

Selected key components of the IYCF community

system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

- Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) 39

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 100

Proportion of the population living in the target area 100%

65

COMMUNICATION ON IYCF Overall national level communication on IYCF is “fair”,

While some key action areas may be adequate including

the national IYCF behaviour change and communication

strategy and channels, other important key action areas

need to be strengthened, including the behaviour change

and communication materials, as well as the monitoring

and evaluation of the effect of communication on IYCF

behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears

to be “fair” and may require additional attention. Weaker

aspects of the comprehensive IYCF monitoring and

evaluation system should be strengthened, particularly the

routine monitoring of on-going community IYCF activities

within the community, skills of community health workers or

the quality of their skills.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication strategy Very Good

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Fair

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Good

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding Poor

Selected key action areas

Policy on HIV and infant feeding ×

National IYCF policy include guidance on HIV and infant feeding

-

HIV and infant feeding in PMTCT policy -

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

-

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding ×

IYCF counseling materials which include HIV and infant feeding are updated regularly

- Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency ×

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components

Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation

66

INDONESIA Indonesia has a stunting prevalence rate of 37% among children under 5 years of

age; while 18% and 14% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 44%, exclusive breastfeeding (< 6 months) at 32% and continued

breastfeeding (20 - 23 months) at 50%. About 75% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Indonesia’s overall national policy,

strategy and plan of actions status

appears to be “poor”. The country may

have none of the building blocks for a

comprehensive IYCF strategy and

continued work in developing a

comprehensive IYCF policy and plan of

actions may be required.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including maternity protection law, maternity leave. However, more

work is needed with respect to the CODE law, its monitoring and enforcement as well

as provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. All the key components,

including the BFHI, health workers capacity development, the IYCF health

services counseling and the IYCF pre and in service training curricula may need

strengthening.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

seem “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Although, there are no information

on some of the key action areas;

however, all the key components

may require extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Poor

Key practices reflected in the policy

Early initiation of breastfeeding

× Exclusive breastfeeding

×

Continued breastfeeding

× Complementary feeding ×

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy × National IYCF plan of action ×

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Fair Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Poor

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Poor

IYCF health service counseling Fair

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): < 1

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 46

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) < 1

Coverage of the training on IYCF counseling among health workers (%) 2

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

-

Community monitoring and evaluation

-

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

- Capacity building on communication skills for community health workers

- Monitoring and evaluation

Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers

- Routine monitoring of the quality of IYCF counseling

-

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

< 1

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

3

Proportion of the population living in the target area

< 5

67

COMMUNICATION ON IYCF Overall national level communication on IYCF seems

“poor”. All the key components are judged to be weak

and may require extensive work, including the national

IYCF behaviour change and communication strategy,

channels and materials, as well as the monitoring and

evaluation of the effect of communication on IYCF

behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “fair” and may require additional attention. Weaker aspects of

the comprehensive IYCF monitoring and evaluation system

should be strengthened, particularly at the national legislation,

community and health system levels as well as communication on

IYCF and IYCF in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Poor

Key action areas or component

National IYCF behaviour change and communication strategy Poor

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Fair

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Good

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies ×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Poor

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

×

Infant feeding training/counseling for HIV+ mothers ×

IYCF training materials include HIV and infant feeding -

IYCF counseling materials which include HIV and infant feeding are updated regularly

- Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Fair Selected key action areas

National IYCF policy include IYCF in emergency ×

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

Breast milk substitutes are provided during emergency

Government procures/distribute breast milk substitutes ×

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF activities

Routine monitoring of ongoing IYCF activities

Overall evaluation/review of IYCF situation ×

68

KENYA Kenya has a stunting prevalence rate of 35% among children under 5 years of

age; while 16% and 7% are underweight and wasted, respectively. Recent reports

on IYCF status indicate that the rate of early initiation of breastfeeding is currently

at 58%, exclusive breastfeeding (< 6 months) at 32% and continued

breastfeeding (20 - 23 months) at 54%. About 83% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Kenya’s overall national policy, strategy

and plan of actions status appears to be

“very good”. The country seems to

have adequate number of the building

blocks for a comprehensive IYCF

strategy. However, more work may be

required to ensure that early initiation of

breastfeeding is reflected in the national

policy.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has few of the key

components, including maternity protection law and maternity leave. However, more

work is needed with respect to the CODE law, it monitoring and enforcement and

provision of paid nursing leave.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. The country seems to

have adequate IYCF health system level components. The country can take

advantage of its strong health system level actions to further strengthen other

weak action areas, such as the complementary feeding intervention.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “fair”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Important components, such as

community system integration may

require extensive action.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy Status

Overall national IYCF policy, strategy and plan of actions

Very Good

Key practices reflected in the policy

Early initiation of breastfeeding

× Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication HIV and infant feeding

IYCF in emergency

National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Fair Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Good

Key action areas or components Baby-friendly hospital initiative - IYCF health pre- and in-service

training curricula Good

IYCF health workers capacity development Very Good

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): -

Hospitals / maternity facilities re-certified Baby-friendly (%): -

Percentage of institutional birth in the country (%) 44

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) -

Coverage of the training on IYCF counseling among health workers (%) 75

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Fair

Key action areas or components

IYCF community system

integration

Poor

IYCF community health workers capacity development

Very Good

Community monitoring and evaluation

Good

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities

Routine monitoring of skills of community health workers

Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

9

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

100

Proportion of the population living in the target area

15%

69

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“good”. While most of the key action areas may be

adequate, including the national IYCF behaviour change

and communication strategy, channels and materials on

IYCF; the monitoring and evaluation of the effect of

communication on IYCF behaviour needs to be

strengthened.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “fair” and may require additional attention. Weaker aspects of

the comprehensive IYCF monitoring and evaluation system

should be strengthened, particularly at the national legislation,

community and health system levels as well as communication on

IYCF and IYCF in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Good

Key action areas or component

National IYCF behaviour change and communication strategy Very Good

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies

Micronutrients supplements provided in non- emergencies

×

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided

Fortified industrially-blended complementary foods are provided

×

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding

Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding counseling for HIV+ mothers

IYCF counseling materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

×Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes ×

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF activities ×

Overall evaluation/review of IYCF situation

70

MALAWI Malawi has a stunting prevalence rate of 53% among children under 5 years of

age; while 15% and 4% are underweight and wasted, respectively. Recent reports

on IYCF status indicate that the rate of early initiation of breastfeeding is currently

at 58%, exclusive breastfeeding (< 6 months) at 57% and continued

breastfeeding (20 - 23 months) at 72%. About 89% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Malawi’s overall national policy, strategy

and plan of actions status appears to be

“very good”. The country seems to

have adequate number of the building

blocks for a comprehensive IYCF

strategy. However, more work may be

required in terms of developing a

national IYCF plan of actions.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has most of the

key components, including the CODE law, its monitoring and enforcement, as well as

the maternity protection law and maternity leave. However, more work is needed with

respect to the provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country

seems to have adequate IYCF health service counseling activities; effort should

be centred on reinforcing other weak key components within the health system

level.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

All the key components within the

community level may require

extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions or practices implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy Status

Overall national IYCF policy, strategy and plan of actions

Very Good

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication HIV and infant feeding

IYCF in emergency

National IYCF strategy

National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Good Key action areas

CODE law

CODE monitoring and enforcement

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components

Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Very Good

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 5

Hospitals / maternity facilities re-certified Baby-Friendly (%): < 2

Percentage of institutional birth in the country 72

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 [total number (%)] 6

Coverage of the training on IYCF counseling among health workers [total number (%)] 43

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

- Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

-

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

8

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

100

Proportion of the population living in the target area

100%

71

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“fair”. Several important key components are judged to

be weak and may require extensive work, including the

IYCF behaviour change and communication channels

and materials, as well as the monitoring and evaluation of

the effect of communication on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation

appears to be “fair” and may require additional attention.

Weaker aspects of the comprehensive IYCF monitoring and

evaluation system should be strengthened, particularly the

routine monitoring of counseling skills at community and

health system levels.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication strategy Good

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Fair

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Good

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies ×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding counseling for HIV+ mothers

IYCF counseling materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

×Monitoring system on infant feeding practices among HIV+ mothers

-

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF activities

Overall evaluation/review of IYCF situation

72

MALI Mali has a stunting prevalence rate of 38% among children under 5 years of age;

while 27% and 15% are underweight and wasted, respectively. Recent reports on

IYCF status indicate that the rate of early initiation of breastfeeding is currently at

46%, exclusive breastfeeding (< 6 months) at 38% and continued breastfeeding

(20 - 23 months) at 56%. About 30% of children 6 to 9 months are breastfed with

complementary food; the nutritional quality of complementary foods from most

developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Mali’s overall national policy, strategy

and plan of actions status appears to be

“fair”. The country seems to have few

of the building blocks for a

comprehensive IYCF strategy and

continued work on IYCF is required.

The policy on IYCF reflected all the key

practices, but very few of the key

components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “poor”; it has only one of

the key components, the maternity leave. However, extensive work may be required

with respect to the CODE law, its monitoring and enforcement, as well as maternity

protection law and the provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. The country may take

advantage of some of its adequate IYCF health system level actions to reinforce

other IYCF action areas, including BFHI, community system level actions,

communication on IYCF.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

All key components require

extensive attention and actions.

There is no information on the

status of some of the key action

areas.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a

comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy

National IYCF plan of action ×

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Poor Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law × Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Good

IYCF health workers capacity development Good

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 5

Hospitals / maternity facilities re-certified Baby-friendly (%): 3

Percentage of institutional births in the country (%) 57

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) < 1

Coverage of the training on IYCF counseling among health workers (%) 79

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Poor

Community monitoring and evaluation

-

Selected key components of the IYCF community

system level actions

Status

Community capacity development

Training on community IYCF counseling since 2006

× Capacity building on communication skills for community health workers

- Monitoring and evaluation

Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers

- Routine monitoring of the quality of IYCF counseling

-

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

0

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

-

Proportion of the population living in the target area

-

73

COMMUNICATION ON IYCF Overall national level communication on IYCF seems

“fair”. Several important key components are judged to

be weak and may require extensive work, including IYCF

behaviour change and communication channels and

materials, as well as the monitoring and evaluation of the

effect of communication on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “good” and may require additional attention. Weaker aspects

of the comprehensive IYCF monitoring and evaluation system

should be strengthened, particularly at the national legislation,

community and health system levels, as well as communication

on IYCF and in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication strategy Very Good

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Poor

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months × Micronutrients supplements (single/multiple) provided

in emergencies -

Micronutrients supplements provided in non- emergencies

-

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided

Fortified industrially-blended complementary foods are provided

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

×

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding ×

IYCF counseling materials which include HIV and infant feeding are updated regularly

- Monitoring system on infant feeding practices among HIV+ mothers

Status

Overall national standing on Infant feeding in emergencies Fair Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

Breast milk substitutes are provided during emergency

Government procures/distribute breast milk substitutes ×

Government accept donations of infant food

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation ×

74

MOZAMBIQUE Mozambique has a stunting prevalence rate of 44% among children under 5

years of age; while 18% and 4% are underweight and wasted, respectively.

Recent reports on IYCF status indicate that the rate of early initiation of

breastfeeding is currently at 63%, exclusive breastfeeding (< 6 months) at 37%

and continued breastfeeding (20 - 23 months) at 54%. About 84% of children 6 to

9 months are breastfed with complementary food; the nutritional quality of

complementary foods from most developing countries is usually poor or

inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Mozambique’s overall national policy,

strategy and plan of actions status

appears to be “poor”. The country may

have none of the building blocks for a

comprehensive IYCF strategy and

continued work in developing a

comprehensive IYCF policy and plan of

actions may be required.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has most of the

key components, including the CODE, maternity protection law, maternity leave and

the provision paid nursing breaks. However, more work is needed with respect to the

CODE monitoring and enforcement.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country

seems to have adequate IYCF counseling service and capacity development at

the health system level; several other key components, including the BFHI, the

pre- and in-service training curricula and health workers capacity development

activities need to be improved upon.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Key components, such as

community system integration,

community capacity development

and training, as well as monitoring

and evaluation require extensive

attention.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Poor

Key practices reflected in the policy

Early initiation of breastfeeding

× Exclusive breastfeeding

×

Continued breastfeeding

× Complementary feeding ×

Selected key components reflected in the national IYCF policy

Status

Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Good Key action areas

CODE law

CODE monitoring and enforcement

×

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Good

IYCF health service counseling Very Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 0

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 50

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 19

Coverage of the training on IYCF counseling among health workers (%) 100

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) 0

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) -

Proportion of the population living in the target area -

75

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“good”. While most of the key action areas may be

adequate, including the national IYCF behaviour change

and communication strategy, channels, as well as the

monitoring and evaluation; the behaviour change and

communication materials on IYCF needs extensive

attention.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation

appears to be “Fair”. Weaker aspects of the comprehensive

IYCF monitoring and evaluation system should be

strengthened, particularly at the national legislation,

community and health system levels. For instance, routine

monitoring of the quality of IYCF counseling at the

community level need to be strengthened.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Good

Key action areas or component

National IYCF behaviour change and communication Good

IYCF behaviour change and communication channels Very Good

Behaviour change and communication materials on IYCF Poor

Monitoring and evaluating the effect of communication on behaviour Very Good

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided

Lipid-based nutrient supplements are provided

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding -

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency ×

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

×

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation ×

76

NIGER Niger has a stunting prevalence rate of 46% among children under 5 years of

age; while 34% and 12% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 40%, exclusive breastfeeding (< 6 months) at 10%. About 52% of

children 6 to 9 months are breastfed with complementary food; the nutritional

quality of complementary foods from most developing countries is usually poor or

inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Niger’s overall national policy, strategy

and plan of actions status appears to be

“fair”. The country has few of the

building blocks for a comprehensive

IYCF strategy and continued work on

IYCF is required. At present the policy

on IYCF reflected most of the key

practices, but very little number of the

key components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including maternity protection law, maternity leave and provision of

paid nursing leave. However, more work is needed with respect to the CODE law, as

well as its monitoring and enforcement.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. Although, the country

seems to have adequate health workers capacity development activities, IYCF

counseling service and BFHI; several other key components, including the BFHI,

the pre- and in-service training curricula and need to be reinforced.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “fair”. Strengthening

IYCF activities within the

communities should be a high

priority action area. Key

components, such as community

system integration as well as

monitoring and evaluation require

extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the national IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy

National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Fair Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Fair

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Good

IYCF health service counseling Very Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-Friendly (%): 11

Hospitals / maternity facilities re-certified Baby-Friendly (%): 4

Percentage of institutional birth in the country 30

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) < 2

Coverage of the training on IYCF counseling among health workers (%) 12

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Fair

Key action areas or components

IYCF community system integration Fair

IYCF community health workers capacity development

Very Good

Community monitoring and evaluation Poor

Selected key components of the IYCF community

system level actions

Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

51

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

12

Proportion of the population living in the target area

15

77

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“fair”. While some of the key action areas may be

adequate, including the national IYCF behaviour change

and communication strategy and channels, other

important key components including behaviour change

and communication materials on IYCF and the

monitoring and evaluation of the effect of communication

on IYCF behaviour needs to be strengthened.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “poor” and may require extensive attention. Additionally,

more work is needed to strengthen the broader monitoring and

evaluation system within the national legislation, community and

health system levels as well as communication on IYCF and IYCF

in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication Good

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Fair

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies -

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided

Lipid-based nutrient supplements are provided

Status

Overall national standing on HIV and infant feeding Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

-Monitoring system on infant feeding practices among HIV+ mothers

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF - Overall evaluation/review of IYCF situation ×

78

NIGERIA Nigeria has a stunting prevalence rate of 43% among children under 5 years of

age; while 24% and 11% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 38%, exclusive breastfeeding (< 6 months) at 13% and continued

breastfeeding (20 - 23 months) at 32%. About 75% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Nigeria’s overall national policy, strategy

and plan of actions status appears to be

“fair”. The country seems to have

some of the building blocks for a

comprehensive IYCF strategy and

continued work on IYCF is required. At

present the policy on IYCF reflected

most of the key practices, but very little

number of the key components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “very good”; it is judged to

have all the key components. However, to take advantage of the current adequate

IYCF legislation and law; key components not reflected in the national IYCF policy may

be strengthened, including the international code of marketing of breast-milk substitute,

BCC, IYCF in emergency and infant feeding and IYCF.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. Although, most of the key

components seem to the adequate with the exception of the BFHI which needs

more work. Further, there is need to strengthen the capacity of more health

workers on IYCF counseling.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “good”. Seem adequate,

however strengthening the

community system integration may

be needed. Additionally, routine

monitoring and evaluation of

community health workers trained

on IYCF counseling should be part

of the routine monitoring of IYCF

activities.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Very Good Key action areas

CODE law

CODE monitoring and enforcement

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Good

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Very Good

IYCF health workers capacity development Good

IYCF health service counseling Very Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 8

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 39

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) < 1

Coverage of the training on IYCF counseling among health workers (%) -

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Good

Key action areas or components

IYCF community system integration Fair

IYCF community health workers capacity development

Very Good

Community monitoring and evaluation

Very Good

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities

Routine monitoring of skills of community health workers

Routine monitoring of the quality of IYCF counseling

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) -

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 100

Proportion of the population living in the target area 100%

79

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“good”. While most of the key action areas may be

adequate, including the national IYCF behaviour change

and communication strategy, channels and materials; the

monitoring and evaluation of the effect of communication

in IYCF behaviour needs extensive attention.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation

appears to be “Very good”. However, monitoring and

evaluation of national IYCF actions at the national level

need to be strengthened. For instance, proportion and

coverage of community health workers trained on IYCF

counseling skills need to be routinely monitored.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Good

Key action areas or component

National IYCF behaviour change and communication Very Good

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies ×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

×Monitoring system on infant feeding practices among HIV+ mothers

Status

Overall national standing on Infant feeding in emergencies Good Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes ×

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Very good

Key action areas or components Monitoring and evaluation for national IYCF

×

Routine monitoring of ongoing IYCF activities

Overall evaluation/review of IYCF situation

80

PHILIPPINES Philippines has a stunting prevalence rate of 32% among children under 5 years

of age; while 22% and 7% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 54%, exclusive breastfeeding (< 6 months) at 34% and continued

breastfeeding (20 - 23 months) at 34%. About 58% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Philippines’ overall national policy,

strategy and plan of actions status

appears to be “good”. The country has

adequate number of the building blocks

for a comprehensive IYCF strategy. At

present the policy on IYCF reflected

some of the key IYCF components,

while more work is needed with some

others.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “very good”. However, to

take advantage of the current adequate IYCF legislation and law; key components not

reflected in the national IYCF policy may be strengthened, including the international

code of marketing of breast milk substitutes, BCC as well as the national plan of

actions on IYCF.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country

seems to have adequate IYCF health worker capacity development, several

other key components, including the BFHI, the pre- and in-service training

curricula and IYCF health service counseling activities need to be reinforced.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Key components, such as

community integration, community

capacity development and training,

as well as monitoring and evaluation

require extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy Status

Overall national IYCF policy, strategy and plan of actions

Good

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding

IYCF in emergency

National IYCF strategy

National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Very Good Key action areas

CODE law

CODE monitoring and enforcement

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Fair

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Good

IYCF health service counseling Poor

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 83

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 40

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 82

Coverage of the training on IYCF counseling among health workers (%) 100

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community

system level actions

Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

- Monitoring and evaluation

Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) 13

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 100

Proportion of the population living in the target area -

81

COMMUNICATION ON IYCF Overall national level communication on IYCF seems

“poor”. Several important key components are judged to

be weak and may require extensive work, including IYCF

behaviour change and communication channels and

materials, as well as the monitoring and evaluation of the

effect of communication on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears

to be “fair” and may require additional attention. Weaker

aspects of the comprehensive IYCF monitoring and evaluation

system should be strengthened, particularly at the community

and health system levels as well as communication on IYCF

and IYCF in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Poor

Key action areas or component

National IYCF behaviour change and communication Good

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Poor

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies ×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Fair Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

-

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

Breast milk substitutes are provided during emergency

Government procures/distribute breast milk substitutes

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF activities

Overall evaluation/review of IYCF situation

82

SIERRA LEONE Sierra Leone has a stunting prevalence rate of 36% among children under 5

years of age; while 21% and 10% are underweight and wasted, respectively.

Recent reports on IYCF status indicate that the rate of early initiation of

breastfeeding is currently at 51%, exclusive breastfeeding (< 6 months) at 11%

and continued breastfeeding (20 - 23 months) at 50%. About 73% of children 6 to

9 months are breastfed with complementary food; the nutritional quality of

complementary foods from most developing countries is usually poor or

inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Sierra Leone’s overall national policy,

strategy and plan of actions status

appears to be “very good”. The

country has most of the building blocks

for a comprehensive IYCF strategy, but

continued work on IYCF is required. In

particular, more work may be needed

with respect to IYCF in emergency and

national IYCF plan of action.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including maternity protection law, maternity leave. However, more

work is needed with respect to the CODE law, its monitoring and enforcement as well

as the provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. All the key components

may require extensive actions. In particular, BFHI, pre- and in-service training

curricula and IYCF health service counseling activities.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “fair”. Strengthening

IYCF activities within the

communities should be a high

priority action area. Key

components, such as community

system integration, as well as

monitoring and evaluation require

extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Very Good

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication HIV and infant feeding

IYCF in emergency × National IYCF strategy

National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Fair Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Poor

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Fair

IYCF health service counseling Poor

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 0

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 25

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 0

Coverage of the training on IYCF counseling among health workers (%) -

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Fair

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Very Good

Community monitoring and evaluation

Fair

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities

Routine monitoring of skills of community health workers

Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%)

-

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%)

100

Proportion of the population living in the target area

100%

83

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“fair”. While most of the key action areas may be

adequate, the national IYCF behaviour change and

communication strategy may need extensive attention.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “fair” and may require extensive attention. Additionally, more

work may be needed to strengthen the broader monitoring and

evaluation system within the national legislation, community and

health system levels as well as IYCF in exceptionally difficult

circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication strategy Poor

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Good

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months × Micronutrients supplements (single/multiple) provided

in emergencies -

Micronutrients supplements provided in non- emergencies

-

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided ×

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Fair

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency ×

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

×

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation ×

84

SOMALIA Somalia has a stunting prevalence rate of 42% among children under 5 years of

age; while 32% and 13% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 26%, exclusive breastfeeding (< 6 months) at 9% and continued

breastfeeding (20 - 23 months) at 35%. About 15% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Somalia’s overall national policy,

strategy and plan of actions status

appears to be “fair”. The country has

few of the building blocks for a

comprehensive IYCF strategy and

continued work on IYCF is required. At

present the policy on IYCF reflected

most of the key practices, but only one

of the key components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “poor” and may require

extensive work. It has none of the key components or action areas, including the

CODE law, it monitoring and enforcement as well as the maternity protection law,

maternity leave and the provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country

seems to have adequate health workers capacity development activities at the

health system level; other key components, including the BFHI, the pre- and in-

service training curricula and counseling activities’ need to be strengthened.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “fair”. Strengthening

IYCF activities within the

communities should be a high

priority action area. Key

components, such as community

system integration, as well as

monitoring and evaluation require

extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative ×International code of marketing of breast milk substitute ×Behavioural change and communication HIV and infant feeding × IYCF in emergency × National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Poor Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law ×Maternity leave ×

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Poor

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Good

IYCF health service counseling Poor

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): < 1

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 9

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 [total number (%)] -

Coverage of the training on IYCF counseling among health workers [total number (%)] 2

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Fair

Key action areas or components

IYCF community system integration Fair

IYCF community health workers capacity development

Very Good

Community monitoring and evaluation

Fair

Selected key components of the IYCF community

system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities

Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) - Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 16

Proportion of the population living in the target area -

85

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“poor”. Several important key components are judged to

be weak and may require extensive work, including

National IYCF behaviour change and communication

strategy, channels, materials and , as well as the

monitoring and evaluation of the effect of communication

on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “good” and may require additional attention. Weaker aspects

of the comprehensive IYCF monitoring and evaluation system

should be strengthened, particularly at the national legislation,

community and health system levels as well as communication on

IYCF and IYCF in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Poor

Key action areas or component

National IYCF behaviour change and communication Poor

IYCF behaviour change and communication channels Poor

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies ×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months × Fortified local complementary foods are provided -

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency ×

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Good

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation

86

SOUTH SUDAN South Sudan has a stunting prevalence rate of 31% among children under 5

years of age; while 28% and 23% are underweight and wasted, respectively.

Recent reports11

on IYCF status indicate that the rate of exclusive breastfeeding

(< 6 months) is currently at 45% and about 21% of children 6 to 8 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS South Sudan’s overall national policy,

strategy and plan of actions status

appears to be “poor”. The country has

very few of the building blocks for a

comprehensive IYCF strategy and

continued work on IYCF is required. At

present it had none of the key

components and very few of the IYCF

practices are reflected in the policy.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “poor”; and may require

extensive work. It has none of the key components or action areas, including the

CODE law, it monitoring and enforcement as well as the maternity protection law,

maternity leave and the provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country

seems to have adequate IYCF counseling service at the health system level;

several other key components, including the BFHI, the pre- and in-service

training curricula and health workers capacity development activities need to be

reinforced.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

The community system integration

component may require extensive

attention. There is no information on

most of the other key components.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or

intervention implemented”

- No information

Poor Very low number of key IYCF actions or

intervention implemented

Fair Low number of the key IYCF actions or

interventions implemented

Good Average number of key IYCF actions or

intervention implemented

Very Good High number or all of the key IYCF actions

or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy Status

Overall national IYCF policy, strategy and plan of actions

Poor

Key practices reflected in the policy

Early initiation of breastfeeding

× Exclusive breastfeeding

Continued breastfeeding

× Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative ×International code of marketing of breast milk substitute ×Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy × National IYCF plan of action × Summary of national IYCF legislation and

law

Status

Overall national IYCF legislation Poor Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law ×Maternity leave -

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Poor

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Poor

IYCF health service counseling Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 0

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 12

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 0

Coverage of the training on IYCF counseling among health workers (%) -

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

-

Community monitoring and evaluation

-

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

- Capacity building on communication skills for community health workers

- Monitoring and evaluation

Routine monitoring of IYCF activities -Routine monitoring of skills of community health workers

- Routine monitoring of the quality of IYCF counseling

- Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) 0

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) -

Proportion of the population living in the target area -

87

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“fair”. Several key components are judged to be weak

and may require extensive work, including the national

IYCF behaviour change and communication strategy

and channels, as well as monitoring and evaluation of

the effects of communication on behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “poor” and may require extensive attention. Additionally,

more work is needed to strengthen the broader monitoring and

evaluation system within the national legislation, community and

health system levels as well as communication on IYCF and IYCF

in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication strategy Poor

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements

Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months × Micronutrients supplements (single/multiple) provided

in emergencies -

Micronutrients supplements provided in non- emergencies

-

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Poor

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

×

Infant feeding training/counseling for HIV+ mothers ×

IYCF training materials include HIV and infant feeding -

IYCF counseling materials which include HIV and infant feeding are updated regularly

- Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency -

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

×

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF

×

Routine monitoring of ongoing IYCF ×

Overall evaluation/review of IYCF situation ×

88

SUDAN North Sudan has a stunting prevalence rate of 35% among children under 5 years

of age; while 32% and 16% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 73%, exclusive breastfeeding (< 6 months) at 41%. About 53% of

children 6 to 23 months are breastfed with complementary food; the nutritional

quality of complementary foods from most developing countries is usually poor or

inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS North Sudan’s overall national policy,

strategy and plan of actions status

appears to be “fair”. The country

seems to have most of the building

blocks for a comprehensive IYCF

strategy. However, more work is

required in strengthening its BFHI and

IYCF in emergency.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including maternity protection law, maternity leave and provision of

paid nursing leave. However, more work is needed with respect to the CODE law, its

monitoring and enforcement.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country

seems to be adequate in some of the key components; however, there is need

to further strengthen its BFHI and training curricula.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

All the key components may require

extensive attention.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a

comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative ×International code of marketing of breast milk substitute

Behavioural change and communication HIV and infant feeding

IYCF in emergency × National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Fair Key action areas

CODE law ×

CODE monitoring and enforcement

-

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Fair

IYCF health workers capacity development Good

IYCF health service counseling Very Good

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): 12

Hospitals / maternity facilities re-certified Baby-friendly (%): 12

Percentage of institutional birth in the country 19

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) -

Coverage of the training on IYCF counseling among health workers (%) 62

Summary of IYCF community system level actions

Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Fair

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community

system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) -

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 60

Proportion of the population living in the target area -

89

COMMUNICATION ON IYCF

Overall national level communication on IYCF is “fair”.

Some key components are judged to be weak and may

require extensive work, including behaviour change and

communication materials on IYCF, as well as the

monitoring and evaluation of the effect of communication

on IYCF behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “fair” and may require additional attention. Weaker aspects of

the comprehensive IYCF monitoring and evaluation system

should be strengthened, particularly at the national legislation,

community and health system levels as well as communication on

IYCF and IYCF in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication Good

IYCF behaviour change and communication channels Good

Behaviour change and communication materials on IYCF Fair

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding

interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of

complementary food supplements

Status

Micronutrient supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies ×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided ×

Fortified industrially-blended complementary foods are provided

Lipid-based nutrient supplements are provided

Status

Overall national standing on HIV and infant feeding Poor

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

×

Infant feeding training/counseling for HIV+ mothers ×

IYCF training materials include HIV and infant feeding -

IYCF counseling materials which include HIV and infant feeding are updated regularly

- Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Fair

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF

Overall evaluation/review of IYCF situation ×

90

UGANDA

Uganda has a stunting prevalence rate of 38% among children under 5 years of

age; while 16% and 6% are underweight and wasted, respectively. Recent reports

on IYCF status indicate that the rate of early initiation of breastfeeding is currently

at 42%, exclusive breastfeeding (< 6 months) at 60% and continued

breastfeeding (20 - 23 months) at 54%. About 80% of children 6 to 9 months are

breastfed with complementary food; the nutritional quality of complementary foods

from most developing countries is usually poor or inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country

actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Uganda’s overall national policy,

strategy and plan of actions status

appears to be “fair”. The country has

very few of the building blocks for a

comprehensive IYCF strategy and

continued work on IYCF is required. At

present very few of the key IYCF

components are reflected in the national

policy.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “good”; it has some of the

key components, including the CODE, its monitoring and enforcement, as well as

maternity protection law and maternity leave. Nevertheless, more work is needed with

respect to the provision of paid nursing breaks.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “fair”. Although, the country

seems to have adequate IYCF training curricula and health workers capacity

development counseling service at the health system level, several other key

components, including the BFHI and IYCF health service counseling may

require to be reinforced.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

All the key components are weak

and may require extensive

reinforcement.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative

International code of marketing of breast milk substitute

Behavioural change and communication × HIV and infant feeding × IYCF in emergency × National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Good Key action areas

CODE law

CODE monitoring and enforcement

Maternity protection law

Maternity leave

Paid nursing breaks ×

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Fair

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Good

IYCF health workers capacity development Good

IYCF health service counseling Fair

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%): < 1

Hospitals / maternity facilities re-certified Baby-friendly (%): 0

Percentage of institutional birth in the country 41

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 9

Coverage of the training on IYCF counseling among health workers (%) 36

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Poor

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

× Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) -

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 21

Proportion of the population living in the target area -

91

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“fair”. Several key components are judged to be weak

and may require extensive work, including the national

IYCF behaviour change and communication strategy and

channels, as well as monitoring and evaluation of the

effects of communication on behaviour.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level IYCF monitoring and evaluation appears to

be “poor” and may require extensive attention. Additionally,

more work is needed to strengthen the broader monitoring and

evaluation system within the national legislation, community and

health system levels as well as communication on IYCF and IYCF

in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication Poor

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Very Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Fair

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months

Micronutrients supplements (single/multiple) provided in emergencies

×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months

×

Fortified local complementary foods are provided -

Fortified industrially-blended complementary foods are provided

-

Lipid-based nutrient supplements are provided -

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

×

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency ×

Government procures/distribute breast milk substitutes -Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF

Routine monitoring of ongoing IYCF ×

Overall evaluation/review of IYCF situation

92

UNITED REPUBLIC OF TANZANIA The United Republic of Tanzania has a stunting prevalence rate of 44% among

children under 5 years of age; while 17% and 4% are underweight and wasted,

respectively. Recent reports on IYCF status indicate that the rate of early initiation

of breastfeeding is currently at 67%, exclusive breastfeeding (< 6 months) at 41%

and continued breastfeeding (20 - 23 months) at 55%. About 91% of children 6 to

9 months are breastfed with complementary food; the nutritional quality of

complementary foods from most developing countries is usually poor or

inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS United Republic of Tanzania’s overall

national policy, strategy and plan of

actions status appears to be “poor”.

The country has very few of the building

blocks for a comprehensive IYCF

strategy and continued work on IYCF is

required. At present there is no

information on the status of most of the

key IYCF components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “very good”. However, to

take advantage of the current adequate IYCF legislation and law; key components not

reflected in the national IYCF policy may need strengthening.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “good”. The country may need to

take advantage of its adequate IYCF actions at the health system level to further

strengthen other IYCF action areas, several other key components, including the

BFHI and health workers capacity development activities in delivering IYCF

counseling need to be reinforced.

COMMUNITY SYSTEM LEVEL ACTIONS

The IYCF community level actions

may be “fair”. Strengthening IYCF

activities within the communities

should be a high priority action

area. More work is required with

respect to reinforcing the IYCF

community system integration as

well as monitoring and evaluation

activities.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or intervention implemented”

- No information

Poor Very low number of key IYCF actions or intervention implemented

Fair Low number of the key IYCF actions or interventions implemented

Good Average number of key IYCF actions or intervention implemented

Very Good High number or all of the key IYCF actions or interventions implemented

National policy, strategy and plan of action for a comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Poor

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

× Complementary feeding ×

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative -International code of marketing of breast milk substitute -Behavioural change and communication - HIV and infant feeding - IYCF in emergency - National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Very Good Key action areas

CODE law

CODE monitoring and enforcement

Maternity protection law

Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Good

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Very Good

IYCF health workers capacity development Very Good

IYCF health service counseling Good

National status of the Baby-Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%) < 2

Hospitals / maternity facilities re-certified Baby-friendly (%) < 1

Percentage of institutional birth in the country 50

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 (%) 6

Coverage of the training on IYCF counseling among health workers (%) 8

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Fair

Key action areas or components

IYCF community system integration Fair

IYCF community health workers capacity development

Very Good

Community monitoring and evaluation

Poor

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) 0

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) 42

Proportion of the population living in the target area 41

93

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“fair”. While some of the key action areas may be

adequate, other aspects including the IYCF behaviour

change and communication channels as well as the

monitoring and evaluation of the effect of communication

on behaviour may need strengthening.

ADDITIONAL COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION

Overall national level communication on IYCF appears to be

“poor” and may require extensive attention. Additionally, more

work is needed to strengthen the broader monitoring and

evaluation system within the national legislation, community and

health system levels as well as communication on IYCF and IYCF

in exceptionally difficult circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication Very Good

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions/components

Status

Overall complementary feeding interventions / components score

Fair

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Fair

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months Micronutrients supplements (single/multiple) provided

in emergencies ×

Micronutrients supplements provided in non- emergencies

Targeted food supplements are provided to improve CF for children 6-24 months Fortified local complementary foods are provided × Fortified industrially-blended complementary foods are

provided

Lipid-based nutrient supplements are provided

Status

Overall national standing on HIV and infant feeding Good

Selected key action areas

Policy on HIV and infant feeding

National IYCF policy include guidance on HIV and infant feeding

HIV and infant feeding in PMTCT policy

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

Infant feeding training/counseling for HIV+ mothers

IYCF training materials include HIV and infant feeding

IYCF counseling materials which include HIV and infant feeding are updated regularly

Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

-

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

×

Breast milk substitutes are provided during emergency

×

Government procures/distribute breast milk substitutes

-Government accept donations of infant food -

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF activities

×

Routine monitoring of ongoing IYCF activities

Overall evaluation/review of IYCF situation

×

94

YEMEN Yemen has a stunting prevalence rate of 58% among children under 5 years of

age; while 43% and 15% are underweight and wasted, respectively. Recent

reports on IYCF status indicate that the rate of early initiation of breastfeeding is

currently at 30% and exclusive breastfeeding (< 6 months) at 12%. About 76% of

children 6 to 9 months are breastfed with complementary food; the nutritional

quality of complementary foods from most developing countries is usually poor or

inadequate.

Overview of the scale, scope and status of comprehensive IYCF in-country actions are summarized below:

NATIONAL POLICY, STRATEGY AND PLAN OF ACTIONS Yemen’s overall national policy, strategy

and plan of actions status appears to be

“fair”. The country has very few of the

building blocks for a comprehensive

IYCF strategy and continued work on

IYCF is required. At present it had some

of the key components, but more work

is required in terms of the BFHI and HIV

and infant feeding components.

IYCF LEGISLATION AND LAW The overall national IYCF legislation and law status seems “fair”; it has some of the

key components, including the CODE law, maternity leave and provision of paid

nursing breaks. However, more work is needed with respect to the CODE monitoring

and enforcement as well as maternity protection law.

HEALTH SYSTEM LEVEL ACTIONS The health system level actions appear to be “poor”. Although, the country

seems to have adequate IYCF capacity development at the health system level,

other key components, including the BFHI, the pre- and in-service training

curricula and IYCF health service counseling activities may need to be

reinforced.

COMMUNITY SYSTEM LEVEL ACTIONS The IYCF community level actions

may be “poor”. Strengthening IYCF

activities within the communities

should be a high priority action area.

Extensive work is required to

strengthen its weak IYCF

community system integration,

community capacity development

and training, as well as monitoring

and evaluation require extensive

attention.

KEYS

Yes “Part of the key IYCF actions/ interventions implemented”

× No “ Not part of the key IYCF actions or

intervention implemented”

- No information

Poor Very low number of key IYCF actions or

intervention implemented

Fair Low number of the key IYCF actions or

interventions implemented

Good Average number of key IYCF actions or

intervention implemented

Very Good High number or all of the key IYCF actions

or interventions implemented

National policy, strategy and plan of action for a

comprehensive IYCF strategy

Status

Overall national IYCF policy, strategy and plan of actions

Fair

Key practices reflected in the policy

Early initiation of breastfeeding

Exclusive breastfeeding

Continued breastfeeding

Complementary feeding -

Selected key components reflected in the National IYCF policy

Status

Baby-friendly hospital initiative ×International code of marketing of breast milk substitute

Behavioural change and communication × HIV and infant feeding × IYCF in emergency

National IYCF strategy

National IYCF plan of action

Summary of national IYCF legislation and law

Status

Overall national IYCF legislation Fair Key action areas

CODE law

CODE monitoring and enforcement

×

Maternity protection law ×Maternity leave

Paid nursing breaks

Summary of IYCF health system level actions

Status

Overall IYCF health system level actions score Poor

Key action areas or components Baby-friendly hospital initiative Poor

IYCF health pre- and in-service training curricula Poor

IYCF health workers capacity development Good

IYCF health service counseling Fair

National status of the Baby Friendly Hospital Initiative (estimated)

Hospitals / maternity facilities ever certified Baby-friendly (%) 0

Hospitals / maternity facilities re-certified Baby-friendly (%) 0

Percentage of institutional birth in the country 20

Capacity building of health workers in delivering IYCF counseling (estimated)

Health workers trained on IYCF counseling since 2006 [total number (%)] -

Coverage of the training on IYCF counseling among health workers [total number (%)] 0

Summary of IYCF community system level actions Status

Overall IYCF community system level actions score Poor

Key action areas or components

IYCF community system integration Fair

IYCF community health workers capacity development

Fair

Community monitoring and evaluation

Poor

Selected key components of the IYCF community system level actions Status

Community capacity development

Training on community IYCF counseling since 2006

Capacity building on communication skills for community health workers

×

Monitoring and evaluation

Routine monitoring of IYCF activities ×Routine monitoring of skills of community health workers

× Routine monitoring of the quality of IYCF counseling

×

Capacity building of community health workers (CHWs) in delivering community-based IYCF counseling (estimated)

Community health workers trained on community IYCF counseling since 2006 (%) -

Coverage of trained community health workers providing IYCF counseling activities as part of other community-based programme (%) -

Proportion of the population living in the target area -

95

COMMUNICATION ON IYCF

Overall national level communication on IYCF seems

“fair”. Several key components may need to be

strengthened, including the national IYCF behaviour

change and communication strategy and channels, as

well as monitoring and evaluation of the effects of

communication on behaviour.

COMPLEMENTARY FEEDING INTERVENTIONS/COMPONENTS

IYCF IN EXCEPTIONALLY DIFFICULT CIRCUMSTANCES HIV AND INFANT FEEDING

INFANT FEEDING IN EMERGENCIES

IYCF MONITORING AND EVALUATION Overall national level IYCF monitoring and evaluation

appears to be “poor” and may require extensive attention.

Additionally, more work is needed to strengthen the broader

monitoring and evaluation system within the national

legislation, community and health system levels as well as

communication on IYCF and IYCF in exceptionally difficult

circumstances.

Summary of national level communication on IYCF

Status

Overall national level communication on IYCF Fair

Key action areas or component

National IYCF behaviour change and communication Fair

IYCF behaviour change and communication channels Fair

Behaviour change and communication materials on IYCF Good

Monitoring and evaluating the effect of communication on behaviour Poor

Summary of additional complementary feeding interventions / components

Status

Overall complementary feeding interventions / components score

Poor

Selected key strategies

IYCF counseling of care-givers in relation to home preparation of complementary foods

Poor

Provision of complementary food supplements Poor

Selected key interventions in relation to the provision of complementary food supplements

Status

Micronutrients supplements (single/multiple) are provided to improve CF for children 6-24 months

Micronutrients supplements (single/multiple) provided in emergencies

Micronutrients supplements provided in non- emergencies

×

Targeted CF supplements are provided to improve CF for children 6-24 months

Fortified local complementary foods are provided ×

Fortified industrially-blended complementary foods are provided

×

Lipid-based nutrient supplements are provided ×

Status

Overall national standing on HIV and infant feeding Poor

Selected key action areas

Policy on HIV and infant feeding ×

National IYCF policy include guidance on HIV and infant feeding

-

HIV and infant feeding in PMTCT policy -

Status

Other selected key action areas

Infant feeding policy updated based on 2010 WHO rapid advice

-

Infant feeding training/counseling for HIV+ mothers -

IYCF training materials include HIV and infant feeding

-

IYCF counseling materials which include HIV and infant feeding are updated regularly

- Monitoring system on infant feeding practices among HIV+ mothers

×

Status

Overall national standing on Infant feeding in emergencies Poor Selected key action areas

National IYCF policy include IYCF in emergency

National emergency preparedness plan includes IYCF in emergency

National emergency preparedness plan updated based on the latest edition of IYCF in emergency

×

Status

Other selected key action areas Health workers and IYCF counsellors trained on IYCF in emergency

Breast milk substitutes are provided during emergency

×

Government procures/distribute breast milk substitutes

×

Government accept donations of infant food ×

Summary of IYCF monitoring and evaluation score

Status

Overall IYCF monitoring and evaluation score Poor

Key action areas or components Monitoring and evaluation for national IYCF

×

Routine monitoring of ongoing IYCF ×

Overall evaluation/review of IYCF situation ×

96

Section 5: ANNEXES

97

ANNEX 1:

Assessment Matrix Questionnaire

98

99

100

101

102

103

104

ANNEX 2:

Completion of Assessment Matrix Region Version I Matrix Completed

in 2008 Version II Completed in

2010 Version II Matrix Completed

2010-2011 Matrix Not Completed

WCAR Mauritania, Liberia, Cote d'Ivoire, Burkina Faso, Ghana, Togo, Benin, Nigeria, Niger, Congo Brazzaville

Mali, Senegal, Gambia, Sierra Leone, Congo Brazzaville, Gabon, D. Rep. Congo

Guinea (Conakry), Guinea Bissau, Chad, Cameroon, Equatorial Guinea, Central African Rep.

ROSA Sri Lanka, India, Nepal Afghanistan, Bhutan, Bangladesh Pakistan

MENA North Sudan, South Sudan, Yemen

ESAR Angola, Namibia, Botswana, South Africa, Malawi, Zambia, Zimbabwe, Mozambique, Madagascar, Tanzania, Burundi, Uganda, Kenya, Ethiopia, Somalia, Swaziland, Rwanda

Lesotho, Comoros, Eritrea

EAPR Thailand, Lao People's Dem. Rep., Cambodia, China, Korea, Indonesia, Timor-Leste, Papua New Guinea, Fiji, Myanmar, Vanuatu, Mongolia

Philippines, Vietnam, Malaysia

CEE/CIS Bosnia and Herzegovina, Kazakhstan, Kosovo, Romania, Tajikistan, Turkmenistan, Uzbekistan

Kyrgyzstan

Albania, Armenia, Azerbaijan, Belarus, Croatia, Georgia, Moldova, Montenegro, Serbia, Turkey, Ukraine

Nutritionally vulnerable countries are shown in red

TOTALS

10

23

33

22

Response rate

Result WCAR ESAR ROSA EAPR CEE/CIS MENA TOTAL

Number of countries (#received by countries matrix) 22 20 7 15 19 3 86

Number of matrices Completed (Other Countries) 10 9 4 12 8 na 43

Number of Matrices completed (Nutritionally vulnerable Countries)

7 8 2 2 na 3 22

Total number of matrices completed (All countries) 17 17 6 14 8 3 65

Response Rate for other countries (%) 53.3 66.7 100 92.3 42.1 na 69.3

Response Rate for the Countries designated Nutritionally Vulnerable y (%)

100 100 66.7 100 na 100 95.6

Total Response Rate (%) 77.3 80 85.7 93 42.1 100 75.6

Na= not applicable i.e. no country in the region fell in this category.

105

ANNEX 3:

Key IYCF interventions and indicators

Components and Interventions for a comprehensive IYCF strategy

Indicators

National action level

Policy/Advocacy % of countries with national stand-alone IYCF policy, strategy and plan of action

% of countries with all key IYCF elements in National IYCF Policy

Development & enforcement of national legislation on the marketing of BMS

% of countries with existing ICMBS law or regulation

% of countries with system of monitoring and enforcement of ICMBS law in place

Development & enforcement of national legislation on maternity protection

% of countries with maternity protection laws or regulations in place

% of countries with paid maternity leave

% of countries with paid nursing breaks provided for mothers after return to work

Health system action level

Development/updating of IYCF integrated curriculum for health provider pre-service and in-service education

% of countries with updated pre-service and in-service curricula

% of countries with all 3 elements of a comprehensive IYCF package in pre-service curricula for health professionals

Capacity development on IYCF for health providers/lactation counsellors

% of countries with pre-service and in-service training

% of countries with IYCF job aids and counseling cards for health professionals

% of countries with health workers trained in stand-alone IYCF counseling course 2006-2009

% of countries with routine performance monitoring

Establishment of integrated IYCF counseling services in health facilities at relevant MCH contacts in primary health care services

% of countries with IYCF counseling taking place in the health system

% of countries with caregivers helped or trained in home-preparation of CF

Development & implementation of supervision/quality assurance system for IYCF services in the health system

% of countries with routine monitoring on skills of HW % of countries with routine monitoring of quality of counseling %of countries with regular supportive supervision provided by managers

Institutionalization of the Ten Steps to Successful Breastfeeding in all maternities (BFHI)

% of countries with ever- certified BF facilities

% of countries with BF facilities re-certified since 2006

Community action level

Establishment of community based integrated IYCF counseling services at community level

% of countries with established community-based activities in country

% of countries with stand alone community-based IYCF activities

Capacity development of CHW and IYCF counseling services at community level

% of countries with CHW trained with a stand-alone IYCF counseling

% of countries with specific capacity building on communication skills for HWs.

% of countries with routine monitoring of community health worker skills

% of countries with supportive supervision of CHW

% of countries monitoring quality of counseling skills of CHW

% of countries with recognition mechanism for well-performing workers

Creation of mother support groups for IYCF in the community

% of countries with mother support groups (or other groups) conducting sessions to promote IYCF

Communication

Implementation of communication for behaviour and social change through multiple channels

% of countries with 8 multiple communication channels

% of countries with communication at multiple channels ( national, health system, community levels )

% of countries with BCC materials available

% of countries with national level communication Strategy

% of countries with national coordination mechanism

% of countries with IYCF communication elements in IYCF/national strategy

% of countries with routine monitoring of IYCF communication activities

Additional Complementary feeding Components

Improving the quality of complementary foods through locally available ingredients

% of countries providing micronutrient supplements for CF (6-24 months) % of countries providing local CF (unfortified) % of countries providing fortified local CF

Provision of nutrition supplements and foods for complementary feeding (MNPs, LNS, fortified complementary foods) in food-insecure populations

% of countries providing targeted food supplements % of countries providing industrially-blended CF (unfortified) % of countries with providing fortified industrially-blended CF % of countries with providing lipid based supplements

Social protection schemes with nutrition component - complementary feeding. (e.g. in kind complementary foods, vouchers, cash transfers)

% of countries with social protection program available with food security component

106

IYCF in difficult circumstances

HIV and infant feeding % of countries with IF and PMTCT addressed in IYCF national policy

% of countries with complete, adequate training and counseling on IF and HIV

% of countries with adequately trained HW on HIV and IF

% of countries with follow-up and continuous support for HIV + mothers

IYCF in emergencies

% of countries with IYCF policy whcich includes infant feeding in emergencies

% of countries with complete, adequate training and counseling on infant feeding in emergencies

% of countries with BMS provided during emergencies

Monitoring and Evaluation

Monitoring, review and evaluation % of countries with overall evaluation or review of IYCF situation in the country

% of countries with monitoring of process indicators

107

ANNEX 4:

Country Descriptions

Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses

CEE/CIS Kosovo 09/24/2010 Agron Gashi Health And Nutrition Officer

UNICEF Agashi@Unicef.Org

Tajikistan 11/15/2010 Mutrib Bakhruddinov Nutrition Officer UNICEF Mbakhruddinov@Unicef.Org

Bosnia And Herzegovina

10/18/2010 Selena Bajraktarevic Health Nutrition Ecd Officer

UNICEF Sbajraktarevic@Unicef.Org

Uzbekistan 09/30/2010 Bakhodir Rahimov Nutrition Officer UNICEF Brahimov@Unicef.Org

Turkmenistan 09/30/2010 Shafag Rahimova Health And Nutrition Specialist

UNICEF Srahimova@Univef. Org

Romania 10/12/2010 Anemona Munteanu Health And Nutrition Consultant

UNICEF Amunteanu@Unicef.Org

Kyrgyzstan 03/15/2011 Damira Abakirova Health And Nutrition Officer

UNICEF Dabakirova@Unicef.Org

Kazakhstan 11/26/2009 Aigul Nurgabilova Nutrition Officer UNICEF Anurgabilova@Unicef.Org

EAPR Korea NA Sawasan Rawas Nutrition Specialist UNICEF Srawas@Unicef.Org

Vanuatu 03/19/2010 Jennifer Timothy Nutrition And Dietetics Coordinator.

Ministry Of Health Jtimothy@Vanuatu.Gov.Vu

Cambodia 03/16/2010 Multiple Na Na Jconkle@Unicef.Org

China 03/18/2010 Lilian Selenje And Chang Suying

Nutrition Specialist UNICEF Lselenje@Unicef.Org

Indonesia 03/16/2010 Sonia Blaney Nutrition Manager UNICEF sblaney@unicef.org

Mongolia 03/22/2010 Batjargal Jamiyan Director Of Nutrition Research Center

Nutrition Research Center Of Public Health Institute

Batjar_J@Hotmail.Com

Myanmar 03/18/2010 Dr. Kyaw Win Sein Nutrition Specialist UNICEF Kwsein@Unicef.Org

Papua New Guinea

03/18/2010 Lazarus Dawa And Clementine Yaman

Nutrition Project Officer And Nutrition Officer

Department Of Health And UNICEF

Lazarus Dawa <Ldawa@Live.Com.Au> And Cyaman@Unicef.Org

Timor-Leste 03/09/2010 Dirce M. Soares/ Faraja Chiwile

Head Of Nutrition Department/ Nutrition Specialist

Ministry Of Health/UNICEF

Dominut_2006@Yahoo.Com, Fchiwile@Unicef.Org

Thailand 03/19/2010 Pornthida Padthong Communication Officer

UNICEF Thailand Ppadthong@Unicef.Org

108

Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses

Vietnam 03/01/2011 Roger Mathisen, Do Hong Phuong

Nutrition Specialist / Health And Nutrition Policy Officer

UNICEF Rmathisen@Unicef.Org, Dhphuong@Unicef.Org

Philippines 03/15/2011 Vicenta E. Borja Supervising Health Program Officer

Department Of Health

Vicentaborja@Hotmail.Com

Fiji 03/18/2010 Ms Jimaima Schultz Manager National Food And Nutrition Centre, Ministry Of Health, Fiji

Managernfnc@Connect.Com.Fj

Lao People's Democratic Republic

03/19/2011 Dr Khamseng Philavong Senior Officer, MCH Center

MOH Khamseng_P@Hotmail.Com

ESAR Madagascar

01/20/2011 Amal Bennaim Nutrition Specialist UNICEF Abennaim@Unicef.Org

Burundi 01/20/2011 Hedy Ip Nutrition Specialist UNICEF Hip@Unicef.Org

Zambia 01/31/2011 Ruth Siyandi Nutrition Officer UNICEF Rsiyandi@Unicef.Org

Angola 01/02/2011 Vandana Agarwal Nutrition Specialist UNICEF Vagarwal@Unicef.Org

Somalia 02/03/2011 Erin McCloskey Nutrition Specialist-IYCF & Micronutrients

UNICEF Somalia Emccloskey@Unicef.Org

Mozambique

03/01/2011 Maaike Arts Nutrition Specialist UNICEF Marts@Unicef.Org

Botswana 02/04/2011 Patrick Codjia Nutrition Specialist UNICEF Pcodjia@Unicef.Org

Ethiopia 02/21/2011 Abebe Hailemariam Nutrition Specialist UNICEF Abhailemariam@Unicef.Org

Tanzania 01/20/2011 Elizabeth Macha Ecd/Nutrition Specialist

UNICEF Emacha@Unicef.Org

Rwanda 03/18/2010 Deborah Kortso Collison UNICEF Nutrition Officer

UNICEF Dkcollison@Unicef.Org

South Africa

02/02/2011 Joan Majti Senior Nutrition And Child Survival Specialist

UNICEF Jmatji@Unicef.Org

Swaziland 06/06/2009 Makhosini Mamba Health Specialist UNICEF Mmamba@Unicef.Org

Uganda 02/17/2011 Dr. Mbonye Andrew Commissioner Community Health

Ministry Of Health Snamukoseb@Yahoo.Com,

109

Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses

Namibia 01/28/2011 Steve Okokwu Health Specialist UNICEF Sokokwu@Unicef.Org

Zimbabwe 03/22/2011 Fitsum Assefa Nutrition Manager UNICEF Fassefa@Unicef.Org

Malawi 04/14/2011 Benson M. Kazembe Micronutrient Officer UNICEF Benson M. Kazembe

Kenya 05/06/2011 Linda Beyer Nutrition Specialist, IYCN And HIV

UNICEF Lbeyer@Unicef.Org

Mena Yemen 01/25/2011 Rajia Sharahan, Nagib Abdulbaqi

Nutrition Officer UNICEF Rsharhan@Unicef.Org, Nabdulbaqi@Unicef.Org

South Sudan

02/16/2011 Bertha Jackson Nutrition Specialist UNICEF Bjackson@Unicef.Org

North Sudan

03/08/2011 Mara Nyawo Nutrition Surveillance UNICEF Mnyawo@Unicef.Org

Rosa Bangladesh 03/18/2010 Dr. Mohsin Ali Nutrition Specialist UNICEF Mohali@Unicef.Org

India 03/03/2010 Dr. Kajali Paintal Nutrition Specialist UNICEF Kpaintal@Unicef.Org

Nepal 03/17/2010 Pragya Mathema Nutrition Specialist UNICEF Pmathema@Unicef.Org

Sri Lanka 03/15/2010 Dr. (Ms) H. S. Jayawickrama

Programme Manager, Child Health

Family Health Bureau, Ministry Of Healthcare & Nutrition

Senanij@Hotmail.Com

Afghanistan

03/07/2011 Zakia Maroof Nutrition Officer UNICEF Zmaroof@Unicef.Org

Bhutan 04/01/2011 Chandralal Mongar And Ugyen Zangmo

Health And Nutrition Officer And Nutrition Programme Officer Respectively

UNICEF And Ministry Of Health Respectively

Cmongar@Unicef.Org And Ugyenzangmo@Health.Gov.Bt

WCAR Congo Brazzaville

02/02/2011 Isabelle Mouyokani Nutrition Officer UNICEF Ismouyokani@Unicef.Org

Mauritania 02/04/2011 Mohamed Ag Bendech/ Ines Lezama

Nutrition Specialist UNICEF Magbendech@Unicef.Org, Ilezama@Unicef.Org

C. African Rep.

02/04/2011 Benedict Mbeng Nutrition Consultant UNICEF Btabiojongmbeng@Unicef.Org

Gambia 02/08/2011 Mathew Baldeh/Bakary Jallow

EPI Specialist/Principal Programme Officer

UNICEF/National Nutrition Agency (Nana)

Bakaryjallow24@Yahoo.Co.Uk

110

Region Country Date Completed Contact Person (S) Position(S)/Title(S) Organization E-Mail Addresses

WCAR Senegal 02/03/2011 Acajou Doom Et Dr. Mama Madame Dionne

Nutrition Specialist UNICEF/MOH Adioum@Unicef.Org

Ghana 02/02/2011 Ernestina Agyepong Nutrition Specialist UNICEF Eagyepong@Unicef.Org

Gabon 02/09/2011 Ayang Ebang Michel Nutritionist Centre National De Nutrition

Ayangebangm@Yahoo.Fr

Togo 02/11/2011 Amina Bangana (En Collaboration Avec Le Service National De Nutrition/Ministère De La Santé)

Nutritionist/Nutrition Officer

UNICEF Abangana@Unicef.Org

Benin 03/01/2011 Anne-Sophie Le Dain Nutrition Specialist UNICEF Aledain@Unicef.Org

Niger 11/04/2009 Gwénola Desplats Nutrition Specialist UNICEF Gdesplats@Unicef.Org

Sierra Leone

02/20/2011 Rashid Abdulai Nutrition Officer UNICEF Rabdulai@Unicef.Org

D. Rep. Congo

03/21/2011 Moïse Kabongo (Nutrition Officer), Simeon Nanama (Nutrition Manager), Kamanda Augustin (National Nutrition Program)

Nutrition Officer, Nutrition Manager, Pronanut Rdc

UNICEF And Pronanut

Mkabongo@Unicef.Org, Snanama@Unicef.Org, Kbishimini@Yahoo.Fr

Mali 03/24/2011 Anne Marie Dembele Nutrition Officer UNICEF Amdembele@Unicef.Org

Nigeria 04/11/2011 Stanley Citekwe OIC Chief Of Nutrition UNICEF Schitekwe@Unicef.Oeg

Burkina Faso

04/21/2011 Fatoumata Lankoande Specialiste En Nutrition UNICEF Flankoande@Unicef.Org

Liberia Na Na Na Na Na

Cote d'Ivoire

Na Na Na Na Na

111

ANNEX 5a:

IYCF Policy, Strategy and Plan of actions

COUNTRY Stand alone/Not stand alone

policy

Initiation BF

EBF Continued BF

CF Initiation of CF

BFHI 10 Steps

Community

Actions

ICMBS Maternal

Nutrition

Mother Support Groups

BCC HIV/ IF IYCF in Emerge

ncies

Strategy POA Policy, Strategy, POA Sub-Score

CEE/CIS

Bosnia and Herz.

d 0 1 0 1 1 0 1 1 0 1 0 0 0 0 0 0 4

Kosovo na na na na na na na na na na na na na na na 0 0 0

Romania 0 na na na na na na na na na na na na na na 0 0 0

Turkmenistan 1 1 1 1 0 0 0 1 1 0 na na 0 0 1 0 0 4

Uzbekistan 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 5

Tajikistan d 1 1 1 0 1 1 1 1 1 1 0 0 0 0 0 1 6

Kazakhstan d 1 1 1 1 1 1 1 0 1 1 1 0 1 0 0 0 7

Kyrgyzstan d 1 1 1 1 1 0 1 1 1 1 1 1 1 0 0 0 8

n 6 4 6 5 4 4 3 6 4 3 4 2 1 2 1 1 2 M

N 7 6 6 6 6 6 6 6 6 6 5 5 6 6 6 8 8 4

% 85.7 66.7 100 83.3 66.7 66.7 50 100 66.7 50 80 40 16.7 33.3 16.7 12.5 25

EAPR

Cambodia 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 0 8

China 1 0 1 0 1 0 0 1 1 0 0 0 0 0 1 0 3

Fiji c 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 2

Indonesia na 0 0 0 0 0 na na na na na na na na na 0 0 0

Korea na 0 1 1 1 1 1 1 1 0 0 0 0 0 0 0 1 5

Lao D.Rep. 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 8

Mongolia c 0 0 0 1 1 na na na na na na na na na 0 0 2

Myanmar c 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 0 5

P. New Guinea c na 0 na na na 1 0 1 1 0 0 1 1 0 0 0 3

Philippines 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 0 8

Thailand na 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9

Timor-Leste c na na na na na na na na na na na na na na 0 1 1

Vanuatu 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9

Vietnam c 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 9

n 10 6 9 8 11 10 9 9 10 6 6 6 5 7 4 5 5 M

N 11 12 13 12 12 12 11 11 11 11 11 11 11 11 10 14 14 5

% 90.9 50.0 69.2 66.7 91.7 83.3 81.8 81.8 90.9 54.5 54.5 54.5 45.5 63.6 40.0 35.7 35.7

ESAR

Angola d 0 0 0 0 0 1 1 1 0 1 0 0 1 0 0 0 3

Botswana a 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 8

Burundi c 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1

Ethiopia c 0 0 0 0 0 na na na na na na na na na 1 1 1

Kenya 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9

112

COUNTRY Stand alone policy

Initiation BF

EBF Continued

BF

CF Initiation of

CF

BFHI 10 Steps

Community

Actions

ICMBS

Maternal

Nutrition

Mother

Support

Groups

BCC HIV/ IF IYCF in Emerge

ncies

Strategy POA Policy, Strategy, POA

Sub-Score

Madagascar c 1 1 1 1 1 1 0 1 0 1 1 1 1 0 1 1 8

Malawi 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 9

Mozambique 0 0 0 0 0 0 na na na na na na na na na 0 0 0

Namibia 1 1 1 1 1 1 0 1 1 0 0 1 1 0 0 1 0 6

Rwanda c 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 8

Somalia e 1 1 1 1 1 0 0 1 1 1 1 1 0 0 0 0 6

South Africa 1 0 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 6

Swaziland 0 na na na na na na na na na na na na na na 1 1 1

Tanzania 0 1 1 0 0 0 na na na na na na na na na 1 1 2

Uganda 1 1 1 1 1 1 1 0 1 1 0 0 0 0 0 1 1 6

Zambia 1,c 1 0 0 1 0 0 0 1 0 0 0 0 0 0 1 1 3

Zimbabwe a 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 8

n 12 9 12 10 11 10 9 8 12 8 7 7 8 7 5 11 8 M

N 17 16 16 16 16 16 13 13 13 13 13 13 13 13 13 17 17 5

% 70.6 56.3 75.0 62.5 68.8 62.5 69.2 61.5 92.3 61.5 53.8 53.8 61.5 53.8 38.5 64.7 47.1

MENA

North Sudan c 1 1 1 1 1 0 0 0 1 0 0 1 1 0 1 1 6

South Sudan f 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 3

Yemen 1 1 1 1 na na 0 0 1 1 0 0 0 0 1 1 1 5

n 2 2 3 2 2 2 0 1 2 2 0 0 1 1 1 2 2 M

N 3 3 3 3 2 2 3 3 3 3 3 3 3 3 3 3 3 5

% 66.7 67 100 67 100 100 0 33 67 67 0 0 33 33 33 67 67

ROSA

Afghanistan c 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10

Bangladesh 0 0 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 8

Bhutan 1 1 1 1 1 1 1 0 1 0 1 0 0 1 1 1 1 8

India c 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 2

Nepal 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 8

Sri Lanka c,d 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10

n 5 5 5 5 5 5 4 4 5 4 5 2 4 5 5 6 4 M

N 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 8

% 83.3 83.3 83.3 83.3 83.3 83.3 66.7 66.7 83.3 66.7 83.3 33.3 66.7 83.3 83.3 100 66.7

WCAR

Gambia c 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10

Benin d 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 3

113

COUNTRY Stand alone policy

Initiation BF

EBF Continued

BF

CF Initiation of

CF

BFHI 10 Steps

Community

Actions

ICMBS

Maternal

Nutrition

Mother

Support

Groups

BCC HIV/ IF IYCF in Emerge

ncies

Strategy POA Policy, Strategy, POA

Sub-Score

Burkina Faso c,d 1 1 1 1 1 1 0 1 1 0 1 1 0 0 1 7

Cen.Afr.Rep. d 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 9

Congo Brazzaville

c 1 1 1 1 1 1 1 1 0 0 0 1 1 0 1 0 7

Cote d'Ivoire c 1 1 1 1 0 1 na na 1 na na na 1 1 na na 5

D. Rep. Congo d 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 9

Gabon d 1 1 1 1 1 1 0 1 1 1 0 0 1 0 1 1 8

Ghana d 0 1 1 1 1 1 1 1 1 0 0 0 0 0 1 1 6

Liberia c,d na na na na na na na na na na na na na na na na 1

Mali 1,c 1 1 1 1 0 1 0 1 0 0 0 0 0 0 1 0 5

Mauritania c 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 9

Niger c 1 1 1 1 1 1 1 1 1 0 0 0 0 0 1 0 6

Nigeria 1 1 1 1 1 1 1 0 1 0 0 0 0 0 0 1 1 6

Senegal 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10

Sierra Leone c 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 9

Togo 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10

n 17 14 16 15 15 13 15 9 14 13 7 8 9 11 7 13 9 M

N 17 16 16 16 16 16 16 15 15 16 15 15 15 15 16 15 15 7

% 100 87.5 100 93.8 93.8 81.3 93.8 60.0 93.3 81.3 46.7 53.3 60.0 73.3 43.8 86.7 60.0

COUNTRY TOTAL

n 51 40 51 45 48 44 40 37 47 36 29 25 28 33 23 38 30 M

N 61 59 60 59 58 58 55 54 54 55 53 53 54 54 54 63 63 6

% 83.6 67.8 85.0 76.3 82.8 75.9 72.7 68.5 87.0 65.5 54.7 47.2 51.9 61.1 42.6 60.3 47.6

na= no response/ data not available/ not applicable a= BEING DRAFTED , b= PLANNED, c= PART OF NUTRITION POLICY, d=PART OF HEALTH POLICY, e=PART OF THE NUTRITION STRATEGY, f= MENTIONED IN DRAFTED NUTRITION HEALTH POLICY; M-=mean 1= Yes , 0=No Nutritionally vulnerable countries are highlighted in yellow

114

ANNEX 5b:

IYCF Legislation and law

Region COUNTRY

CODE LAW

CODE Monitoring & Enforcement

Maternity Protection Law Maternity Leave

Paid Nursing Breaks

LEGISLATION SUB-SCORE

CEE/CIS Romania

1 1 1 1 1 10

CEE/CIS Kazakhstan 1 0 1 1 1 8

CEE/CIS Kyrgyzstan 1 1 0 1 1 8

CEE/CIS Bosnia and Herz.

1 0 1 1 0 6

CEE/CIS Turkmenistan 1 0 1 1 0 6

CEE/CIS Kosovo

1 0 0 1 0 4

CEE/CIS Tajikistan

1 0 0 1 0 4

CEE/CIS Uzbekistan a na 0 1 0 2

n 7 2 4 8 3

N 8 7 8 8 8 M

% 87.5 28.6 50.0 100.0 37.5 6

EAPR P. N.Guinea

1 1 1 1 1 10

EAPR Vietnam

1 1 1 1 1 10

EAPR Philippines 1 1 1 1 1 10

EAPR Mongolia 1 1 1 1 1 10

EAPR Vanuatu

1 0 1 1 1 8

EAPR Lao PDR

1 0 1 1 1 8

EAPR China

1 0 1 1 1 8

EAPR Cambodia 1 na 1 1 1 8

EAPR Thailand

1 1 1 1 0 8

EAPR Korea

0 na 1 1 1 6

EAPR Myanmar

0 na 1 1 0 4

EAPR Indonesia 0 na 1 1 0 4

EAPR Fiji

1 0 0 1 0 4

EAPR Timor-Leste 0 na 0 0 0 0

n 10 5 12 13 9 M

N 14 9 14 14 14 7

% 71.4 55.6 85.7 92.9 64.3

ESAR Zimbabwe 1 1 1 1 1 10

ESAR Tanzania 1 1 1 1 1 10

ESAR Botswana 1 1 1 1 1 10

ESAR Zambia

1 1 1 1 0 8

ESAR Uganda 1 1 1 1 0 8

ESAR Mozambique 1 0 1 1 1 8

ESAR Malawi 1 1 1 1 0 8

ESAR Swaziland 0 0 1 1 1 6

ESAR Madagascar 0 na 1 1 1 6

ESAR Angola 0 na 1 1 1 6

ESAR South Africa 0 na 1 1 0 4

ESAR Kenya 0 na 1 1 0 4

ESAR Ethiopia 0 na 1 1 0 4

ESAR Burundi

0 na 1 1 0 4

ESAR Namibia

0 na 0 1 0 2

ESAR Somalia 0 na 0 0 0 0

ESAR Rwanda

0 na 0 0 0 0

n 7 6 14 15 7 M

N 17 8 17 17 17 6

% 41.2 75.0 82.4 88.2 41.2

MENA North Sudan 0 na 1 1 1 6

MENA Yemen 1 0 0 1 1 6

MENA South Sudan 0 na 0 na 0 0

n 1 0 1 2 2 M

N 3 1 3 2 3 4

% 33.3 0.0 33.3 100.0 66.7

ROSA Afghanistan 1 0 1 1 1 8

ROSA India 1 1 1 1 0 8

ROSA Sri Lanka

1 1 1 1 0 8

ROSA Bhutan

0 na 1 1 1 6

Region COUNTRY CODE CODE Monitoring & Maternity Protection Maternity Leave Paid Nursing LEGISLATION

115

law Enforcement Law Breaks SUB-SCORE

ROSA Bangladesh 1 na 1 1 0 6

ROSA Nepal

1 0 1 0 0 4

n 5.0 2.0 6.0 5.0 2.0 M

N 6.0 4.0 6.0 6.0 6.0 7

% 83.3 50.0 100.0 83.3 33.3

WCAR Ghana

1 1 1 1 1 10

WCAR Nigeria 1 1 1 1 1 10

WCAR Senegal

1 1 1 1 1 10

WCAR Burkina Faso 1 0 1 1 1 8

WCAR Gabon

1 0 1 1 1 8

WCAR Mauritania 1 0 1 1 1 8

WCAR Gambia

1 1 1 1 0 8

WCAR Niger 0 na 1 1 1 6

WCAR Togo

0 na 1 1 1 6

WCAR Cen.Afr.Rep. 0 na 1 1 1 6

WCAR Benin

1 0 1 1 0 6

WCAR Sierra Leone 0 na 1 1 0 4

WCAR

Congo Brazzaville

0 na 1 1 0 4

WCAR Mali 0 na 0 1 0 2

WCAR D. Rep. Congo 1 0 1 1 0 6

WCAR Cote d'Ivoire na na na na na NI

WCAR Liberia

na na na na na NI

n 9 4 14 15 9 M

N 15 9 15 15 15 7

% 60.0 44.4 93.3 100 60.0

COUNTRY TOTAL

n 39 19 50 56 32 M

N 63 38 63 61 62 6

% 61.9 50.0 79.4 91.8 51.6

na= no response, not available, not applicable. M= mean. NI= No Information. Nutritionally vulnerable countries are highlighted in yellow

116

ANNEX 5c: National level IYCF action score

Region COUNTRY Policy, Strategy, Plan of actions

SUB-SCORE LEGISLATION SUB-SCORE

NATIONAL level actions SCORE

CEE/CIS Bosnia and Herz. 4 6 5 CEE/CIS Kazakhstan 7 8 7 CEE/CIS Kosovo 0 4 2 CEE/CIS Kyrgyzstan 8 8 8 CEE/CIS Romania 0 10 5 CEE/CIS Tajikistan 6 4 5 CEE/CIS Turkmenistan 4 6 5

CEE/CIS Uzbekistan 5 2 3

Mean 4 6 5

EAPR Cambodia 8 8 8 EAPR China 3 8 5 EAPR Fiji 2 4 3 EAPR Indonesia 0 4 2 EAPR Korea 5 6 5 EAPR Lao D. Rep. 8 8 8 EAPR Mongolia 2 10 6 EAPR Myanmar 5 4 4 EAPR P. New Guinea 3 10 6

EAPR Philippines 8 10 9

EAPR Thailand 9 8 8 EAPR Timor-Leste 1 0 0 EAPR Vanuatu 9 8 8 EAPR Vietnam 9 10 9

Mean 5 7 6

ESAR Angola 3 6 4 ESAR Botswana 8 10 9 ESAR Burundi 1 4 2 ESAR Ethiopia 1 4 2

ESAR Kenya 9 4 6

ESAR Madagascar 8 6 7 ESAR Malawi 9 8 8 ESAR Mozambique 0 8 4 ESAR Namibia 6 2 4 ESAR Rwanda 8 0 4

ESAR Somalia 6 0 3

ESAR South Africa 6 4 5 ESAR Swaziland 1 6 3 ESAR Tanzania 2 10 6 ESAR Uganda 6 8 7 ESAR Zambia 3 8 5 ESAR Zimbabwe 8 10 9

Mean 5 6 5

MENA North Sudan 6 6 6 MENA South Sudan 3 0 1 MENA Yemen 5 6 5

Mean 5 4 4

ROSA Afghanistan 10 8 9 ROSA Bangladesh 8 6 7 ROSA Bhutan 8 6 7 ROSA India 2 8 5 ROSA Nepal 8 4 6 ROSA Sri Lanka 10 8 9

Mean 8 7 7

WCAR Togo 10 6 8 WCAR Sierra Leone 9 4 6 WCAR Senegal 10 10 10 WCAR Nigeria 6 10 8 WCAR Niger 6 6 6 WCAR Mauritania 9 8 8 WCAR Mali 5 2 3 WCAR Liberia 1 NI 0 WCAR Ghana 6 10 8 WCAR Gambia 10 8 9 WCAR Gabon 8 8 8

117

Region COUNTRY Policy, Strategy, Plan of actions

SUB-SCORE LEGISLATION SUB-SCORE

NATIONAL level actions SCORE

WCAR D. Rep. Congo 9 0 4

WCAR Cote d'Ivoire 5 NI 2

WCAR Congo Brazzaville

7 4 5

WCAR Cen.Afr.Rep. 9 6 7 WCAR Burkina Faso 7 8 7 WCAR Benin 3 6 4

Mean 7 6 6

Total Mean 5 6 6

NI= No information. . Nutritionally vulnerable countries are highlighted in yellow

118

ANNEX 5d:

IYCF health service pre- and in-service training curricula

IYCF ELEMENTS MEDICAL TRAINING PACKGE

IYCF ELEMENTS NURSES/ OTHER HEALTH PROFESSIONALS

TRAINING PACKAGE REFERENCES MEDICAL DOCTORS REFERENCES HEALTH PROFESSIONALS INSERVICE REFS.

COUNTRY

Baby Friendly Practice

s Appropri

ate BF Appropriate CF

Baby Friendly Practice

s nurses/

HP

Appropriate BF nurses/

HP

Appropriate CF nurses/

HP

Global Strategy

DOCS Revised BHI

DOCS

Guiding Principles Breastfed

DOCS

Guiding Principles

for Feeding

Non-Breastfed

DOCS

Global Strategy (Nurses)

Revised BHI

(Nurses)

Guiding Principles Breastfed (Nurses)

Guiding Principles

Non-Breastfed (Nurses)

Global Strategy In-servic

e

Revised BHI

In-servic

e

Guiding Principles BF

In-service

Guiding Principles

for Feeding Non-BF

In-service

CURRICULA

SUBSCORE

CEE/CIS Kosovo na na na na na na na na na na na na na na 1 0 0 0 1

Romania 0 0 1 na na na na na na na na na na na na na na na 1

Bosnia Herz. 0 1 0 0 1 0 0 0 1 0 0 0 1 0 1 0 1 0 3

Uzbekistan 1 1 1 1 1 1 0 1 0 0 0 1 1 1 1 1 1 1 8

Kyrgyzstan 1 1 1 1 1 1 1 0 1 0 0 0 1 1 1 0 1 1 7

Kazakhstan 1 1 1 1 1 1 0 0 1 1 0 0 1 0 1 0 1 1 7

Turkmenistan 1 1 1 1 1 0 1 0 1 1 0 0 1 1 1 0 1 0 7

Tajikistan 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9

n 5 6 6 5 6 4 3 2 5 3 0 2 6 4 7 2 6 4 M

N 7 7 7 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 5

% 71.4 85.7 85.7 83.3 100 66.7 50.0 33.3 83.3 50.0 0.0 33.3 100 66.7 100 28.6 85.7 57.1 EAPR Cambodia 0 0 0 0 1 0 na na na na na na na na 1 1 1 1 3

China 0 1 1 0 1 1 na na na na na na na na 1 1 1 1 4

Myanmar na na na na na na na na na na na na na na 1 0 0 0 1

Timor-Leste na na na na na na na na na na na na na na na na na na 0

Philippines na na na na na na na na na na na na na na 1 0 1 0 1

Lao P.Dem. Rep.

1 1 1 1 0 0 na na na na 1 0 1 1 1 0 1 1 6

Korea 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 0 4

Indonesia 1 0 1 0 1 1 0 0 1 0 na na na na na na na na 3

Thailand 1 1 1 1 1 1 0 1 0 0 1 1 1 1 1 1 1 1 8

Vietnam 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 0 4

Fiji 1 1 1 1 1 1 1 0 0 0 1 0 0 0 1 1 1 1 7

P.N.Guinea 1 1 1 1 1 1 1 0 1 1 1 0 1 0 1 0 1 0 7

Vanuatu 1 1 1 1 1 1 1 1 1 1 0 1 1 1 na na na na 7

Mongolia 0 1 1 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 8

n 8 9 10 7 8 7 4 5 4 3 4 3 7 4 11 5 10 6 M

N 11 11 11 11 11 11 8 8 8 8 8 8 8 8 11 11 11 11 4

% 72.7 81.8 90.9 63.6 72.7 63.6 50.0 62.5 50.0 37.5 50.0 37.5 87.5 50.0 100.0

45.5 90.9 54.5

ESAR Somalia 1 0 0 0 1 0 na na na na na na na na na na na na 1

Mozambique 1 0 1 1 1 1 na na na na 0 0 1 0 na na na na 3

Botswana na na na 1 1 1 na na na na na na na na na na na na 2

119

IYCF ELEMENTS MEDICAL TRAINING PACKGE

IYCF ELEMENTS NURSES/ OTHER HEALTH PROFESSIONALS

TRAINING PACKAGE REFERENCES MEDICAL DOCTORS REFERENCES HEALTH PROFESSIONALS INSERVICE REFS.

COUNTRY

Baby Friendly Practice

s Appropri

ate BF Appropriate CF

Baby Friendly Practice

s nurses/

HP

Appropriate BF nurses/

HP

Appropriate CF nurses/

HP

Global Strategy

DOCS Revised BHI

DOCS

Guiding Principles Breastfed

DOCS

Guiding Principles

for Feeding

Non-Breastfed

DOCS

Global Strategy (Nurses)

Revised BHI

(Nurses)

Guiding Principles Breastfed (Nurses)

Guiding Principles

Non-Breastfed (Nurses)

Global Strategy In-servic

e

Revised BHI

In-servic

e

Guiding Principles BF

In-service

Guiding Principles

for Feeding Non-BF

In-service

CURRICULA

SUBSCORE

Namibia na na na 1 1 1 na na na na 1 0 1 0 1 0 1 0 4

Malawi 0 1 0 0 1 0 na na na na na na na na 1 0 1 1 3

Madagascar 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 1 5

South Africa 1 1 1 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 8

Swaziland 0 1 0 1 0 0 0 1 0 0 0 0 1 0 1 1 0 1 4

Burundi 1 1 1 0 1 1 0 0 1 1 0 0 1 1 1 0 1 0 6

Angola 1 1 1 0 1 1 0 1 0 1 0 0 0 1 na na na na 4

Kenya 0 1 1 1 1 1 1 1 0 0 1 1 0 0 1 1 1 1 7

Zambia 0 1 1 0 1 1 1 1 0 1 0 0 1 1 1 1 1 1 7

Tanzania 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 9

Ethiopia 0 1 1 1 1 1 1 0 1 1 0 0 1 1 1 0 1 1 7

Uganda 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 8

Rwanda 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9

Zimbabwe 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9

n 9 13 12 12 15 13 7 9 6 8 2 6 12 9 12 8 12 11 M

N 15 15 15 17 17 17 12 12 12 12 14 14 14 14 13 13 13 13 6

% 60.0 86.7 80.0 70.6 88.2 76.5 58.3 75.0 50.0 66.7 14.3 42.9 85.7 64.3 92.3 61.5 92.3 84.6 MENA

Yemen 0 0 0 na na na na na na na na na na na 1 1 1 1 2

South Sudan 1 1 1 1 0 0 0 1 0 0 0 0 1 0 na na na na 3

North Sudan 1 1 0 1 1 0 0 0 1 0 0 0 1 0 1 0 0 1 4

n 2 2 1 2 1 0 0 1 1 0 0 0 2 0 2 1 1 2 M

N 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3

% 67 67 33 100 50 0 0 50 50 0 0 0 100 0 100 50 50 100 ROSA Bangladesh na na na na na na na na na na na na na na na na na na na

India 1 1 0 1 1 0 na na na na 1 0 0 0 1 0 0 0 3

Nepal 1 1 1 1 1 1 na na na na 0 0 1 0 1 0 1 0 5

Afghanistan 0 1 0 0 1 0 na na na na na na na na na na na na 1

Bhutan 0 0 0 1 1 1 na na na na 1 1 0 0 1 1 0 0 4

Sri Lanka 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10

n 3 4 2 4 5 3 1 1 1 1 3 2 2 1 4 2 2 1 M

N 5 5 5 5 5 5 1 1 1 1 4 4 4 4 4 4 4 4 5

% 60 80 40 80 100 60 100 100 100 100 75 50 50 25 100 50 50 25 WCAR Gambia na na na 0 1 1 na na na na 1 0 1 1 1 0 1 1 4

Niger 1 1 1 1 1 1 na na na na na na na na na na na na 3

Sierra Leone 0 1 1 0 1 1 na na na na na na na na 1 0 0 0 3

Cote d'Ivoire 1 0 0 na na na na na na na na na na na na na na na 1

Liberia 0 0 0 na na na na na na na na na na na na na na na 0

Congo 1 1 1 1 0 0 0 1 0 0 0 0 1 0 1 0 1 0 4

120

IYCF ELEMENTS MEDICAL TRAINING PACKGE

IYCF ELEMENTS NURSES/ OTHER HEALTH PROFESSIONALS

TRAINING PACKAGE REFERENCES MEDICAL DOCTORS REFERENCES HEALTH PROFESSIONALS INSERVICE REFS.

COUNTRY

Baby Friendly Practice

s Appropri

ate BF Appropriate CF

Baby Friendly Practice

s nurses/

HP

Appropriate BF nurses/

HP

Appropriate CF nurses/

HP

Global Strategy

DOCS Revised BHI

DOCS

Guiding Principles Breastfed

DOCS

Guiding Principles

for Feeding

Non-Breastfed

DOCS

Global Strategy (Nurses)

Revised BHI

(Nurses)

Guiding Principles Breastfed (Nurses)

Guiding Principles

Non-Breastfed (Nurses)

Global Strategy In-servic

e

Revised BHI

In-servic

e

Guiding Principles BF

In-service

Guiding Principles

for Feeding Non-BF

In-service

CURRICULA

SUBSCORE

Brazzaville

Gabon 1 1 1 1 0 0 0 1 0 0 0 0 1 0 na na na na 3

Benin na na na na na na 0 0 0 1 0 0 0 1 1 0 1 1 3

Ghana 1 1 1 1 1 1 1 1 0 0 0 1 0 0 1 1 0 0 6

Senegal 0 1 1 0 1 1 1 0 1 0 1 0 1 0 1 0 1 0 6

Mali 1 1 1 0 1 1 1 0 1 1 0 0 1 1 1 0 1 0 7

Burkina Faso 1 1 1 1 1 1 1 1 0 1 0 1 0 1 na na na na 6

C. Afr. Rep. 1 1 1 na na na 1 1 1 1 na na na na na na na na 4

Togo 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10

Mauritania 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 8

D.Rep.Congo 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 9

Nigeria 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 9

n 12 13 12 9 11 11 9 9 7 8 5 5 9 8 11 3 9 5 M

N 15 15 15 13 13 13 12 12 12 12 12 12 12 12 11 11 11 11 5

% 80 87 80 69 85 85 75 75 58 67 42 42 75 67 100 27 82 45 COUNTRY TOTAL

n 39 47 43 39 46 38 24 27 24 23 14 18 38 26 11 3 9 5 M

N 56 56 56 54 54 54 41 41 41 41 46 46 46 46 11 11 11 11 5

% 69.6 83.9 76.8 72.2 85.2 70.4 58.5 65.9 58.5 56.1 30.4 39.1 82.6 56.5

100.0 27.3 81.8 45.5

Nutritionally vulnerable countries are highlighted in yellow

121

ANNEX 5e:

IYCF health workers capacity development

COUNTRY

PRE-SERVICE

TRAINING MEDICAL

INI-SERVICE TRAINING HEALTH PROF.

IN-SERVICE TRAINING

IYCF job aids/counseling cards for health

professionals

IYCF Training

2006

HW trained stand alone counseling

Capacity Development

Sub-Score

CEE/CIS Kosovo 0 na 1 1 1 1 7

Romania 1 1 0 0 0 na 3

Bosnia Herz. 0 1 0 0 0 na 2

Uzbekistan 1 1 1 0 1 1 8

Kyrgyzstan 1 1 1 1 1 1 10

Kazakhstan 1 na 0 1 1 1 7

Turkmenistan 0 1 1 0 1 1 7

Tajikistan 1 1 1 1 1 1 10

n 5 6 5 4 6 6 M

N 8 6 8 8 8 6 7

% 63 100 63 50 75 100 EAPR Cambodia 0 1 1 1 1 1 8

China 1 na 1 1 1 0 7

Myanmar 0 na 1 0 1 0 3

Timor-Leste 0 na 0 1 1 1 5

Philippines 0 na 1 1 1 1 7

Lao P.Dem. Rep. 1 1 1 0 1 1 8

Korea 0 na na 1 1 1 5

Indonesia 0 na 0 0 1 na 2

Thailand 0 na 1 1 1 1 7

Vietnam 0 na 0 1 1 1 5

Fiji 0 1 1 1 1 na 7

P.N.Guinea 0 1 0 1 1 1 7

Vanuatu 0 1 0 0 0 2

Mongolia 1 1 1 1 1 1 10

n 3 6 8 10 13 9 M

N 14 6 13 14 14 11 5

% 21 100 62 71 93 82 ESAR Somalia 1 na 1 1 1 0 7

Mozambique 1 1 0 0 1 1 7

Botswana 0 na 0 1 1 na 3

Namibia 0 1 na 1 0 na 3

Malawi 1 1 1 1 1 1 10

Madagascar 0 na 1 1 1 1 7

South Africa 1 1 1 1 1 1 10

Swaziland 0 na 1 0 1 1 5

Burundi 1 1 0 0 0 na 3

Angola 1 1 O 1 0 na 5

Kenya 1 1 1 1 1 1 10

Zambia 1 1 1 1 1 1 10

Tanzania 1 1 1 1 1 1 10

Ethiopia 1 1 0 1 1 1 8

Uganda 1 na 0 1 1 1 7

Rwanda 1 1 1 1 1 1 10

Zimbabwe 1 1 1 1 1 1 10

n 13 12 10 14 14 12 M

122

COUNTRY

PRE-SERVICE

TRAINING MEDICAL

INI-SERVICE TRAINING HEALTH PROF.

IN-SERVICE TRAINING

IYCF job aids/counseling cards for health

professionals

IYCF Training

2006

HW trained stand alone counseling

Capacity Development

Sub-Score

N 17 12 15 17 17 13 7

% 76 100 67 82 82 92 MENA Yemen 0 0 1 1 1 1 7

South Sudan 0 0 0 0 0 0

North Sudan 1 0 1 1 1 1 8

n 1 0 2 2 2 2 M

N 3 3 3 3 3 2 5

% 33 0 67 67 67 100 ROSA

Bangladesh 0 0 1 1 1 5

India 1 1 1 1 1 na 8

Nepal 0 1 0 0 1 na 3

Afghanistan 0 0 1 1 1 5

Bhutan 0 1 1 1 1 1 8

Sri Lanka 1 1 1 1 1 1 10

n 2 4 3 5 6 4

N 6 4 6 6 6 4 M

% 33 100 50 83 100 100 6

WCAR Gambia 0 0 1 1 1 5

Niger 1 1 1 0 1 na 7

Sierra Leone 1 1 0 0 1 na 5

Cote d'Ivoire 0 na 1 0 0 na 2

Liberia 0 na 0 na 0 na 0

Congo Brazzaville 1 na 0 1 0 na 3

Gabon 0 na na 0 1 1 3

Benin 0 0 1 0 1 1 5

Ghana 1 1 1 1 1 1 10

Senegal 0 1 1 1 1 na 7

Mali 1 1 0 1 1 na 7

Burkina Faso 0 1 1 1 1 1 8

C. Afr. Rep. 1 0 0 0 1 1 5

Togo 1 1 1 1 1 1 10

Mauritania 1 1 0 0 1 1 7

D.Rep.Congo 1 1 1 1 1 1 10

Nigeria 0 1 1 1 1 1 8

n 9 10 9 9 14 10 M

N 17 12 16 16 17 10 6

% 53 83 56 56 82 100 COUNTRY TOTAL

n 33 38 37 44 55 43 N 65 43 62 64 65 46 M

% 50.8 88.4 59.7 68.8 84.6 93.5 6

N=NUMBER, n= Total, %=percentage, M= Mean, na=not available, not applicable, no answer,

Nutritionally vulnerable countries are highlighted in yellow

123

ANNEX 5f:

Training of health providers on IYCF counseling

Country

No of HPs trained on stand-alone IYCF

counseling course since 2006

Total number of HPs in the Country

% of HPs trained on IYCF counselling course since 2006

Total no of districts/province/region

covered by the IYCF training

Total number of district /province/region in the

country

Coverage (% of district / province /

region covered by the training)

Coverage of IYCF counseling currently taking place within

the Health system (%)

CEE/CIS

Kosovo 350 7000 5.0 NI 36 - 30

Tajikistan 480 42673 1.1 NI 30 - -

BOSNIA AND HERZEGOVINA

NI NI - NI NI - -

UZBEKISTAN 2321 117754 2.0 102 199 51 60

Turkemnistan 920 6000 15.3 36 55 65 100

Romania NI NI - NI NI - -

KYRGYZSTAN 270 40000 0.7 1 7 14 -

KAZAKASTAN 20600 60656 34.0 6 16 38 65

EAPR

Korea 1000 70,000 1.4 101 206 49

Vanuatu NI NI - NI NI - 20

Mongolia 60 NI - 5 21 24 -

MYANMAR NI NI - NI 52 - 30

Indonesia 1000 223438 0.5 3 200 2 < 5

Papua New Guinea 138 NI - 20 20 100 100

Cambodia 500 NI - 18 77 23 71

China NI NI - NI 2800 - -

Thailand 200 NI - NI NI - 95

TIMOR-LESTE 100 NI - NI NI - -

South Africa 600 NI - 53 53 100 -

VIETNAM 1000 299100 0.3 100 690 14 -

Philippines 28,063 34,298 81.8 17 17 100 63

Fiji NI NI - 20 20 100 15

Lao People's Democratic Republic

1148 11000 10.4 63 142 44 40

ESAR

Madagascar 1800 NI - 27 119 23 -

Burundi 120 4422 2.7 6 45 13 25

Zambia 6207 NI - 54 72 75 100

Angola 0 0 0.0 0 164 0 -

Somalia NI NI - 2 128 2 -

Mozambique 3700 NI - 144 144 100 100

Botswana NI NI - NI NI - 94

UGANDA 1133 12585 9 20 56 35.7 32

NAMIBIA NI NI - NI NI - -

Tanzania 645 11081 5.8 11 135 8 -

SWAZILAND 300 NI - 4 4 100 100

RWANDA 480 42673 1.1 NI 30 - NI

124

Country

No of HPs trained on stand-alone IYCF

counseling course since 2006

Total number of HPs in the Country

% of HWs trained on IYCF counselling since

2006

Total no of districts/province/region

covered by the IYCF training

Total number of district/province/region

in the country

Coverage (% of district / province /

region covered by the training)

Coverage of IYCF counseling currently taking place within

the Health system (%)

Ethiopia 9000 59000 15.3 170 800 21 21

Malawi 540 8389 6.44 12 28 43 NI

Zimbabwe 200 25000 0.8 40 62 65 98

Kenya 3500 18587 18.8 165 284 58 -

MENA

YEMEN 105 NI - 0 334 0 -

North Sudan 500 NI - 81 131 62 -

South Sudan 0 NI - NI NI - NI

ROSA

BANGLADESH 250 150000 0.2 2 64 3

India 23450 192510 12.2 NI 642 - -

Nepal NI 12000 - 10 75 13 30

Sri Lanka 269 8500 3.2 17 26 65 ~ 80

AFGHANISTAN 1950 19235 10.1 NI 393 - 100

Bhutan 216 556 38.8 9 20 45 -

WCAR

Congo Brazzaville NI 187 - 27 27 100 -

CAR 20 2000 1.0 1 24 4 53

Gambia 118 NI - 6 6 100 -

Ghana 119 61841 0.2 38 170 22 100

GABON 37 NI - 5 54 9 -

Togo 2776 7000 39.7 35 35 100 100

BENIN 222 4374 5.1 3 34 9 90

NIGER 56 3404 1.6 5 42 11.9 NI

Sierra Leone 0 9954 0.0 13 13 100 -

MAURITANIA 421 10376 4.1 54 54 100 -

Senegal NI NI - NI NI - 60

DRC 750 65000 1.2 27 515 5.2 -

MALI NI NI - NI 60 - -

Nigeria 572 106338 0.5 NI 774 - -

Burkina Faso 1500 15603 9.6 63 63 100 100

Cote d'Ivoire NI NI - NI NI - -

Liberia NI NI - NI NI - -

Nutritionally vulnerable countries are highlighted in yellow , NI= No information

125

ANNEX 5g:

IYCF Health System Counselling

IYCF health service counselling

COUNTRY Counseling in health

system ANC PMTCT GMP IMCI ENA COUNSELLING

SUB-SCORE

CEE/CIS Kosovo 1 na na na na na 2

Romania 0 na na na na na 0

Bosnia Herz. 1 1 0 1 0 0 5

Uzbekistan 1 0 0 0 1 0 3

Kyrgyzstan 1 1 1 0 1 0 7

Kazakhstan 1 1 1 1 1 0 8

Turkmenistan 1 1 1 1 1 1 10

Tajikistan 1 0 1 1 1 0 7

n 7 4 4 4 5 1 M

N 8 6 6 6 6 6 5

% 87.5 66.7 66.7 66.7 83.3 16.7 EAPR Cambodia 1 1 1 1 1 0 8

China 1 0 1 0 1 0 5

Myanmar 1 0 0 1 0 0 3

Timor-Leste 1 na na na na na 2

Philippines 1 0 1 0 0 0 3

Lao P.Dem. Rep. 1 1 1 0 1 0 7

Korea 1 0 0 1 1 0 5

Indonesia 1 1 0 1 0 0 5

Thailand 1 1 1 0 0 0 5

Vietnam 1 0 1 1 0 0 5

Fiji 1 1 1 0 1 0 7

P.N.Guinea 1 1 1 1 1 0 8

Vanuatu 1 1 1 0 1 0 7

Mongolia 0 0 0 1 1 0 3

n 13 7 9 7 8 0 M

N 14 13 13 13 13 13 5

% 92.9 53.8 69.2 53.8 61.5 0.0 ESAR Somalia 0 na na na na na 0

Mozambique 1 1 1 1 1 1 10

Botswana 1 1 1 0 0 0 5

Namibia 1 0 0 1 0 0 3

Malawi 1 1 1 1 1 0 8

Madagascar 1 0 0 0 1 0 3

South Africa 1 0 1 1 1 0 7

Swaziland 1 0 1 0 1 0 5

Burundi 1 1 1 0 0 0 5

Angola 1 1 1 0 1 0 7

Kenya 1 1 1 0 1 0 7

Zambia 1 1 1 1 0 0 7

Tanzania 1 0 1 1 1 1 8

Ethiopia 1 0 0 1 1 1 7

Uganda 1 1 1 0 0 0 5

Rwanda 1 0 1 1 1 0 7

Zimbabwe 1 0 1 1 1 0 7

126

IYCF health service counselling

COUNTRY Counseling in health

system ANC PMTCT GMP IMCI ENA COUNSELLING

SUB-SCORE

n 16 8 13 9 11 3 M

N 17 16 16 16 16 16 6

% 94.1 50.0 81.3 56.3 68.8 18.8 MENA Yemen 1 1 0 0 1 0 5

South Sudan 0 1 1 0 1 1 7

North Sudan 1 1 1 1 1 1 10

n 2 3 2 1 3 2 M

N 3 3 3 3 3 3 7

% 66.7 100 66.7 33.3 100 66.7 ROSA Bangladesh 1 0 0 0 1 0 3

India 1 1 1 1 1 0 8

Nepal 1 0 0 1 1 0 5

Afghanistan 1 1 0 0 1 0 5

Bhutan 1 1 1 1 1 0 8

Sri Lanka 1 1 0 1 0 0 5

n 6 4 2 4 5 0 M

N 6 6 6 6 6 6 6

% 100 66.7 33.3 66.7 83.3 0.0 WCAR Gambia 1 1 1 1 1 0 8

Niger 1 1 1 1 1 1 10

Sierra Leone 0 na na na na na 0

Cote d'Ivoire 1 1 na 1 1 0 7

Liberia 0

0

Congo Brazzaville 1 0 1 0 1 0 5

Gabon 1 0 1 0 1 0 5

Benin 1 1 1 0 1 1 8

Ghana 1 0 1 1 1 1 8

Senegal 1 1 1 1 1 1 10

Mali 1 0 1 0 1 1 7

Burkina Faso 1 0 1 0 1 0 5

C. Afr. Rep. 1 0 1 0 1 1 7

Togo 1 0 1 1 1 1 8

Mauritania 1 1 1 1 0 0 7

D.Rep.Congo 1 0 1 1 1 1 8

Nigeria 1 1 1 1 1 1 10

n 15 7 14 9 14 9 N 17 15 14 15 15 15 M

% 88.2 46.7 100 60.0 93.3 60.0 7

COUNTRY TOTAL n 59 33 44 34 46 15

N 65 59 58 59 59 59 M

% 90.8 55.9 75.9 57.6 78.0 25.4 6

n= number, N= Total, %=percentage Nutritionally vulnerable countries are highlighted in yellow, 1=Yes, 0= No

127

ANNEX 5h:

Baby-Friendly Hospital Initiative

HSCOUNTRY Ever Certified

hospitals Ever re-certified

% of

institutional Births

% ever certified Baby Friendly

Hospital

% re-certified Baby Friendly

Hospital

BFHI SUB-

SCORE

CEE/CIS

Uzbekistan 1 1 99 51 20 4

Turkmenistan 1 0 99 87 0 4

Tajikistan 1 0 64 1 0 0

Romania 1 1 96 11 11 1

Kyrgyzstan 1 1 66 63 23 4

Kosovo 1 1 96 100 76 9

Kazakhstan 1 1 100 16 14 2

Bosnia and Herz. 1 0 99 62 0 3

n 8 5

N 8 8 M M M

% 100 62.5 48.9 18.0 3

EAPR

China 1 0 95 NI 0

Cambodia 1 0 22 11 0 1

Fiji 1 1 99 100 52 8

Indonesia 1 0 46 0 0 0

Korea 1 0 NI NI 0

Lao PDR 1 0 20 41 0 2

Mongolia 1 0 98 NI 0

Myanmar 1 0 NI NI 0

Papua New Guinea 1 1 36 15 5 1

Philippines 1 0 40 83 0 4

Thailand 1 1 96 67 10 4

Timor Leste 1 0 NI NI 0

Vanuatu 0 0 80 0 0 0

Vietnam 1 1 79 8 0 0

n 13 4

N 14 14 M M M

% 93 29 36.1 4.79 2

ESAR

Zimbabwe 1 1 60 4 1 0

Zambia 1 0 48 23 0 1

Uganda 1 0 41 1 0 0

128

HSCOUNTRY Ever Certified

hospitals Ever re-certified

% of

institutional Births

% ever certified Baby Friendly

Hospital

% re-certified Baby Friendly

Hospital

BFHI SUB-

SCORE

Tanzania 1 1 50 2 0 0

Swaziland 1 1 74 59 18 4

South Africa 1 1 95 46 47 5

Somalia 1 0 9 1 0 0

Rwanda 1 0 64 1 0 0

Namibia 1 0 81 100 0 5

Mozambique 0 0 50 0 0 0

Malawi 1 1 72 5 2 0

Madagascar 1 0 30 3 0 0

Kenya 1 1 44 NI

Ethiopia 0 0 18 0 0 0

Burundi 1 1 56 1 1 0

Botswana 0 0 94 5 0 0

Angola 1 0 42 2 0 0

n 14 6

N 16 14 M M M

% 87.5 42.9 15.8 4.31 0

MENA

Yemen 0 0 20 0 0 0

South Sudan 0 0 NI 0 0 0

North Sudan 1 1 19 12 12 1

n 1 1

N 3 3 M M M

% 33 33 4 4 0

ROSA

India 1 0 41 10 0 0

Sri Lanka 1 0 98 23 0 1

Nepal 1 0 21 8 0 0

Bhutan 1 0 63 1 0 0

Bangladesh 1 0 18 50 0 2

Afghanistan 0 0 15 0 0 0

n 5 0

N 6 6 M M M

% 83 0 15.3 0.0 0

WCAR

Benin 1 1 78 3 1 0

129

HSCOUNTRY Ever Certified

hospitals Ever re-certified

% of

institutional Births

% ever certified Baby Friendly

Hospital

% re-certified Baby Friendly

Hospital

BFHI SUB-

SCORE

Burkina Faso 1 0 NI 70 0 3

C. Afr. Rep. 1 0 68 4 0 0

Congo Brazzaville 1 0 80 2 0 0

Cote d'Ivoire 1 0 NI 9 0 0

D. Rep. Congo 1 0 64 1 0 0

Gabon 1 0 NI NI 0

Gambia 0 0 NI 0 0 0

Ghana 1 1 57 29 0 1

Liberia 0 0 NI 0 0 0

Mali 1 1 NI 5 4 0

Mauritania 1 1 - 3 2 0

Niger 1 1 30 76 31 5

Nigeria 1 0 39 8 0 0

Senegal 1 0 66 16 0 0

Sierra Leone 0 0 25 0 0 0

Togo 1 0 33 34 0 2

n 14 5

N 17 17 M M M

% 82 29 16.3 2.24 1

ALL Countries

n 55 22 M M M

N 65 65 22.7 5.56 1

% 85 34

N= number, N= Total, %= percent, na=data not available/no answer, not applicable; NI= No information. Nutritionally vulnerable countries are highlighted

in yellow

130

ANNEX 5i:

Health system level IYCF actions score

COUNTRY BFHI SUB-

SCORE CIRRICULA SUB-

SCORE CAPACITY DEVELOPMENT

SUB-SCORE COUNSELLING

SUB-SCORE HEALTH SYSTEM ACTIONS SCORE

CEE/CIS

Uzbekistan 4 8 8 3 6

Turkmenistan 4 7 7 10 7

Tajikistan 0 9 10 7 7

Romania 1 1 3 0 1

Kyrgyzstan 4 7 10 7 7

Kosovo 9 1 7 2 5

Kazakhstan 2 7 7 8 6

Bosnia Herz. 3 3 2 5 3

MEAN 3 5 7 5 5

EAPR

China 0

4 7 5 4

Cambodia 1

3 8 8 5

Fiji 8

7 7 7 7

Indonesia 0

3 2 5 2

Korea 0

4 5 5 3

Lao P.Dem. Rep. 2

6 8 7 6

Mongolia 0

8 10 3 5

Myanmar 0

1 3 3 2

P.N.Guinea 1

7 7 8 6

Philippines 4

1 7 3 4

Thailand 4

8 7 5 6

Timor-Leste 0

0 5 2 2

Vanuatu 0

7 2 7 4

Vietnam 0

4 5 5 3

MEAN 2 5 6 5 5

ESAR

Zimbabwe 0

9 10 7 6

Zambia 1

7 10 7 6

Uganda 0

8 7 5 5

Tanzania 0

9 10 8 7

Swaziland 4

4 5 5 4

South Africa 5

8 10 7 7

Somalia 0

1 7 0 2

Rwanda 0

9 10 7 6

Namibia 5

4 3 3 4

Mozambique 0

3 7 10 5

Malawi 0

3 10 8 5

131

COUNTRY

BFHI SUB-

SCORE CIRRICULA SUB-

SCORE CAPACITY DEVELOPMENT

SUB-SCORE COUNSELLING

SUB-SCORE HEALTH SYSTEM ACTIONS SCORE

Madagascar 0

5 7 3 4

Kenya 0

7 10 7 6

Ethiopia 0

7 8 7 5

Burundi 0

6 3 5 3

Botswana 0

2 3 5 2

Angola 0

4 5 7 4

MEAN 0 6 7 6 5

MENA

Yemen 0

2 7 5 3

South Sudan 0

3 0 7 2

North Sudan 1

4 8 10 6

MEAN 0 3 5 7 4

ROSA

India 0 3 8 8 5

Sri Lanka 1 10 10 5 6

Nepal 0 5 3 5 3

Bhutan 0

4 8 8 5

Bangladesh 2

na 5 3 3

Afghanistan 0

1 5 5 3

MEAN 0 4 7 6 4

WCAR

Benin 0 3 5 8 4

Burkina Faso 3 6 8 5 5

C. Afr. Rep. 0 4 5 7 4

Congo Brazzaville 0 4 3 5 3

Cote d'Ivoire 0 1 2 7 2

D.Rep.Congo 0 9 10 8 6

Gabon 0 3 3 5 3

Gambia 0 4 5 8 4

Ghana 1 6 10 8 6

Liberia 0 0 na na na

Mali 0 7 7 7 5

Mauritania 0 8 7 7 5

Niger 5 3 7 10 6

Nigeria 0 9 8 10 7

Senegal 0 6 7 10 6

Sierra Leone 0 3 5 0 2

Togo 2 10 10 8 7

MEAN 1 5 6 7 5

Total Mean 1 5 6 6 5

Nutritionally vulnerable countries are highlighted in yellow

132

ANNEX 5j:

Community-based IYCF actions

Country COMMUNITY-BASED PROGRAMMES WHICH INCLUDE IYCF ACTIVITIES / IMPLEMENTATION Community-level CD Community-level M &E Community-based System actions Score

Comm.

Activity

Activity

standalone

PMTCT

ANC GMP IMCI ENA Mother

to Mother

Dedicated

IYCF CHWs

Multi-

purpose

CHWs

TBA or

THP

Mothers

support

groups

COMM. SYSTEM INTEGRATION SUB-SCORE

Training on

IYCF 2006

Capa. buildin

g on comm. skills

for CHW

COMM. CD

SUBSCORE

Routine monitoring of IYCF activities

Routine monitori

ng of skills of

CHW

Routine monitori

ng of quality

of counseli

ng

Supportive

supervision CHW

Recognition

mechanism

M&E SUBSCORE

CEE/CIS

Bosnia and Herz.

1 1 0 1 0 0 0 0 1 0 0

0 3 0 1 5 0 1 0 0 0 2 3

Kazakhstan 0 0 0 0 0 1 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 1

Kosovo 1 na na na na na na na na na na na 1 0 na 0 na na na na na 0 0

Kyrgyzstan 1 0 0 0 0 1 0 0 1 0 0 0 2 1 1 10 0 0 0 1 1 4 5

Romania 0 na na na na na na na na na na na 0 na na 0 0 na na na na 0 0

Tajikistan 1 0 0 0 0 1 0 0 0 1 0 1 3 0 1 5

0 0 0 na 0 3

Turkmenistan

1 1 0 0 0 0 0 na na 0 0

1 2 1 na 5 na na na na na 0 2

Uzbekistan 0 0 na na na na na na 1 0 0 0 1 na na 0 na na na na na 0 0

n 5 2 0 1 0 3 0 0 3 1 0 3 M 2 3 M 0 1 0 1 1 M M

N 8 6 5 5 5 5 5 4 5 6 6 6 2 6 4 3 4 4 4 4 3 1 2

% 62.5 33.3 0.0 20.0 0.0 60.0 0.0 0.0 60.0 16.7 0.0 50.0 33.3 75.0 0.0 25.0 0.0 25.0 33.3 EAPR

Vietnam 1 0 0 0 1 0 0 0 0 1 0 na 2 1 1 10 na na na 1 na 2 5

Vanuatu 1 1 na na na na na na na na na 0 2 0 0 0 0 0 0 0 0 0 1

Timor-Leste 1 0 0 0 0 0 0 1 0 0 0 0 2 0 na 0 0 0 0 0 0 0 1

Thailand na na na na na na na na na na na na 0 na na 0 na na na na na 0 0

Philippines 1 na 0 0 0 1 0 0 na na na 0 2 1 na 5

0 1 0 na 2 3

P. N. Guinea 1 0 0 1 0 0 0 0 0 1 0 0 2 1 1 10 0 0 0 0 na 0 4

Myanmar 0 na na na na na na na na na na na 0 0 na 0 0 na na na na 0 0

Mongolia 0 na 0 0 0 1 0 0 na na na na 1 0 0 0 0 na na na na 0 0

Lao P. D. Rep.

1 0 0 0 0 1 0 0 1 1 0

1 4 1 na 5 na na na na na 0 3

Korea na na na na na na na na 1 na na na 1 1 na 5 na na na na na 0 2

Indonesia 1 0 na na na na na na na na na na 1 na na 0 na na na na na 0 0

Fiji 1 0 0 1 0 0 0 0 0 1 0 0 2 1 na 5 0 0 0 1 1 4 4

China 1 1 na na na na na na 0 1 0 1 3 1 1 10 0 0 0 0 na 0 4

Cambodia 1 0 na na na na na na 1 1 0 1 3 1 1 10 1 1 0 1 0 6 6

n 10 2 0 2 1 3 0 1 3 6 0 3 M 8 4 M 1 1 1 3 1 M M

N 12 9 7 7 7 7 7 7 8 7 7 8 2 12 6 4 8 7 7 8 4 1 2

% 83.3 22.2 0.0 28.6 14.3 42.9 0.0 14.3 37.5 85.7 0.0 37.5 66.7 66.7 12.5 14.3 14.3 37.5 25.0 ESAR

Zimbabwe 1 0 0 0 1 0 0 0 0 1 0 0 2 0 1 5 0 0 0 1 0 2 3

Zambia 1 0 0 1 0 0 0 0 1 0 0 1 3 1 DK 5 0 0 na na na 0 3

Uganda 1 1 0 1 0 0 0 0 0 1 0 0 3 1 0 5 0 0 0 0 0 0 3

Tanzania 1 0 0 0 0 0 0 1 1 1 0 1 4 1 1 10 0 0 0 0 na 0 4

Swaziland 1 0 0 0 0 0 0 1 0 1 0 0 2 1 0 5 0 0 0 0 0 0 2

South Africa 1 0 na na na na na na 1 0 0 0 2 1 na 5 1 0 0 1 na 4 3

Somalia 1 1 0 0 0 0 1 0 1 0 0 1 4 1 1 10 1 0 0 1 na 4 5

Rwanda 1 0 0 0 0 0 1 0 1 1 1 1 5 1 0 5 1 1 1 1 0 8 6

Namibia 1 0 0 0 0 1 0 0 0 1 0 0 2 1 0 5 0 0 0 0 0 0 2

133

Country COMMUNITY-BASED PROGRAMMES WHICH INCLUDE IYCF ACTIVITIES Community-based CD Community-based M &E

Community-based System actions Score

Comm. Activity

Activity standalone

PMTCT ANC GMP IMCI ENA Mother to Mother

IYCF CHWs

Multi-purpose CHWs

TBA or THP

Mothers support groups

COMM. SYSTEM INTEGRATION SUB-SCORE

Training on IYCF 2006

Capa. building on comm. skills for CHW

COMM. CD SUBSCORE

Routine monitoring of IYCF activities

Routine monitoring of skills of CHW

Routine monitoring of quality of counseling

Supportive supervision CHW

Recognition mechanism

M&E SUBSCORE

ESAR

Mozambique

1 1 na na na na na na

1 0 0

0 2 1 0 5 0 0 0 1 0 2 3

Malawi 1 0 1 0 0 0 0 0 1 1 0 0 3 1 na 5 0 0 na na na 0 3

Madagascar

1 1 na na na na na na 1 0 0

1 3 1 1 10 1 1 1 1 na 8 5

Kenya 1 0 0 1 0 0 0 0 0 1 0 0 2 1 1 10 1 1 0 1 1 8 5

Ethiopia 1 0 0 0 0 0 1 0 0 1 0 0 2 1 0 5 0 0 0 0 na 0 2

Burundi 0 0 0 1 0 0 0 0 0 1 0 0 2 0 0 0 0 0 0 0 na 0 1

Botswana 0 0 na na na na na na 1 1 0 0 2 0 na 0 na na na na na 0 1

Angola 0 0 na na na na na na 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0

n 14 4 1 4 1 1 3 2 9 12 1 5 M 13 5 M 5 3 2 7 1 M M

N 17 17 12 12 12 12 12 12 17 17 17 17 3 17 13 5 16 16 14 14 8 2 3

% 82.4 23.5 8.3 33.3 8.3 8.3 25.0 16.7 52.9 70.6 5.9 29.4 76.5 38.5 31.3 18.8 14.3 50.0 12.5

MENA

Yemen 1 0 na na na na na na 1 1 1 1 4 1 0 5 0 0 0 0 0 0 3

South Sudan

1 0 na na na na na na 0 1 1

1 3 na na 0 na na na na na 0 2

North Sudan

1 1 0 0 0 0 0 1 0 0 1

1 4 1 0 5 0 0 0 0 0 0 3

n 3 1 0 0 0 0 0 1 1 2 3 3 M 2 0 M 0 0 0 0 0 M M

N 3 3 1 1 1 1 1 1 3 3 3 3 4 2 2 3 2 2 2 2 2 0 3

% 100

33.3 0.0 0.0 0.0 0.0 0.0 100.0 33.3 66.7 100.0

100.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0

ROSA

Afghanistan

1 1 na na na na na na

1 0 0

1 3 0 1 5 1 1 0 1 na

6 5

Bangladesh

1 0 0 0 1 0 0 0 0 1

0 0 2 0 1 5 0 0 0 1 0 2 3

Bhutan 0 na na na na na na na na na na na 0 0 0 0 0 0 0 0 0 0 0

India 1 0 0 1 0 0 0 0 0 1 0 0 2 0 0 0

0 0 0 na 0 1

Nepal 1 0 0 0 1 0 0 0 0 1 0 0 2 0 0 0 0 0 0 0 0 0 1

Sri Lanka 1 0 0 0 1 0 0 0 1 0 0 1 3 1 1 10 0 0 0 1 na 2 5

n 5 1 0 1 3 0 0 0 2 3 0 2 M 1 3 M 1 1 0 3

N 6 5 4 4 4 4 4 4 5 5 5 5 3 6 6 4 5 6 6 6

M M

% 83.3 20.0 0.0 25.0 75.0 0.0 0.0 0.0 40.0 60.0 0.0 40.0 16.7 50.0 20.0 16.7 0.0 50.0 1 2

WCAR

Benin 1 0 0 0 0 1 0 0 0 1 0 0 2 1 1 10 0 0 0 0 na 0 4

Burkina Faso

1 0

1 1 0

0 2 1 0 5 1 0 0 1 na 4 4

C. Afr. Rep. 1 0 0 0 0 1 0 0 1 1 1 1 5 1 1 10 1 0 0 1 1 6 7

Congo Brazzaville

0 0 0 0 0 1 0 0 1 0 0

1 2 0 1 5 0 0 0

0 0 2

Cote D'Ivoire

1 na na na na na na na

1 1 1

1 4 1 1 10 1 1 0 1 na

6 7

Dem. Rep. Congo

1 0 0 0 0 0 1 0 0 1 0

1 3 1 0 5 0 0 0 0 0 0 3

Gabon 1 na na na na na na na na na na 1 2 0 na 0 na na na na na 0 1

Gambia 1 0 0 0 0 0 0 1 0 1 1 0 3 1 1 10 0 na na na na 0 4

Ghana 1 0 0 0 1 0 0 0 1 0 0 na 2 na na 0 na na na na na 0 1

134

COMMUNITY-BASED PROGRAMMES WHICH INCLUDE IYCF ACTIVITIES Community-based CD Community-based M &E

Community-based actions Score

Country Comm. Activity

Activity standalone

PMTCT ANC GMP IMCI ENA Mother to Mother

IYCF CHWs

Multi-purpose CHWs

TBA or THP

Mothers support groups

COMM. SYSTEM INTEGRATION SUB-SCORE

Training on IYCF 2006

Capa. building on comm. skills for CHW

COMM. CD SUBSCORE

Routine monitoring of IYCF activities

Routine monitoring of skills of CHW

Routine monitoring of quality of counseling

Supportive supervision CHW

Recognition mechanism

M&E SUBSCORE

Liberia 1 na na na na na na na 0 1 1 0 2 1 1 10 1 1 0 1 na 6 6

Mali 1 0 0 0 0 0 1 0 1 0 0 1 3 0 na 0 na na na na na 0 1

Mauritania 1 0 na na na na na na 1 1 0 0 2 1 1 10 1 1 0 1 na 6 6

Niger 1 1 0 0 1 0 0 0 1 0 0 1 4 1 1 10 0 0 0 0 0 0 5

Nigeria 1 0 0 1 0 0 0 0 1 1 1 1 5 1 1 10 1 1 1 1 1 10 8

Senegal 1 0 0 0 0 1 0 0 1 1 0 1 4 1 1 10 na 1 1 1 NA 6 7

Sierra Leone

1 0 na na na na na na

0 0 0

1 2 1 1 10 1 1 0 1 0 6 6

Togo 1 0 0 0 0 1 0 0 1 0 0 0 2 1 1 10 1 1 1 1 na 8 7

n 16 1 0 1 2 5 2 1 11 10 5 10 13 12 8 7 3 9 2

N 17 14 11 11 11 11 11 11 16 16 16 16 M 16 14 M 13 13 13 12 6 M M

% 94.1 7.1 0.0 9.1 18.2 45.5 18.2 9.1 68.8 62.5 31.3 62.5 3 81.3 85.7 7.4 61.5 53.8 23.1 75.0 33.3 3 5

COUNTRY TOTAL

n 53 11 1 9 7 12 5 5 29 34 9 26 M 39 27 M 15 13 6 23 5 M M

N 63 54 40 40 40 40 40 39 54 54 54 55 3 59 45 5 48 48 46 46 26 1 3

% 84.1 20.3 2.5 22.5 17.5 30.0 12.5 12.8 53.7 62.9 16.7 47.3 66.1 60.0 31.2 27.1 13.0 50.0 19.2

na= not applicable/ no answer/no data available, M=Mean, 1= yes, 0=no . Nutritionally vulnerable countries highlighted in yellow

135

ANNEX 5k: Capacity development and coverage of community based IYCF actions

COUNTRY Training of community health workers on community-based IYCF IYCF Community-based activity coverage

No of IYCF CHWs trained on community-based IYCF since 2006

No of Community health workers trained in IYCF as part of another health course 2006-2009

Total number of community health workers in the country

% CHW trained on Community-based IYCF since 2006

% CHW trained in IYCF as part of another health course 2006-2009

Total number of districts/region/municipalities implementing CHW programmes with IYCF included

Total number of districts/regions/municipalities etc... in the country

Coverage (% of district implementing CHW programmes including IYCF)

Proportion of the population living in target districts

CEE/CIS

Kosovo NI NI NI - - 26 36 72 NI

Tajikistan NI NI 3500 - - 15 65 23 75000 CHILDREN

BOSNIA AND HERZEGOVINA

NI NI 620 - - NI NI - NI

UZBEKISTAN NI NI NI - - NI NI - NI

Turkemnistan NI NI 0 - - 0 0 0 NI

Romania NI NI 400 - - NI NI - NI

KYRGYZSTAN NI 1300 1300 - 100 7 7 100 NI

KAZAKASTAN NI NI 0 - - NI NI - NI

EAPR

VIETNAM NI 10,000 10,000 - 100 682 682 100 NI

Vanuatu NI NI 206 - - 1 6 17 NI

Cambodia 1200 NI 28000 4 - 30 77 39 NI

China 300 NI NI - - NI 2800 - NI

Mongolia NI NI 0 - - NI NI - NI

MYANMAR NI NI NI - - NI NI - NI

Papua New Guinea

50 100 2499 2 4 NI 20 - 30%

TIMOR-LESTE NI NI NI - - 9 13 69 NI

Thailand NI NI NI - - NI NI NI

VIETNAM TOO NI NI 103026 - - 690 690 100 NI

Philippines NI NI NI - - 17 17 100 NI

Fiji NI NI NI - - 3 3 100 NI

Indonesia 150 700 1200000 < 1 < 1 5 200 2.5 < 5

Korea NI NI NI - - 1 206 0 NI

Lao People's Democratic Republic

NI NI NI - - 90 142 63 72

ESAR

Madagascar 6000 NI NI - - 5555 NI - 33

Burundi NI NI 8360 - - 10 45 22 NI

Zambia 60 187 NI - - NI NI - NI

Angola 0 0 0 0 0 - 164

26%

Somalia NI NI NI - - 20 NI NI NI

Mozambique 0 NI 1500 0 - 148 148 100 NI

Botswana NI NI NI - - 24 24 100 100%

Ethiopia 55,800 50,200 106000 53 47 170 800 21 25,500,000

Tanzania 3000 580 12000 25 5 56 135 42 41%

RWANDA 230 342 30000 1 1 15 30 50 1390440

136

COUNTRY Training of community health workers on community-based IYCF IYCF Community-based activity coverage

No of IYCF CHWs trained on community-based IYCF since 2006

No of Community health workers trained in IYCF as part of another health course 2006-2009

Total number of community health workers in the country

% CHW trained on Community-based IYCF since 2006

% CHW trained in IYCF as part of another health course 2006-2009

Total number of districts/region/municipalities implementing CHW programmes with IYCF included

Total number of districts/regions/municipalities etc... in the country

Coverage (% of district implementing CHW programmes including IYCF)

Proportion of the population living in target districts

South Africa 1165 NI 1600 73 6 53 11 NI

UGANDA NI NI 90,000 - - 24 112 21 NI

NAMIBIA NI NI NI - - 12 34 35 70%

SWAZILAND 68 1000 4900 1 20 4 4 100 100%

Zimbabwe NI NI NI - - 57 62 92 90%

Malawi 400 NI 4859 8.23 - 28 28 100 100%

Kenya 4000 NI 44432 9 - 284 284 100 15%

MENA

YEMEN NI NI 0 - - NI 334 - NI

South Sudan NI NI NI - - NI NI - NI

North Sudan NI NI NI - - 79 131 60 NI

ROSA

India 469000 NI 1200000 39 - 642 642 100 100%

Nepal NI NI 5000 - - 23 75 31 NI

Sri Lanka NI NI 10 000 - - 26 26 100 NI

AFGHANISTAN NI NI 18641 - - NI NI - NI

Bhutan NI NI 1200 - - NI NI - NI

BANGLADESH 4500 NI 150000 3 - 16 64 25 7%

WCAR

Congo Brazzaville

365 129 295 124 44 5 27 19 NI

MAURITANIA NI 3800 NI - - 2 11 18 20%

CAR NI 1746 1746 - 100 18 24 75 75%

Gambia 400 NI NI - - 6 6 100 100%

Senegal NI 5000 8000 - 63 64 75 85 NI

Ghana 4000 10,000 16,500 24 61 170 170 100 NI

GABON NI NI NI - NI NI - NI

Togo 1765 1320 8524 - 15 18 35 51 50%

BENIN NI 7190 NI - - 14 34 41 40%

NIGER 1898 NI 3752 50.6 - 5 42 11.9 14.5%

Sierra Leone NI 2205 NI - - 13 13 100 100%

DRC NI 423 834624 NI 0.05 27 515 5 8%

MALI NI NI NI - - 60 60 100 NI

Nigeria NI 95 40,491 - - 774 774 100 100%

Burkina Faso 700 NI 1057 66 - 63 63 100 100%

Liberia 0 NI NI - - NI NI - NI

Cote D'Ivoire NI NI NI - - 6 NI - 35%

"-" Dash= Value could not be calculated because there was no information provided, NI= No information. Nutritionally vulnerable countries are highlighted in yellow

137

ANNEX 5l:

IYCF community activity implementer

Other groups conducting IYCF community-based actions

Region/ Country Groups

CEE/CIS Kosovo Volunteers of Red Cross of Kosovo are providing counseling/promotion to parents about breastfeeding and child nutrition

MENA Yemen Through CBPHC volunteers

EAPR Timor-Leste There are no CHW in Timor-Leste but there are volunteers (Mother Support Group members) who conducts and have been trained on counseling

ESAR South Africa the mothers to mothers programme provides this support to a limited extent

EAPR China provided by all sorts of groups including local government and also companies in the cities

WCAR Mali PMTCT, Mother to Mother and IMCI

WCAR Cote d’Ivoire PEV CPN

WCAR Niger not at national scale

ROSA Afghanistan NGOs who implement CMAM

ESAR Angola National catholic church train the activist for counseling of mothers on IYCF

CEE/CIS Bosnia And Herzegovina

IBFAN Local branch

WCAR Car health workers

ESAR Madagascar growth monitoring

ESAR Uganda Diverse community groups, small scale projects

ROSA India Community volunteers called (ASHA)

WCAR Nigeria Community Resource Persons, provide individual counseling and support to mothers on KHHP including IYCF

WCAR Mauritania Community nutrition centers, BCC community agents, supplementary feeding centers for MAM

ESAR Kenya Community health strategy, mother to mother support groups and workplace support initiative with private sector (better business practices for children).

EAPR Fiji Community Health Nurses and Dieticians

WCAR Ghana community based volunteers

138

ANNEX 5m:

Communication on IYCF

IYCF communication channels

BCC Channels BCC Health System Mass media BCC Community BCC

COUNTRY

Nation

al radio

National TV

National

Campaign

Posters

Interpersona

l Communicati

on

Mobile Phone Messa

ges

Other Chann

els

Religio

us Leader

s

Community

Leaders

BCC HS

Posters and

leaflets

Videos on

IYCF

HW grp. IYCF

sessions

Mass media

Mass media WBF

week.

Mass media frequently/on an

ongoing

National

Campaigns

Ongoing

community BCC

CHWs conduc

t group sessio

ns

Mother

support

groups/other groups

TBAs or

traditional

health practitioners

CHANNELS

SUBSCORE

CEE/CIS Uzbekistan 0 1 1 1 1 0 0 1 1 na 1 1 1 1 1 0 1 1 na na na 6 Turkmenistan

1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 1 1 1 0 7

Tajikistan 0 1 1 1 1 0 0 0 1 na 0 na 0 0 1 0 0 na 0 na na 3 Romania 0 1 1 0 1 0 1 0 0 1 1 1 1 1 1 0 0 1 1 1 0 6 Kyrgyzstan 0 1 1 1 1 0 0 1 1 na na 1 1 1 0 0 1 na 1 na 5 Kosovo 1 1 1 0 1 0 0 0 0 1 0 1 0 1 1 0 0 1 na 1 na 5 Kazakhstan 0 1 1 0 1 0 1 0 0 1 1 1 0 1 1 0 1 1 1 1 1 7 Bosnia Herz. 1 1 0 1 0 0 1 0 0 1 1 1 1 1 1 0 1 na na na na 5 n 3 8 7 5 7 1 3 2 3 5 5 7 4 7 8 0 3 6 3 5 1 N 8 8 8 8 8 8 8 8 8 5 7 7 7 8 8 8 8 6 4 5 3 % 37.5 100 87.5 62.5 87.5 12.5 37.5 25.0 37.5 100 71.4 100 57.1 87.5 100 0.0 37.5 100 75.0 100 33.3 6 EAPR Vietnam 1 1 1 1 1 0 1 0 1 1 na na na 1 1 0 0 na na na na 5 Vanuatu 1 1 1 1 1 0 0 0 0 1 1 0 1 1 1 1 1 0 6 Timor Leste na 0 1 1 1 1 1 0 1 1 1 1 1 1 5 Thailand 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 0 0 0 0 0 0 5 Philippines 0 1 1 0 0 0 1 0 0 1 1 1 1 1 1 0 0 0 4 P.N.Guinea 1 1 0 1 1 1 0 1 1 1 1 1 0 1 0 0 1 0 6 Myanmar 1 1 1 1 0 0 0 0 0 1 1 0 1 1 1 1 0 1 1 0 1 6 Mongolia 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 6 Lao PDR 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 0 7 Korea 0 1 1 0 1 0 0 1 1 1 1 1 0 1 0 1 1 1 1 1 0 7 Indonesia 0 0 1 1 1 0 0 0 1 na na 1 1 1 na na na 1 1 1 0 5 Fiji 0 0 1 1 1 0 1 0 0 1 1 0 1 na 1 0 1 1 1 1 1 6 China 0 1 1 0 1 0 0 0 1 1 0 0 0 1 1 0 0 1 na 1 0 4 Cambodia 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 0 1 1 1 0 8 n 8 11 11 9 10 1 4 4 8 13 11 8 9 13 8 5 6 9 8 8 4 N 13 13 13 13 13 13 14 13 13 13 12 13 13 13 12 12 12 13 9 10 10 M % 61.5 84.6 84.6 69.2 76.9 7.7 28.6 30.8 61.5 100 91.7 61.5 69.2 100 66.7 41.7 50.0 69.2 88.9 80.0 40.0 6 ESAR Zimbabwe 0 1 1 0 1 0 0 0 0 1 1 0 0 1 0 0 0 1 na na na 3 Zambia 1 1 1 1 1 0 1 1 1 1 1 0 0 1 1 0 0 0 0 0 0 6 Uganda 1 1 0 1 1 0 0 0 1 1 1 0 1 1 1 0 0 1 1 1 0 6

139

IYCF communication channels

BCC Channels BCC Health System Mass media BCC Community BCC

COUNTRY

Nation

al radio

National TV

National

Campaign

Posters

Interpersona

l Communicati

on

Mobile Phone Messa

ges

Other Chann

els

Religio

us Leader

s

Community

Leaders

BCC HS

Posters and

leaflets

Videos on

IYCF

HW grp. IYCF

sessions

Mass media

Mass media WBF

week.

Mass media frequently/on an

ongoing

National

Campaigns

Ongoing

community BCC

CHWs conduc

t group sessio

ns

Mother

support

groups/other groups

TBAs or

traditional

health practitioners

CHANNELS

SUBSCORE

Tanzania 1 1 1 1 1 0 1 1 1 0 1 0 1 1 1 0 0 0 6 Swaziland 0 1 1 0 1 0 0 0 0 1 0 0 1 1 1 0 0 1 1 1 0 5 South Africa 1 0 1 0 0 0 0 1 1 1 1 0 1 1 0 1 0 1 0 1 0 5 Somalia 0 0 0 1 1 0 0 1 1 0 0 0 0 1 1 0 0 0 3 Rwanda 0 1 1 0 1 1 0 1 1 0 0 0 1 1 1 0 0 1 1 0 0 5 Namibia na na na na na na 0 na na 1 1 0 1 1 0 0 1 1 1 1 0 4 Mozambique 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 9 Malawi 0 1 1 1 0 0 0 1 1 1 na 1 1 1 1 0 0 1 1 1 na 6 Madagascar 0 0 0 1 1 0 0 0 0 na 0 0 0 1 1 0 0 1 1 1 0 3 Kenya 1 1 1 1 1 0 1 1 1 1 0 1 1 0 1 1 1 1 1 na 8 Ethiopia 0 1 1 0 0 0 0 1 1 0 na 0 0 1 1 0 0 na na na 3 Burundi 0 1 1 1 1 0 0 1 1 1 1 0 1 1 0 1 0 1 1 0 0 6 Botswana na 0 1 1 0 1 1 1 0 0 1 1 0 0 3 Angola 1 1 0 1 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 7 n 7 12 11 10 11 1 2 10 12 12 11 2 12 17 12 4 4 13 11 9 1 N 15 15 15 15 15 15 16 15 15 16 15 17 17 17 17 17 17 16 13 13 11 M % 46.7 80.0 73.3 66.7 73.3 6.7 12.5 66.7 80.0 75.0 73.3 11.8 70.6 100.

0 70.6 23.5 23.5 81.3 84.6 69.2 9.1

5 MENA Yemen 1 1 1 1 1 1 0 1 0 1 1 0 0 1 1 0 1 1 0 0 0 6 South Sudan 1 1 0 0 1 1 0 1 1 1 1 0 0 1 1 0 0 1 0 1 1 6 North Sudan 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 1 0 0 7 n 3 3 2 2 3 2 0 2 2 3 3 1 1 3 2 1 2 3 1 1 1 N 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 M % 100 100 66.7 66.7 100 66.7 0.0 66.7 66.7 100 100 33.3 33.3 100 66.7 33.3 66.7 100 33.3 33.3 33.3 7 ROSA Sri Lanka 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 8 Nepal 0 1 1 1 0 0 0 0 0 1 0 0 0 1 1 1 0 1 0 0 1 4 India 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 8 Bhutan 1 1 1 1 1 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 na 7 Bangladesh 0 0 0 0 1 0 0 1 1 1 1 0 1 1 1 0 0 1 1 1 1 6 Afghanistan 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 1 0 0 6 n 4 5 5 5 5 0 0 3 4 6 5 1 5 6 6 3 3 5 4 4 2 N 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 5 5 4 M % 66.7 83.3 83.3 83.3 83.3 0.0 0.0 50.0 66.7 100 83.3 16.7 83.3 100 100 50.0 50.0 83.3 80.0 80.0 50.0 6 WCAR Togo 0 1 1 0 1 0 1 1 1 1 0 1 1 0 0 1 1 0 0 5 Sierra Leone 0 0 1 1 1 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 0 7

140

IYCF communication channels

BCC Channels BCC Health System Mass media BCC Community BCC

COUNTRY

Nation

al radio

National TV

National

Campaign

Posters

Interpersona

l Communicati

on

Mobile Phone Messa

ges

Other Chann

els

Religio

us Leader

s

Community

Leaders

BCC HS

Posters and

leaflets

Videos on

IYCF

HW grp. IYCF

sessions

Mass media

Mass media WBF

week.

Mass media frequently/on an

ongoing

National

Campaigns

Ongoing

community BCC

CHWs conduc

t group sessio

ns

Mother

support

groups/other groups

TBAs or

traditional

health practitioners

CHANNELS

SUBSCORE

Senegal 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 0 1 1 1 1 1 8 Nigeria 0 1 1 0 1 0 0 1 1 1 1 0 1 1 0 1 0 1 1 1 1 7 Niger 1 1 0 0 1 0 0 1 1 1 1 0 1 1 0 1 1 1 1 1 1 7 Mauritania 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 1 1 1 9 Mali 0 1 1 0 1 0 0 0 1 1 1 0 1 1 1 0 0 1 1 1 0 6 Liberia na na na na na na na na na 0 na na na 1 1 0 0 1 na na na 1 Ghana 0 1 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 8 Gabon 0 1 1 0 0 0 0 1 1 1 1 1 0 1 0 0 1 1 1 1 0 6 Dem. Rep. Congo

1 1 0 0 1 0 0 1 0 na na na na na na na na na na na na 2

Cote D'Ivoire na na na na na na 0 na na 1 1 0 1 1 1 0 0 0 2 Congo B. 0 1 1 0 0 0 0 1 1 1 1 0 1 1 0 1 0 1 1 1 0 6 C. Afr. Rep na na na na na na 0 na na 1 1 na 1 1 1 0 na 1 1 1 1 4 Burkina Faso 0 1 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 8 Benin 0 1 1 0 1 0 1 1 1 1 1 1 1 1 0 1 0 1 1 1 0 7 Gambia 1 1 1 1 1 0 0 1 1 1 0 1 1 1 1 0 na 1 1 1 1 8 n 5 13 12 4 12 2 5 13 13 15 12 3 13 16 10 8 7 15 14 13 7 N 14 14 14 14 14 14 16 14 14 16 15 13 14 16 16 16 14 16 14 14 14 M % 35.7 92.9 85.7 28.6 85.7 14.3 31.3 92.9 92.9 93.8 80.0 23.1 92.9 100 62.5 50.0 50.0 93.8 100 92.9 50.0 6

Country Totals n 30 52 48 35 48 7 14 34 42 54 47 22 44 62 46 21 25 50 40 39 15

N 59 59 59 59 59 59 63 59 59 59 57 59 60 63 62 62 60 59 47 49 44 M

% 50.9 88.1 81.4 59.3 81.4 11.9 22.2 57.6 71.2 91.5 82.5 37.3 73.3 98.4 74.2 33.9 41.7 84.7 85.1 79.6 34.1 6

M=Mean, n=number, N=total, %= percent, na= not applicable, data not available, no response; Nutritionally vulnerable countries are highlighted in yellow

141

ANNEX 5n:

Communication on IYCF: Strategy, materials and monitoring/evaluation

National BCC, M and E and BCC materials

NATIONAL communication on IYCF* Behaviour change and communication M & E Behaviour change and communication materials

COUNTRY

Comm.

Strategy on IYCF

WBW

Health

Days

National Campaig

ns

Comm. Strat.

on IYCF in

Natl IYCF / Nutri strate

gy

Cord. Mechanism implementing agency

NATIONAL BCC SUBSCORE

Monitoring IYCF

comm.activities

Monitoring

people reached media

messages

Monitoring

quality grp

sessions

BCC MONTORI

NG COMMS

SUBSCORE

BCC materia

ls

BF Poste

rs / leafle

ts

CF Poster

s /leafle

ts

Flipcharts for group

sessions

Participato

ry materials other

BCC Materia

ls SUBSco

re

CEE/CIS Bosnia

Herz. 0 1 1 0 0 1

5 0 0 0

0 1 1 0 0 0 1

5

Kazakhstan 1 0 1 1 1 1 8 1 0 0 3 1 1 1 0 1 na 7

Kosovo 0 1 1 0 0 1 5 0 na na 0 1 1 1 0 0 na 5

Kyrgyzstan 1 1 0 1 0 1 7 na 0 0 0 1 1 1 1 1 na 8

Romania 0

0 1 2 0 na na 0 1 1 1 0 0 na 5

Tajikistan 0 1 1 0 1 1 7 0 0 0 0 1 1 0 0 0 na 3

Turkmenistan

0 1 1 0 0 1 5

0 0 0 0 1

1 1 0 0 na 5

Uzbekistan 1 1 1 1 1 1 10 0 na na 0 1 1 0 0 0 na 3

n 3 6 6 3 3 8

1 0 0

8 8 5 1 2 1 N 8 7 7 7 8 8 M 7 5 5 M 8 8 8 8 8 1 M

% 37.5 85.7 85.7 42.9 37.5 100 6 14.3 0.0 0.0 0 100 100 62.5 12.5 25.0 100 5

EAPR Vietnam 0 1 1 0 1 1 7 na na na 0 1 1 1 1 0 na 7

Cambodia 1 1 0 1 1 1 8 0 0 0 0 1 1 1 1 1 na 8

China 1 1 0 0 1 1 7 0 0 0 0 1 1 1 0 0 na 5

Fiji 0 na na na 1 1 3 0 0 0 0 1 1 1 0 0 na 5

Indonesia 0 na na na 0 1 2 0 0 0 0 1 1 0 1 0 na 5

Korea 1 0 1 0 1 1 7 1 1 1 10 1 0 1 0 0 na 3

Lao PDR 1 1 1 1 1 1 10 0 na na 0 1 1 1 1 1 na 8

Mongolia 0 na na na 1 1 3 1 1 0 7 1 1 1 1 0 na 7

Myanmar 1 1 0 0 1 1 7 0 0 0 0 1 1 1 0 0 na 5

P.N.Guinea 1 1 0 1 1 1 8 0 na na 0 1 1 1 1 1 na 8

Philippines 1 0 1 0 1 1 7 0 na na 0 1 na na na na 1 3

Thailand 1 1 0 1 1 1 8 0 0 0 0 1 1 1 0 0 na 5

Timor-Leste

0 na na na na 1 2

na 1 0 3

1 na na na na na 2

Vanuatu 1 1 1 1 1 1 10 0 0 0 0 1 1 1 1 0 na 7

n 9 8 5 5 12 14

2 3 1

14 11 11 7 3 1 N 14 10 10 10 13 14 M 12 10 10 M 14 12 12 12 12 1 M

% 64.3 80.0 50.0 50.0 92.3 100 6 16.7 30.0 10.0 1 100 91.7 91.7 58.3 25.0 100 6

142

National BCC, M and E and BCC materials

NATIONAL communication on IYCF* Behaviour change and communication M & E Behaviour change and communication materials

COUNTRY

Comm.

Strategy on IYCF

WBW

Health

Days

National Campaig

ns

Comm. Strat.

on IYCF in

Natl IYCF / Nutri strate

gy

Cord. Mechanism implementing agency

NATIONAL BCC SUBSCORE

Monitoring IYCF

comm.activities

Monitoring

people reached media

messages

Monitoring

quality grp

sessions

BCC MONTORI

NG COMMS

SUBSCORE

BCC materia

ls

BF Poste

rs / leafle

ts

CF Poster

s /leafle

ts

Flipcharts for group

sessions

Participato

ry materials other

BCC Materia

ls SUBSco

re

ESAR Zimbabwe 0 na na na 1 1 3 1 na na 3 0 na na na na na 0

Zambia 0 na na na 0 1 2 0 0 0 0 1 1 1 1 0 na 7

Uganda 0 na na na 1 1 3 0 na na 0 1 1 1 1 1 1 10

Tanzania 1 1 1 1 1 1 10 0 0 0 0 1 1 1 1 1 na 8

Swaziland 0 1 1 0 1 1 7 0 0 0 0 1 1 0 0 0 na 3

South Africa

0 na na na 1 1 3

0 0 0 0

1 0 1 0 0 na 3

Somalia 0 na na na 1 1 3 0 na na 1 1 1 1 0 na 7

Rwanda 0 na na na 1 1 3 0 0 1 3 1 1 1 1 1 na 8

Namibia 0 1 1 0 1 1 7 1 0 0 3 1 1 1 1 1 na 8

Mozambique

1 1 0 1 1 1 8

1 1 1 10

1 1 0 0 0 na 3

Malawi 0 1 1 1 1 1 8 na 0 0 0 1 1 1 0 0 na 5

Madagascar

1 0 0 0 1 1 5

0 0 0 0

1 1 0 1 0 na 5

Kenya 1 1 1 1 1 1 10 0 0 1 3 1 1 1 1 0 na 7

Ethiopia 1 1 1 0 1 1 8 0 na na 1 na na na na 1 3

Burundi 0 na na na 0 1 2 0 0 0 0 1 1 1 1 0 1 8

Botswana 0 na na na 0 0 0 0 0 0 0 0 na na na na na 0

Angola 0 na na na 0 0 0 0 0 na 0 1 1 1 1 0 1 8

n 5 7 6 4 13 15

3 1 3

15 13 11 10 4 4 N 17 8 8 8 17 17 M 16 13 12 M 17 14 14 14 14 4 M

% 29.4 87.5 75.0 50.0 76.5 88.2 5 18.8 7.7 25.0 2 88.2 92.9 78.6 71.4 28.6 100.0 6

MENA

Yemen 1 1 0 0 na 1 5 0 0 0 0 1 1 1 1 0 na 7

South Sudan

0

na

na

na

0

1 2

0

0

0 0

1

1

1

1

0

na 7

North Sudan

1 1 1 0

1 1 8

na na na 0

1 1 0 1 0 na 5

n 2 2 1 0 1 3

0 0 0

3 3 2 3 0 0 N 3 2 2 2 2 3 M 2 2 2 M 3 3 3 3 3 0 M

% 66.7 100 50.0 0.0 50.0 100 5.0 0.0 0.0 0.0 0.0 100 100 66.7 100.0 0.0 0.0 6

ROSA

Sri Lanka 1 1 0 1 1 1 8 0 0 0 0 1 1 1 0 1 1 8

Nepal 0 na na na na 1 2 0 0 0 0 1 1 1 1 0 na 7

India 1 1 1 1 1 1 10 1 0 0 3 1 1 1 0 0 na 5

Bhutan 0 na na na 0 1 2 1 0 0 3 1 1 1 0 0 na 5

143

National BCC, M and E and BCC materials

NATIONAL communication on IYCF* Behaviour change and communication M & E Behaviour change and communication materials

COUNTRY

Comm.

Strategy on IYCF

WBW

Health

Days

National Campaig

ns

Comm. Strat.

on IYCF in

Natl IYCF / Nutri strate

gy

Cord. Mechanism implementing agency

NATIONAL BCC SUBSCORE

Monitoring IYCF

comm.activities

Monitoring

people reached media

messages

Monitoring

quality grp

sessions

BCC MONTORI

NG COMMS

SUBSCORE

BCC materia

ls

BF Poste

rs / leafle

ts

CF Poster

s /leafle

ts

Flipcharts for group

sessions

Participato

ry materials other

BCC Materia

ls SUBSco

re

Bangladesh 1 1 0 1 1 1 8 0 0 0 0 1 1 1 1 0 na 7

Afghanistan

0 na na na 1 1 3

0 na na 0

1 1 1 1 0 1 8

n 3 3 1 3 4 6

2 0 0

6 6 6 3 1 N 6 3 3 3 5 6 M 6 5 5 M 6 6 6 6 6

M

% 50.0 100 33.3 100 80.0 100 6 33.3 0.0 0.0 1 100 100 100 50.0 16.7

7

WCAR

Togo 1 1 1 1 1 1 10 na 1 0 3 1 1 1 1 1 na 8

Sierra Leone 0 na na na 1 1 3 1 1 0 7 1 1 1 1 1 na 8

Senegal 1 1 1 1 1 1 10 1 1 0 7 1 1 1 1 1 na 8

Nigeria 1 1 1 1 1 1 10 1 0 0 3 1 1 1 1 1 na 8

Niger 1 1 0 1 1 1 8 1 0 0 3 1 0 0 1 0 1 5

Mauritania 1 1 1 1 1 1 10 1 0 1 7 1 1 1 1 0 na 7

Mali 1 1 1 1 1 1 10 0 0 0 0 1 0 1 0 0 na 3

Liberia na na na na na na 0 0 na na 0 1 1 1 0 1 na 7

Ghana 1 1 1 1 0 1 8 1 0 1 7 1 1 1 0 0 1 7

Gabon 0 na na na 1 1 3 0 na na 0 na na na na na na 0

D. Rep. Congo

0 na na na 1 1 3

0 na na 0

1 1 1 0 0 na 5

Cote'd'Ivoire na na na na na na 0 0 na na 0 1 1 1 0 1 na 7

Congo Brazzaville

1 1 0 0 1 1 7

1 1 1 10

1 0 1 0 0 na 3

C.Afr. Rep. 0

1 1 3 0 0 na na na na na 0

Burkina Faso 1 1 1 0 1 1 8 1 1 1 10 1 1 1 1 1 na 8

Benin 1 1 0 0 1 1 7 0 0 0 0 1 0 0 1 0 na 3

Gambia 1 1 0 0 1 1 7 na na na 0 1 1 1 0 0 na 5

n 11 11 7 7 14 15

8 5 4

15 11 13 8 7 2 N 15 11 11 11 15 15 M 14 11 11 M 16 15 15 15 15 2 M

% 73.3 100 63.6 63.6 93.3 100 6 57.1 45.5 36.4 2 93.8 73.3 86.7 53.3 46.7 100 5

Country Totals

n 33 37 26 22 47 61

16 9 8

61 52 48 32 17 10

N 63 41 41 41 60 63

57 46 44

64 58 58 58 58 10 M

% 52.4 90.2 63.4 53.7 78.3 96.8

28.1 19.6 18.2

95.3 89.6 82.7 55.2 29.3 100 6

na= not available/not applicable/ no response M= Mean, 1=Yes, 2=No,

Nutritionally vulnerable countries are highlighted in yellow *36 countries with 5 or more communication on IYCF channels and 4 countries with 8 communications on IYCF channels

144

ANNEX 5o:

Communication on IYCF actions score

COUNTRY BCC MONTORING COMMS

SUBSCORE CHANNELS SUBSCORE

NATIONAL BCC SUBSCORE

BCC Materials SUBSCORE

Communication on IYCF actions SCORE

CEE/CIS Uzbekistan 0 6 10 3 5

Turkmenistan 0 7 5 5 4

Tajikistan 0 3 7 3 3

Romania 0 6 2 5 3

Kyrgyzstan 0 5 7 8 5

Kosovo 0 5 5 5 4

Kazakhstan 3 7 8 7 6

Bosnia Herz. 0 5 5 5 4

Mean 0 6 6 5 4

EAPR Vietnam 0 5 7 7 5

Vanuatu 0 6 10 7 6

Timor-Leste 3 5 2 2 3

Thailand 0 5 8 5 4

Philippines 0 4 7 3 3

P. N.Guinea 0 6 8 8 5

Myanmar 0 6 7 5 4

Mongolia 7 6 3 7 6

Lao PDR 0 7 10 8 6

Korea 10 7 7 3 7

Indonesia 0 5 2 5 3

Fiji 0 6 3 5 4

China 0 4 7 5 4

Cambodia 0 8 8 8 6

Mean 1 6 6 6 5

145

COUNTRY BCC MONTORING COMMS

SUBSCORE CHANNELS SUBSCORE

NATIONAL BCC SUBSCORE

BCC Materials SUBSCORE

Communication on IYCF actions SCORE

ESAR Zimbabwe 3 3 3 0 2

Zambia 0 6 2 7 4

Uganda 0 6 3 10 5

Tanzania 0 6 10 8 6

Swaziland 0 5 7 3 4

South Africa 0 5 3 3 3

Somalia 0 3 3 7 3

Rwanda 3 5 3 8 5

Namibia 3 4 7 8 5

Mozambique 10 9 8 3 7

Malawi 0 6 8 5 5

Madagascar 0 3 5 5 3

Kenya 3 8 10 7 7

Ethiopia 0 3 8 3 3

Burundi 0 6 2 8 4

Botswana 0 3 2 0 1

Angola 0 7 2 8 4

Mean 1 5 5 6 4

MENA Yemen 0 6 5 7 4

South Sudan 0 6 2 7 4

North Sudan 0 7 8 5 5

Mean 0 7 5 6 4

ROSA Sri Lanka 0 8 8 8 6

Nepal 0 4 2 7 3

India 3 8 10 5 6

Bhutan 3 7 2 5 4

146

COUNTRY BCC MONTORING COMMS

SUBSCORE CHANNELS SUBSCORE

NATIONAL BCC SUBSCORE

BCC Materials SUBSCORE

Communication on IYCF actions SCORE

Bangladesh 0 6 8 7 5

Afghanistan 0 6 3 8 4

Mean 1 6 6 7 5

WCAR Togo 3 5 10 8 6

Sierra Leone 7 7 3 8 6

Senegal 7 8 10 8 8

Nigeria 3 7 10 8 7

Niger 3 7 8 5 6

Mauritania 7 9 10 7 8

Mali 0 6 10 3 5

Liberia 0 1 0 7 2

Ghana 7 8 8 7 7

Gabon 0 6 3 0 2

D. Rep. Congo 0 2 3 5 2

Cote D'Ivoire 0 2 0 7 2

Congo Brazzaville 10 6 7 3 6

Cen. Afr. Rep. 0 4 3 0 2

Burkina Faso 10 8 8 8 8

Benin 0 7 7 3 4

Gambia 0 8 7 5 5

Mean 3 6 6 5 5

TOTAL Mean 2 6 6 6 5

Nutritionally vulnerable countries highlighted in yellow

147

ANNEX 5p: Complementary feeding components / intervention

COUNTRY

Micronutrient supplements

( single/multi)

Single micronutrient

Multi-micronutrie

nt

In emergency

non-emergency

Targeted food

supplements

Local CFs (

unfortified)

Industrially

blended CFs

un-fortifie

d

Fortif

ied local CFs

Fortified

industrially-

blended CFs

Lipid

based

Social protec

tion progra

m

Prov. of CF suppl. Sub

score

Caregivers

counselled in home prep. of CF

Cooking Classe

s

Food preparation

demonstrations

on TV

Food preparatio

n demonstrations on

radio

Local food

events

Publis

hed recipe guides

for mother

s

Counseling cards

on food

preparation (

for health system

)

Counseling cards

on food

preparation (

for community)

CF counseling sub score

CF Score

CEE/CIS

Bosnia Herz. 1 1 1 1 0 1 0 1 0 1 na 1 7 0 0 4 Kazakhstan 1 1 0 0 1 0 na na na na na 1 3 1 0 1 0 0 0 0 0 3 3

Kosovo 1 1 1 1 0 0 na na na na na 0 3 1 0 1 0 0 1 1 0 5 4 Kyrgyzstan 1 0 1 0 1 1 1 0 0 0 0 0 4 0 0 2

Romania 1 1 0 1 1 0 na na na na na 0 3 0 0 2

Tajikistan 0 na na na na 0 na na na na na 0 0 0 0 0 Turkmenistan 1 1 1 1 0 1 1 1 0 0 0 0 6 0 0 1 0 0 1 0 0 3 4

Uzbekistan 1 0 1 0 1 0 na na na na na 0 2 0 0 1 n 7 5 5 4 4 3 2 2 0 1 0 2 M 2 0 3 0 0 2 1 0 M M N 8 7 7 7 7 8 3 3 3 3 2 8 3 8 3 3 3 3 3 3 3 1 2

% 87.5 71.4 71.4 57 57.1 37.5 67 66.7 0 33.3 0 25 25.0 0.0 100.0 0.0 0.0 66.7 33.3 0.0

EAPR

Cambodia 1 0 1 0 1 1 0 0 0 1 0 1 5 1 0 1 0 0 0 1 1 5 5

China 1 0 1 1 0 1 0 0 0 0 0 1 4 1 0 1 0 0 0 1 0 4 4 Fiji 0 na na na na 1 0 0 0 1 0 0 2 0 0 1

Indonesia 1 1 1 0 1 1 1 0 0 1 0 1 7 0 0 4

Korea 1 0 1 0 1 1 1 na 1 na na 5 0 3 Lao People's Democratic Republic

1 0 1 0 1 0 na na na na na 0 2 0 0 1

Mongolia 1 1 1 0 1 1 1 1 0 0 0 1 7 1 1 0 0 1 1 1 6 7

Myanmar 0 na na na na 1 1 1 0 0 0 0 2 1 0 1 0 0 1 0 0 4 3 Papua New Guinea

0 na na na na 0 na na na na na 0 0 1 0 0 0 1 1 1 1 6 3

Philippines 1 0 1 0 1 1 0 na 1 na na 1 5 1 0 1 0 0 0 0 0 3 4 Thailand 1 0 1 0 1 0 na na na na na 0 2 0 0 1

Timor-Lest 0 na na na na 1 1 0 0 0 0 na 2 0 1 Vanuatu 1 1 0 1 0 0 na na na na na 0 2 0 0 1 Vietnam 1 1 1 0 1 1 0 1 1 na 1 7 1 0 0 0 1 0 1 1 5 6

n 10 4 9 2 8 10 5 2 3 4 0 6 M 7 0 5 0 2 3 5 4 M N 14 10 10 10 10 14 9 8 10 8 7 12 4 12 6 7 7 7 7 7 7 2 % 71.4 40 90 20 80 71.4 56 25 30 50 0 50 58.3 0.0 71.4 0.0 28.6 42.9 71.4 57.1

ESAR

Angola 0 na na 0 0 0 na na na na na na 0 0 0 0 Botswana 0 na na na na 1 0 0 0 1 0 1 2 1 1 2 Burundi 1 1 0 0 1 0 na na na na na 0 2 0 0 1 Ethiopia 0 na na na na 0 na na na na na na 0 0 0 0 Kenya 1 0 1 1 0 1 1 0 1 0 na 1 6 0 0 3 Madagascar 1 na na 0 1 1 0 0 0 0 0 0 2 1 1 0 0 1 1 0 1 6 4 Malawi 1 1 1 0 1 1 1 0 0 1 na 1 7 1 0 1 0 0 0 1 0 4 5 Mozambique 1 1 0 1 1 1 0 0 0 1 1 na 6 1 0 0 0 1 0 0 0 3 4 Namibia 1 0 1 0 1 1 0 na 1 na na 0 4 1 0 0 0 0 1 0 3 3 Rwanda 0 na na na na 0 na na na na na 0 0 0 0 0 Somalia 1 1 0 0 1 0 na na na na na na 2 1 0 0 0 1 0 1 0 4 3 South Africa 1 0 1 0 1 1 0 1 0 1 0 1 6 1 0 1 0 0 0 1 0 4 5 Swaziland 1 0 1 0 1 1 0 0 1 1 0 0 5 0 3 Tanzania 1 0 1 0 1 1 0 0 0 1 1 1 6 1 0 0 0 0 1 0 3 4

148

COUNTRY

Micronutrient supplements

( single/multi)

Single micronutrient

Multi-micronutrie

nt

In emergency

non-emergency

Targeted food

supplements

Local CFs (

unfortified)

Industrially

blended CFs

un-fortifie

d

Fortif

ied local CFs

Fortified

industrially-

blended CFs

Lipid

based

Social protec

tion progra

m

Prov. of CF suppl.

Sub score

Caregiver

s counselled in

home prep. of CF

Cooking

Classes

Food preparation

demonstrations

on TV

Food preparatio

n demonstrations on

radio

Local food

events

Publis

hed recipe guides

for mother

s

Counseling

cards on food prepara

tion ( for

health system

)

Counseling

cards on food prepara

tion ( for

community)

CF counseling sub

score

CF Score

Uganda 1 1 0 0 1 0 na na na na na 0 2 1 0 1 1 1 0 0 1 6 4 Zambia 1 1 0 1 0 0 na na na na na 1 3 1 0 1 0 0 0 1 0 4 3 Zimbabwe 0 na na 0 1 0 na na na na na 1 2 1 0 1 0 0 1 1 1 6 4 n 12 6 6 3 11 9 2 1 3 6 2 7 M 11 1 5 1 4 2 7 3 M M N 17 11 11 14 14 17 9 8 9 8 7 13 3 16 8 10 10 10 10 10 7 3 3

% 70.6 54.5 54.5 21 78.6 52.9 22 12.5 33 75 29 53.8 68.8 12.5 50.0 10.0 40.0 20.0 70.0 42.9

MENA North Sudan 1 1 0 0 1 1 0 0 0 1 1 0 5 1 1 0 0 0 1 0 0 4 4 South Sudan 0 na na na na 1 0 0 0 1 0 0 2 1 0 0 0 1 0 0 0 3 2 Yemen 1 0 1 1 0 1 0 na 0 0 0 na 3 0 0 0 0 0 1 0 1 2 n 2 1 1 1 1 3 0 0 0 2 1 0 M 2 1 0 0 1 1 1 0 M M N 3 2 2 2 2 3 3 2 3 3 3 2 3 3 2 3 3 3 3 3 3 3 3 % 66.7 50 50 50 50 100 0 0 0 66.7 33 0

ROSA

Afghanistan 1 0 1 1 0 0 na na na na na 0 2 1 0 0 0 0 1 0 1 4 3 Bangladesh 1 1 1 0 1 1 0 0 0 0 0 1 5 1 0 1 0 0 0 0 0 3 4 Bhutan 1 1 1 1 0 1 1 0 0 0 0 0 5 0 0 3 India 1 1 1 1 1 1 1 na 1 na 1 8 1 0 0 0 1 1 0 1 5 7 Nepal 1 1 1 1 0 1 0 0 0 1 0 1 6 0 0 3 Sri Lanka 1 0 1 0 1 1 0 0 0 0 0 1 4 1 1 1 1 1 1 0 0 8 6 n 6 4 6 4 3 5 2 0 1 1 0 4 M 4 1 2 1 2 3 0 2 M M N 6 6 6 6 6 6 5 4 5 4 4 6 5 6 4 4 4 4 4 4 4 3 4 % 100 66.7 100 67 50 83.3 40 0 20 25 0 66.7 66.7 ## 50.0 25.0 50.0 75.0 0.0 50.0

WCAR Benin 1 1 1 1 0 0 na na na na na 0 2 1 0 1 0 0 0 1 1 5 4 Burkina Faso 1 1 0 0 1 1 0 0 1 1 0 0 5 1 0 1 0 0 1 1 1 6 6 C. Afr. Rep. 1 1 0 0 1 0 na na na na na na 2 1 0 0 0 1 0 0 0 3 2 Congo Brazzaville 1 1 0 0 1 0 na na na na na na 2 0 0 1 Cote d'Ivoire 1 1 1 1 na 1 1 na na na 1 0 6 1 1 4 DR. Congo 0 na na na na 0 na na na na na 0 0 0 0 0 Gabon 1 1 0 0 1 0 na na na na na 0 2 0 0 1 Gambia 1 1 0 0 1 0 na na na na na na 2 1 0 1 0 0 0 1 0 4 3 Ghana 1 1 0 0 1 1 1 0 1 na na 0 5 1 0 1 0 0 0 0 0 3 4 Liberia 1 1 1 0 1 1 0 na na na na 0 4 0 4 Mali 0 na na na na 1 na 1 1 1 0 0 3 1 0 1 0 0 1 1 1 6 5 Mauritania 1 1 0 0 1 1 1 0 0 0 1 1 6 0 0 3 Niger 1 1 0 1 1 0 0 0 1 1 0 5 0 0 3 Nigeria 1 1 0 0 1 1 0 0 0 1 0 0 4 1 0 1 0 0 1 1 1 6 5 Senegal 1 1 1 0 1 1 1 1 na 1 0 1 8 1 1 0 1 1 0 1 1 8 8 Sierra Leone 0 na na na na 1 1 0 0 0 0 0 1 1 1 0 0 1 0 0 0 4 2 Togo 1 1 0 1 0 1 0 0 0 na na 1 4 1 0 1 0 0 1 1 1 6 5 n 14 14 4 3 11 10 5 2 3 5 3 3 M 11 2 7 1 3 4 7 6 M M N 17 14 14 13 13 17 10 9 8 7 8 14 4 17 10 10 10 10 10 10 10 3 3 % 82.4 100 28.6 23 84.6 58.8 50 22.2 38 71.4 38 21.4 64.7 20 70.0 10.0 30.0 40.0 70.0 60.0 Country Total

n 51 34 31 17 38 40 16 7 10 19 6 22 M 37 5 22 3 12 15 21 15 M M N 65 50 50 52 52 65 39 34 38 33 31 55 4 62 33 37 37 37 37 37 34 3 4 % 78.5 68 62 33 73.1 61.5 41 20.6 26 57.6 19 40 59.7 15.2 59.5 8.1 32.4 40.5 56.8 44.1

M=Mean, n=number, N=Total, %=percent, na=data not available, Nutritionally vulnerable countries highlighted in yellow

149

ANNEX 5q:

IYCF in difficult circumstances

IYCF in difficult circumstances (HIV and infant feeding)

POLICY TRAINING/ COUNSELLING BMS

Country

IF a

nd

HIV

po

licy

IF &

HIV

in n

atio

nal

IYC

F p

olic

y

IF &

HIV

in P

MTC

T

IF p

olic

y u

pd

ated

b

ased

on

WH

O2

010

gu

idel

ine

IF

tr

ain

ing/

cou

nse

lin

g fo

r H

IV +

m

oth

ers

HIV

& IF

in IY

CF

mat

eria

ls

IF & HIV IYCF

materials

updated

IF in PMTC

T mater

ials

PMTCT

material

s updated Jo

b a

ids

on

HIV

&

IF

Job

aid

s u

pd

ated

HW

tra

ined

on

IF

& H

IV?

HW

tra

ined

on

HIV

& IF

co

un

selin

g IF

co

un

selin

g

inte

grat

ed in

P

MTC

T

HIV

+ m

oth

ers

sup

po

rt o

n IF

Fr

ee in

fan

t

form

ula

to

HIV

+m

oth

ers

Infa

nt

Form

ula

pro

vid

ed b

y G

ove

rnm

ent

Infa

nt

form

ula

pro

vid

ed b

y N

GO

s

Mo

nit

ori

ng

syst

em

on

IF p

ract

ices

amo

ng

HIV

+ m

oth

ers

HIV and IF SCORE

CEE/CIS Uzbekistan 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 9 Romania 0 na 1 1 1 1 1 1 1 1 1 1 na 1 1 1 1 0 0 7 Kosovo 0 na na na 1 1 1 1 1 0 na na 0 1 0 1 1 0 na 4 Kazakhstan 0 0 1 0 0 na na 1 1 na na na 1 na na 0 na na 0 2 Bosnia & Herz.

0 na na na 1 na na na na na na 1 na na na 1 0 1 0 2

Turkmenistan

1 na 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na 8

Tajikistan 1 1 1 1 1 1 1 1 1 0 na 1 0 1 1 1 1 0 0 7 Kyrgyzstan 1 1 1 0 0 na na 1 1 0 1 1 1 1 1 1 0 1 1 7 Number 4 2 5 4 6 5 5 6 6 3 3 5 3 5 4 7 5 2 1

Total 8 3 5 5 8 5 5 6 6 5 3 5 5 5 5 8 6 6 6

Percent 50.0 66.7 100 80 75.0 100 100 100 100 60 100 100 60 100 80 87.5 83.3 33.3 16.7 M=6 EAPR Vietnam 1 1 1 1 1 1 1 na 1 1 1 1 1 1 1 1 1 1 0 8 Philippines 1 1 1 1 1 1 1 1 1 1 na na 1 0 1 1 0 1 0 7 China 1 0 1 1 1 0 na 1 1 1 1 1 1 1 1 1 1 0 1 8 Thailand 1 1 1 1 0 na na 1 1 na na 1 1 1 na 1 1 0 1 6 Vanuatu 1 1 1 1 1 1 1 1 na 1 na 1 1 1 1 0 na na 0 7 Indonesia 1 1 1 0 0 na na 0 na 0 na 0 0 0 0 0 na na 0 2 Myanmar 1 1 1 1 1 1 1 1 1 na na 0 0 1 1 1 0 1 0 7 Korea 0 na na na 0 na na 0 na na na na 0 na na 1 0 1 0 1 P. N. Guinea

1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 na 1 0 8

Lao PDR 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 na na 1 8 Mongolia 1 1 0 1 0 na na 0 na 0 na 1 1 0 0 0 na na 0 3 Fiji 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 8 Timor Leste

0 na 0 1 0 na 1 1 na 1 1 na 0 0 0 0 na na 0 3

Cambodia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 na na 1 9

150

IYCF in difficult circumstances (HIV and infant feeding)

POLICY TRAINING/ COUNSELLING BMS

Country

IF a

nd

HIV

po

licy

IF &

HIV

in n

atio

nal

IYC

F p

olic

y

IF &

HIV

in P

MTC

T

IF p

olic

y u

pd

ated

b

ased

on

WH

O2

010

gu

idel

ine

IF

tr

ain

ing/

cou

nse

lin

g fo

r H

IV +

m

oth

ers

HIV

& IF

in IY

CF

mat

eria

ls

IF & HIV IYCF

materials

updated

IF in PMTC

T mater

ials

PMTCT

material

s updated Jo

b a

ids

on

HIV

&

IF

Job

aid

s u

pd

ated

HW

tra

ined

on

IF

& H

IV?

HW

tra

ined

on

HIV

& IF

co

un

selin

g IF

co

un

selin

g

inte

grat

ed in

P

MTC

T

HIV

+ m

oth

ers

sup

po

rt o

n IF

Fr

ee in

fan

t

form

ula

to

HIV

+m

oth

ers

Infa

nt

Form

ula

pro

vid

ed b

y G

ove

rnm

ent

Infa

nt

form

ula

pro

vid

ed b

y N

GO

s

Mo

nit

ori

ng

syst

em

on

IF p

ract

ices

amo

ng

HIV

+ m

oth

ers

HIV and IF SCORE

Number 12 9 10 12 9 8 9 10 9 9 7 9 10 9 8 9 4 5 5

Total 14 12 13 13 14 9 9 13 9 11 7 11 14 13 12 14 7 8 14

Percent 85.7 75.0 76.9 92.3 64.3 88.9 100 76.9 100 81.8

100 81.8 71.4 69.2 66.7 64.3 57.1 62.5 35.7

ESAR 7

Rwanda 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 9

Zimbabwe 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9

Mozambique 1 1 1 1

1 na

1 1 0 1 na 1 1 1 1 1 1 0 1 8

Zambia 1 na 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9

Malawi 1 1 1 1 1 1 0 1 0 1 na na 1 1 1 na na na na 6

Swaziland 1 1 1 1 1 1 0 1 0 1 0 1 1 1 1 1 0 1 1 8

Namibia 1 1 1 1 1 1 1 1 na 0 na 1 na 1 1 1 0 1 0 7

South Africa 1 1 1 na

1 1 0 1 1 0 na 1 1 1 1 1 0 1 1 7

Kenya 1 1 1 1 1 1 0 1 0 1 0 1 1 1 1 0 na na 0 6

Ethiopia 1 1 1 0 1 1 0 1 0 1 0 0 1 1 0 0 na na 0 5

Botswana 0 na na na 1 0 na 1 0 1 0 na 1 0 1 0 na na 0 3

Madagascar 1 1 1 1

1 1 1 1 na 1 1 na 1 1 na 0 na na 1 7

Burundi 1 0 1 0 0 na na 1 1 0 na 0 0 1 0 0 na na 0 3

Angola 1 0 1 0 0 na na 1 0 0 na 1 1 1 0 na na 0 3

Uganda 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 1 8

Tanzania 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 0 8

Somalia 1 1 1 1 1 1 1 1 1 0 na 1 1 1 1 0 na na 0 7

Number 16 13 16 11 15 13 9 17 8 12 6 12 15 16 13 7 2 5 2

Total 17 15 16 15 17 14 14 17 15 17 10 14 16 17 16 15 7 7 17

Percent 94.1 86.7 100 73.3 88.2 92.9 64.3 100 53.3 70.

6 60.0 85.7 93.8 94.1 81.3 46.7 28.6 71.4 11.8

M=7 MENA

Yemen 0 na na na na na na 1 0 na na 1 1 1 1 0 na na 0 3

S. Sudan 1 1 1 0 0 na na 0 na 0 na na 0 0 0 1 0 1 0 3

N. Sudan 1 1 1 0 0 na na na na 0 na na 0 0 0 0 na na 0 3

Number 2 2 2 0 0 na na 1 0 0 na na 1 1 1 1 0 1 0

Total 3 2 2 2 2 na na 2 1 2 na na 3 3 3 3 1 1 3

Percent 66.7 100 100 0.0 0.0 na na 50.0 0.0 0.0 na na 33.3 33.3 33.3 33.3 0.0 100 0.0 M=3 ROSA

Afghanistan 1 1 1 1

0 na na 1 1 0 na 1 1 1 1 1 1 0 na 6

Banglades 1 1 1 1 0 na na 1 1 1 0 1 0 0 0 1 0 1 0 5

151

IYCF in difficult circumstances (HIV and infant feeding)

POLICY TRAINING/ COUNSELLING BMS

Country

IF a

nd

HIV

po

licy

IF &

HIV

in n

atio

nal

IYC

F p

olic

y

IF &

HIV

in P

MTC

T

IF p

olic

y u

pd

ated

b

ased

on

WH

O2

010

gu

idel

ine

IF

tr

ain

ing/

cou

nse

lin

g fo

r H

IV +

m

oth

ers

HIV

& IF

in IY

CF

mat

eria

ls

IF & HIV IYCF

materials

updated

IF in PMTC

T mater

ials

PMTCT

material

s updated Jo

b a

ids

on

HIV

&

IF

Job

aid

s u

pd

ated

HW

tra

ined

on

IF

& H

IV?

HW

tra

ined

on

HIV

& IF

co

un

selin

g IF

co

un

selin

g

inte

grat

ed in

P

MTC

T

HIV

+ m

oth

ers

sup

po

rt o

n IF

Fr

ee in

fan

t

form

ula

to

HIV

+m

oth

ers

Infa

nt

Form

ula

pro

vid

ed b

y G

ove

rnm

ent

Infa

nt

form

ula

pro

vid

ed b

y N

GO

s

Mo

nit

ori

ng

syst

em

on

IF p

ract

ices

amo

ng

HIV

+ m

oth

ers

HIV and IF SCORE

h

Bhutan 1 1 1 0 1 1 0 1 0 1 0 1 1 1 0 1 1 0 0 6

India 0 na na na 1 0 na 1 1 0 na 1 0 1 0 0 na na 0 3

Nepal 1 1 0 1 0 na na 1 1 0 na 0 0 na 1 na na na 0 3

Sri Lanka 1 1 1 1 0 na na 0 na 0 na 0 0 0 0 0 na na 1 3

Number 5 5 4 4 2 1 0 5 4 2 0 4 2 3 2 3 2 1 3

Total 6 5 5 5 6 2 1 6 5 6 2 6 6 5 6 5 3 3 6

Percent 83.3 100.

0 80.0 80.0 33.3 50.0 0.0 83.3 80.0 33.

3 0.0 66.7 33.3 60.0 33.3 60.0 66.7 33.3 50.0

M=4 WCAR

Benin 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 9

B. Faso 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 1 8

CAR 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 8

Congo B. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 na 9

Cote D'Ivoire

1 1 1 0 1 1 1 1 1 1 na 1 1 1 1 1 0 1 na 8

DRC 0 na 1 1 1 1 1 1 1 1 1 1 1 1 0 1 na na 0 7

Gabon 1 1 na 0 1 1 0 1 0 1 0 na 1 1 1 1 0 1 na 6

Gambia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 na na 1 8

Ghana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 9

Liberia 0 na na na 1 1 0 1 1 1 0 1 1 1 0 0 na na na 4

Mali 1 1 1 0 1 0 na 1 0 0 na 1 0 1 1 1 0 1 1 6

Mauritania 1 1 1 1 0 0 na 1 1 0 na 1 1 1 0 0 na na 0 5

Niger 1 1 1 1 1 1 na 1 na 0 na 1 1 1 na 0 na na 1 6

Nigeria 1 1 1 1 1 1 0 1 na 1 na na na 1 0 1 0 1 1 6

Senegal 1 1 1 0 1 0 na 1 1 0 0 0 1 0 0 na na na 4

S. Leone 1 1 1 1 1 1 1 0 na na na 0 na na na na 0 na 0 4

Togo 1 1 1 1 0 na na na na na na na na na na na na na 1 3

Number 15 15 15 11 15 13 9 15 11 11 7 12 12 15 9 9 1 7 4

Total 17 15 15 16 17 16 12 16 13 15 9 14 14 15 14 15 9 8 14

Percent 88.2 100 100 68.8 88.2 81.3 75.0 93.8 84.6 73.

3 77.8 85.7 85.7 100.

0 64.3 60.0 11.1 87.5 28.6

M=6

ALL

Number 54 47 53 42 47 40 31 55 38 36 23 45 44 50 38 35 14 21 17

Total 64 53 57 57 65 46 41 61 50 57 31 54 59 58 57 60 33 33 62

Percent 84.4 88.7 93.0 73.7 72.3 87.0 75.6 90.2 76.0 63.

2 74.2 83.3 74.6 86.2 66.7 58.3 42.4 63.6 27.4 M=6

na= no response /not applicable, 1=Yes, 0= No; Nutritionally vulnerable countries highlighted in yellow

152

ANNEX 5r:

IYCF in difficult circumstances

IYCF in difficult circumstances (Infant feeding in emergency)

Country

Nat

ion

al IY

CF

po

licy

incl

ud

es IY

CF

in

Emer

g.

Nat

ion

al

Emer

g.p

rep

ared

nes

s

pla

n in

clu

de

IYC

F in

Em

erg.

Nat

ion

al E

mer

g.

Pre

p.

Pla

n u

pd

ated

*

Up

-to

-dat

e gu

idel

ines

/tra

inin

g

mat

eria

ls o

n IY

CF

in

Emer

g.

HW

s/IY

CF

cou

nse

llors

tra

ined

o

n IY

CF

in E

me

rg.

Trai

nin

g m

ater

ials

p

rete

sted

Effe

ctiv

enes

s o

f m

essa

ges

test

ed

Bas

elin

e o

n K

AP

con

du

cted

Po

st-i

nte

rven

tio

n o

f

KA

P c

on

du

cted

BM

S p

rovi

ded

in

emer

gen

cies

Go

vt

pro

cure

s/d

istr

ibu

te

BM

S d

uri

ng

emer

gen

cies

Go

vt a

ccep

t

do

nat

ion

s o

f in

fan

t

foo

ds

IF in

Em

erg

en

cies

SCO

RE

CEE/CIS Uzbekistan 0 0 na na 0 na 0 na na 1 1 1 2

Romania 0 0 na na 0 na na na na 0 na Na 0

Kosovo na na na na 0 na na na na 0 na na 0

Kazakhstan 0 0 na na 0 na 0 na na 0 na na 0

Bosnia & Herz. 0 0 na na 0 na 0 0 0 1 1 1 2

Turkmenistan 0 na na na 0 na na na na 0 na na 0

Tajikistan 1 1 0 0 0 0 0 0 0 0 0 0 2

Kyrgyzstan 0 0 na na 0 na 0 0 0 1 0 1 2

Number 1 1 0 0 0 0 0 0 0 3 2 3 M = 1.0

Total 7 6 1 1 7 1 5 4 4 8 4 4

Percent 14.3 16.7 0 0 0 0 0 0 0 37.5 50.0 75.0 EAPR

Vietnam 1 1 1 na 0 na 0 na na 0 na na 2 Philippines 1 na na 0 1 1 na 1 na 1 1 0 5 China 0 0 na na 1 1 na 1 1 1 0 1 5 Thailand 1 1 1 na na na na na na 1 0 1 4 Vanuatu 1 1 1 1 0 na 0 0 0 1 0 na 4 Indonesia 0 1 1 1 1 na 0 na na 1 0 0 4 Myanmar 1 1 0 1 0 0 0 0 0 0 na na 2 Korea na 1 na 1 na na na na na 0 na na 2 P. N. Guinea 0 0 0 0 1 0 0 0 0 0 0 0 1 Lao PDR 0 0 na na 0 0 0 0 0 0 na na 0 Mongolia 0 0 na na 0 na 0 na na 0 na na 0 Fiji 0 1 na 0 0 na 0 0 0 0 na na 1 Timor Leste 0 1 0 0 0 0 0 0 0 0 0 1 2 Cambodia 1 0 0 na 0 na 0 na na 0 na na 2 Number 6 8 5 4 4 2 0 2 1 5 1 3

Total 13 13 8 8 12 7 10 8 7 14 7 6 M = 2.4

Percent 46.2 61.5 62.5 50.0 33.3 28.6 0.0 25.0 14.3 35.7 14.3 50.0 ESAR

Rwanda 1 1 1 0 0 0 0 0 0 0 0 0 2

Zimbabwe 0 1 na na 0 na 0 na na 0 na na 1

Mozambique 0 0 0 na 0 na 0 na na 0 na na 0

Zambia 0 0 na na 0 na 0 na na 0 na na 0

Malawi 1 1 na na 0 na 1 na na 0 na na 2

153

IYCF in difficult circumstances (Infant feeding in emergency)

Country

Nat

ion

al IY

CF

po

licy

incl

ud

es IY

CF

in

Emer

g.

Nat

ion

al

Emer

g.p

rep

ared

nes

s

pla

n in

clu

de

IYC

F in

Em

erg.

Nat

ion

al E

mer

g.

Pre

p.

Pla

n u

pd

ated

*

Up

-to

-dat

e gu

idel

ines

/tra

inin

g

mat

eria

ls o

n IY

CF

in

Emer

g.

HW

s/IY

CF

cou

nse

llors

tra

ined

o

n IY

CF

in E

me

rg.

Trai

nin

g m

ater

ials

p

rete

sted

Effe

ctiv

enes

s o

f m

essa

ges

test

ed

Bas

elin

e o

n K

AP

con

du

cted

Po

st-i

nte

rven

tio

n o

f

KA

P c

on

du

cted

BM

S p

rovi

ded

in

emer

gen

cies

Go

vt

pro

cure

s/d

istr

ibu

te

BM

S d

uri

ng

emer

gen

cies

Go

vt a

ccep

t

do

nat

ion

s o

f in

fan

t

foo

ds

IF in

Em

erg

en

cies

SCO

RE

Swaziland 0 1 0 0 0 1 0 0 0 0 0 0 2

Namibia 0 0 na na 0 na 0 na na 0 na na 0

South Africa 1 0 0 0 0 na 0 0 0 1 0 1 2

Kenya 1 1 1 0 0 na 0 0 0 0 0 0 2

Ethiopia 1 0 na na 0 na na na na 0 na na 1

Botswana 0 0 na na 0 na 0 na na 1 1 0 2

Madagascar 0 1 1 na na na 0 na na 0 na na 2

Burundi 0 0 na na 0 0 na 0 na 0 na na 0

Angola 0 0 na na 0 na 0 0 0 0 0 0 0

Uganda 1 0 - na 0 0 0 0 0 0 na na 2

Tanzania 1 1 na 1 0 na na na na 0 na na 2

Somalia 0 0 na na 0 na 0 na na 0 na na 0

Number 7 7 4 1 0 1 1 0 0 2 1 1

Total 17 17 7 5 16 4 14 10 6 17 6 6 M = 1.2

Percent 41.2 41.2 57.1 20.0 0.0 25.0 7.1 0.0 0.0 11.8 16.7 16.7 MENA

Yemen 1 1 0 0 1 1 0 0 0 0 0 0 3

S. Sudan na 1 0 0 1 1 1 1 0 0 na na 4

N. Sudan 1 1 1 0 0 0 0 1 0 0 na na 3

Number 2 3 1 0 2 2 1 2 0 0 0 0

Total 2 3 3 3 2 3 3 3 3 3 1 1 M = 3.3

Percent 100 100 33.3 0.0 66.7 33.3 66.7 0.0 0.0 0.0 0.0 0.0 ROSA

Afghanistan 1 1 0 0 0 na na na na 1 0 0 2

Bangladesh 1 0 0 na 0 0 0 0 0 1 0 0 2

Bhutan 1 1 0 0 0 na 0 0 0 na na na 2

India 0 0 na na 0 na 0 na na 0 na na 0

Nepal 1 1 na 1 1 0 na 0 0 0 0 0 3

Sri Lanka 1 1 1 1 na na na na na 1 0 1 5

Number 5 4 2 2 1 0 0 0 0 3 0 1

Total 6 6 4 4 5 2 3 3 3 5 4 4 M = 2.3

Percent 83.3 66.7 50.0 50.0 20.0 0.0 0.0 0.0 0.0 60.0 0.0 25.0 WCAR

Benin 0 0 na na 0 0 0 0 0 0 0 0 0

B. Faso 0 0 na na 0 na 1 1 0 na na na 2

CAR 1 1 0 0 0 na 0 na na 0 na na 2

Congo B. 1 1 0 na 1 0 1 1 1 0 na na 5

Cote D'Ivoire na na na na na na na na na na na na 0

DRC 1 1 0 0 0 0 0 0 0 1 0 0 2

Gabon 1 na na na na 0 na 0 0 0 na na 1

Gambia 1 0 1 na 1 0 0 0 0 0 0 0 2

Ghana 1 1 1 1 1 1 0 0 0 0 na na 5

154

IYCF in difficult circumstances (Infant feeding in emergency)

Country

Nat

ion

al IY

CF

po

licy

incl

ud

es IY

CF

in

Emer

g.

Nat

ion

al

Emer

g.p

rep

ared

nes

s

pla

n in

clu

de

IYC

F in

Em

erg.

Nat

ion

al E

mer

g.

Pre

p.

Pla

n u

pd

ated

*

Up

-to

-dat

e gu

idel

ines

/tra

inin

g

mat

eria

ls o

n IY

CF

in

Emer

g.

HW

s/IY

CF

cou

nse

llors

tra

ined

o

n IY

CF

in E

me

rg.

Trai

nin

g m

ater

ials

p

rete

sted

Effe

ctiv

enes

s o

f m

essa

ges

test

ed

Bas

elin

e o

n K

AP

con

du

cted

Po

st-i

nte

rven

tio

n o

f

KA

P c

on

du

cted

BM

S p

rovi

ded

in

emer

gen

cies

Go

vt

pro

cure

s/d

istr

ibu

te

BM

S d

uri

ng

emer

gen

cies

Go

vt a

ccep

t

do

nat

ion

s o

f in

fan

t

foo

ds

IF in

Em

erg

en

cies

SCO

RE

Liberia 0 na na na na na na na na na 0 0 0

Mali 1 0 - na 1 1 1 0 0 1 0 1 6

Mauritania 1 1 1 0 0 1 na 0 0 1 na 1 5

Niger 1 0 na na 0 na 0 na na 0 na na 1

Nigeria 1 1 1 1 1 1 0 1 1 0 0 0 7

Senegal 1 1 1 na 0 na 1 1 1 1 1 1 7

S. Leone 0 0 na na 1 0 0 0 0 0 na na 1

Togo 1 1 1 1 1 1 1 1 0 0 na na 7

Number 12 8 7 3 7 5 5 5 3 4 1 3

Total 16 14 10 6 15 10 14 13 13 14 7 8

Percent 75.0 57.1 70.0 50.0 46.7 50.0 35.7 38.5 23.1 28.6 14.3 37.5 M =3.1

ALL 26 24 15 9 14 9 6 9 4 15 4 10 2.1

Number 63 59 59 27 58 58 49 41 36 61 29 29

Total 41.3 40.7 25.4 33.3 24.1 15.5 12.2 22.0 11.1 24.6 13.8 34.5

Percent

na= no response /not applicable, 1=Yes, 0= No, 1= yes, 0=no Nutritionally vulnerable countries highlighted in yellow.

155

ANNEX 5S:

Overall IYCF in difficult circumstances

Country HIV and IF

SUB-SCORE IF in Emergencies

SUB-SCORE IYCF in Diff. Circums.

SCORE

CEE/CIS

Uzbekistan 9 2 5

Romania 7 0 3

Kosovo 4 0 2

Kazakhstan 2 0 1

Bosnia & Herz. 2 2 2

Turkmenistan 8 0 4

Tajikistan 7 2 4

Kyrgyzstan 7 2 4

Mean 6 1 3

EAPR

Vietnam 8 2 5

Philippines 7 5 6

China 8 5 6

Thailand 6 4 5

Vanuatu 7 4 5

Indonesia 2 4 3

Myanmar 7 2 4

Korea 1 2 1

P. N. Guinea 8 1 4

Lao PDR 8 0 4

Mongolia 3 0 1

Fiji 8 1 4

Timor Leste 3 2 2

Cambodia 9 2 5

Mean 6 2 4

ESAR

Rwanda 9 2 5

Zimbabwe 9 1 5

Mozambique 8 0 4

Zambia 9 0 4

Malawi 6 2 4

Swaziland 8 2 5

Namibia 7 0 3

South Africa 7 2 4

Kenya 6 2 4

Ethiopia 5 1 3

Botswana 3 2 2

Madagascar 7 2 4

Burundi 3 0 1

Angola 3 0 1

Uganda 8 2 5

Tanzania 8 2 5

Somalia 7 0 3

Mean 7 1 4

Country HIV and IF IF in Emergencies IYCF in Diff. Circums.

156

SUB-SCORE SUB-SCORE SCORE

MENA

Yemen 3 3 3

S. Sudan 3 4 3

N. Sudan 3 3 3

Mean 3 3 3

ROSA

Afghanistan 6 2 4

Bangladesh 5 2 3

Bhutan 6 2 4

India 3 0 1

Nepal 3 3 3

Sri Lanka 3 5 4

Mean 4 2 3

WCAR

Benin 9 0 4

B. Faso 8 2 5

CAR 8 2 5

Congo B. 9 5 7

Cote D'Ivoire 8 0 4

DRC 7 2 4

Gabon 6 1 3

Gambia 8 2 5

Ghana 9 5 7

Liberia 4 0 2

Mali 6 6 6

Mauritania 5 5 5

Niger 6 1 3

Nigeria 6 7 6

Senegal 4 7 5

S. Leone 4 1 2

Togo 3 7 5

Mean 6 3 5

TOTAL MEAN 6 2 4

na= no response /not applicable, 1=Yes, 0= No

157

ANNEX 5t:

IYCF Monitoring and evaluation

National level M&E system

M&E at the health system level

M&E at the Community-

level

COUNTRY

M & E for

national

IYCF

undertaken

Baseline

assessment

of EBF

rate

available

Baseline

assessment

of barriers

and

facilitators

for

breastfeeding

available eg.

KAP study

Baseline

assessment

of CF

situation

available

Ongoing

food

security

surveillance

system

Ongoing

nutrition

surveillance

system

Routine

monitoring

of ongoing

IYCF

activities?

Routine

monitoring

of skills of

health

workers?

Routine

monitoring

of quality

of

counseling

_e.g. KAP

surveys of

mothers_?

Monitoring

of other

program

process

indicators

_e.g. # HW

trained)

Evaluation

or review

of IYCF

situation?

Routine

monitoring

of ongoing

IYCF

activities in

the

community?

Routine

monitoring

of skills of

community

health

workers?

Routine

monitoring

of quality

of

counseling

by CHW

_e.g. KAP

surveys of

mothers_?

M&E

Score

CEE/CIS

BOSNIA AND

HERZEGOVINA

0 1 0 1 0 0 0 1 0 0 0 0 1 0

3

KAZAKASTAN 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1

Kosovo 0 1 0 0 0 0 na na na na na na na na 1

KYRGYZSTAN 1 na 1 1 1 1 1 0 0 1 0 0 0 5

Romania 0 0 0 0 0 0 0 na na 0 0 0 na na 0

Tajikistan 1 1 1 1 1 1 1 1 1 0 1 na 0 0 7

Turkemnistan 0 1 1 1 1 0 0 0 0 0 1 na na na 3

UZBEKISTAN 1 0 0 0 0 0 1 1 0 1 1 na na 3

n 3 5 2 4 4 2 3 4 1 1 4 0 1 0

N 8 7 8 8 8 8 7 6 6 7 7 4 4 5 M

% 37.5 71.4 25.0 50.0 50.0 25.0 42.9 66.7 16.7 14.3 57.1 0.0 25.0 0.0 3

EAPR

Cambodia 1 1 1 1 na na 1 1 1 1 0 1 1 0 7

China 1 0 1 1 1 1 0 0 0 0 0 0 0 0 3

Fiji 0 1 1 0 0 1 0 0 0 0 0 0 0 0 2

Indonesia 1 1 1 1 na 1 1 0 0 0 0 na na na 4

Korea na 1 0 1 na na na na na na na na na na 1

Lao People's 1 1 1 1 0 0 0 0 0 1 0 na na na 3

158

National level M&E system

M&E at the health system level

M&E at the Community-

level

COUNTRY

M & E for

national

IYCF

undertaken

Baseline

assessment

of EBF

rate

available

Baseline

assessment

of barriers

and

facilitators

for

breastfeeding

available eg.

KAP study

Baseline

assessment

of CF

situation

available

Ongoing

food

security

surveillance

system

Ongoing

nutrition

surveillance

system

Routine

monitoring

of ongoing

IYCF

activities?

Routine

monitoring

of skills of

health

workers?

Routine

monitoring

of quality

of

counseling

_e.g. KAP

surveys of

mothers_?

Monitoring

of other

program

process

indicators

_e.g. # HW

trained)

Evaluation

or review

of IYCF

situation?

Routine

monitoring

of ongoing

IYCF

activities in

the

community?

Routine

monitoring

of skills of

community

health

workers?

Routine

monitoring

of quality

of

counseling

by CHW

_e.g. KAP

surveys of

mothers_?

M&E

Score

Democratic

Republic

Mongolia 1 1 0 1 0 1 1 1 0 0 1 0 na na 5

MYANMAR na 1 1 1 na 1 1 0 0 0 1 0 na na 4

Papua New Guinea 0 1 1 1 0 1 0 0 0 0 1 0 0 0 3

Philippines 1 1 1 na na na 1 na 0 1 1 na 0 na 4

Thailand 1 1 1 na na na 1 na na na 0 na na na 3

TIMOR-LESTE na 1 1 1 1 1 1 0 0 0 1 0 0 0 4

Vanuatu 0 1 1 1 0 1 0 0 0 0 1 0 0 0 3

VIETNAM 1 1 1 1 1 1 1 1 0 1 1 1 0 0 7

n 8 13 12 11 3 9 8 3 1 4 7 2 1 0

N 11 14 14 12 8 10 13 11 12 12 13 9 8 7 M

% 72.7 92.9 85.7 91.7 37.5 90.0 61.5 27.3 8.3 33.3 53.8 22.2 12.5 0.0 4

ESAR

Angola 0 1 1 0 1 0 0 0 0 0 0 0 0 0 2

Botswana 1 1 na 0 1 1 0 na na 0 1 na na na 3

Burundi 0 1 1 1 1 1 0 0 0 0 0 0 0 0 3

Ethiopia 1 1 0 1 1 0 0 na na 1 0 0 0 0 3

Kenya 1 1 1 1 1 0 0 0 0 0 1 1 1 0 5

Madagascar 1 1 1 0 1 1 0 0 0 0 0 1 1 1 5

Malawi 1 1 0 1 1 1 1 1 0 1 1 0 0 na 6

Mozambique 1 1 1 0 1 1 1 0 0 1 0 0 0 0 5

NAMIBIA 1 1 1 0 0 na 0 0 0 0 0 0 0 0 2

RWANDA 1 1 1 1 1 1 1 1 1 0 1 1 1 1 9

159

National level M&E system

M&E at the health system level

M&E at the Community-

level

COUNTRY

M & E for

national

IYCF

undertaken

Baseline

assessment

of EBF

rate

available

Baseline

assessment

of barriers

and

facilitators

for

breastfeeding

available eg.

KAP study

Baseline

assessment

of CF

situation

available

Ongoing

food

security

surveillance

system

Ongoing

nutrition

surveillance

system

Routine

monitoring

of ongoing

IYCF

activities?

Routine

monitoring

of skills of

health

workers?

Routine

monitoring

of quality

of

counseling

_e.g. KAP

surveys of

mothers_?

Monitoring

of other

program

process

indicators

_e.g. # HW

trained)

Evaluation

or review

of IYCF

situation?

Routine

monitoring

of ongoing

IYCF

activities in

the

community?

Routine

monitoring

of skills of

community

health

workers?

Routine

monitoring

of quality

of

counseling

by CHW

_e.g. KAP

surveys of

mothers_?

M&E

Score

Somalia 1 1 1 1 1 1 1 0 0 1 1 1 0 0 7

South Africa 1 1 1 0 0 0 1 0 0 1 0 1 0 0 4

SWAZILAND 0 1 0 1 1 1 0 0 0 0 1 0 0 0 3

Tanzania 0 1 0 0 1 1 1 0 0 1 0 0 0 0 3

UGANDA 1 1 0 0 1 0 0 0 0 0 1 0 0 0 3

Zambia 1 1 0 1 1 1 0 na na 1 1 0 0 na 5

Zimbabwe 1 1 0 1 1 1 0 0 0 0 0 0 0 0 3

n 13 17 9 9 15 11 6 2 1 7 8 5 3 2

N 17 17 16 17 17 17 17 14 14 17 17 16 16 14 M

% 76.5 100.0 56.3 52.9 88.2 64.7 35.3 14.3 7.1 41.2 47.1 31.3 18.8 14.3 4

MENA

North Sudan 1 1 1 1 1 1 1 0 0 1 0 0 0 0 5

South Sudan 0 1 0 0 1 1 0 0 0 0 0 na na na 2

YEMEN 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1

n 1 3 1 1 2 2 1 0 0 1 0 0 0 0

N 3 3 3 3 3 3 3 3 3 3 3 2 2 2 M

% 33.3 100.0 33.3 33.3 66.7 66.7 33.3 0.0 0.0 33.3 0.0 0.0 0.0 0.0 3

ROSA

AFGHANISTAN 1 1 1 0 0 0 1 0 0 0 0 1 1 0 4

BANGLADESH 0 1 1 1 1 1 1 1 0 0 1 0 0 0 5

Bhutan 0 1 1 1 0 1 0 na na 0 1 0 0 0 3

India 1 1 1 1 0 1 1 1 1 na 1 na 0 0 6

Nepal 0 1 1 1 1 0 0 0 0 0 1 0 0 0 3

160

National level M&E system

M&E at the health system level

M&E at the Community-

level

COUNTRY

M & E for

national

IYCF

undertaken

Baseline

assessment

of EBF

rate

available

Baseline

assessment

of barriers

and

facilitators

for

breastfeeding

available eg.

KAP study

Baseline

assessment

of CF

situation

available

Ongoing

food

security

surveillance

system

Ongoing

nutrition

surveillance

system

Routine

monitoring

of ongoing

IYCF

activities?

Routine

monitoring

of skills of

health

workers?

Routine

monitoring

of quality

of

counseling

_e.g. KAP

surveys of

mothers_?

Monitoring

of other

program

process

indicators

_e.g. # HW

trained)

Evaluation

or review

of IYCF

situation?

Routine

monitoring

of ongoing

IYCF

activities in

the

community?

Routine

monitoring

of skills of

community

health

workers?

Routine

monitoring

of quality

of

counseling

by CHW

_e.g. KAP

surveys of

mothers_?

M&E

Score

Sri Lanka 1 1 1 1 0 1 1 1 1 1 0 0 0 0 6

n 3 6 6 5 2 4 4 3 2 1 4 1 1 0

N 6 6 6 6 6 6 6 5 5 5 6 5 6 6 M

% 50.0 100.0 100.0 83.3 33.3 66.7 66.7 60.0 40.0 20.0 66.7 20.0 16.7 0.0 5

WCAR

Gambia 1 1 1 0 1 1 1 0 0 1 1 1 0 0 6

BENIN 0 1 1 0 1 0 0 0 0 0 1 0 0 0 3

Burkina Faso 1 1 1 1 1 1 0 0 0 1 0 1 1 0 6

CAR 1 1 0 0 1 0 0 1 1 1 1 0 0 0 5

Congo Brazzaville na 1 0 0 0 1 0 na na 0 1 0 0 0 2

Cote d'Ivoire 0 na na na na na 0 na na na na na na na 0

DRC 1 1 1 1 1 1 1 1 1 0 1 0 na na 7

GABON 0 1 na 1 0 1 1 1 1 0 1 na na na 5

Ghana 1 1 1 1 1 0 1 1 0 1 1 1 1 0 7

Liberia 1 1 1 1 1 0 0 na na na na na na na 3

MALI 1 1 0 0 1 1 1 0 0 0 0 1 1 0 5

MAURITANIA 1 1 1 1 1 1 1 0 0 1 1 1 0 0 7

NIGER 1 1 0 1 1 1 na 0 0 0 0 0 0 0 3

Nigeria 0 1 1 1 1 1 1 1 1 1 1 1 1 1 9

Senegal 1 1 1 1 1 1 0 na na na 1 na 1 1 6

Sierra Leone 0 1 1 0 0 1 1 0 na 0 0 1 1 0 4

Togo 1 1 1 1 1 1 1 1 1 na 1 1 1 1 9

n 11 16 11 10 13 12 9 6 5 6 11 8 7 3

N 16 17 15 16 16 16 16 14 12 13 15 13 13 13 M

161

National level M&E system

M&E at the health system level

M&E at the Community-

level

COUNTRY

M & E for

national

IYCF

undertaken

Baseline

assessment

of EBF

rate

available

Baseline

assessment

of barriers

and

facilitators

for

breastfeeding

available eg.

KAP study

Baseline

assessment

of CF

situation

available

Ongoing

food

security

surveillance

system

Ongoing

nutrition

surveillance

system

Routine

monitoring

of ongoing

IYCF

activities?

Routine

monitoring

of skills of

health

workers?

Routine

monitoring

of quality

of

counseling

_e.g. KAP

surveys of

mothers_?

Monitoring

of other

program

process

indicators

_e.g. # HW

trained)

Evaluation

or review

of IYCF

situation?

Routine

monitoring

of ongoing

IYCF

activities in

the

community?

Routine

monitoring

of skills of

community

health

workers?

Routine

monitoring

of quality

of

counseling

by CHW

_e.g. KAP

surveys of

mothers_?

M&E

Score

% 68.8 94.1 73.3 62.5 81.3 75.0 56.3 42.9 41.7 46.2 73.3 61.5 53.8 23.1 5

ALL COUNTRY M

n 39 60 41 40 39 40 31 18 10 20 34 16 13 5 4

N 61 64 62 62 58 60 62 53 52 57 61 49 49 47

% 63.9 93.8 66.1 64.5 67.2 66.7 50.0 34.0 19.2 35.1 55.7 32.7 26.5 10.6