Islamic Republic of Afghanistan Ministry of Public Health

National Infant and Young Child Feeding Policy and

Strategy 2009 - 2013

17st September 2009 Final version approved by the Executive Board

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � � � � ! " # � $ % This Infant Young Child Feeding Policy and Strategy was prepared by the MoPH Public Nutrition Department, with technical assistance from USAID/BASICS and in close collaboration with the IYCF Working Group*. The Public Nutrition Department and IYCF Working Group would like to extend their thanks to the Deputy Minister for Health Care Services Provision, the General Director of Health Care Services Provision, and the Director Preventive Medicine and Primary Health Care, for their continued support throughout the policy and strategy development process. The Public Nutrition Department is grateful for the suggestions presented by participants in the National Consensus Workshop on IYCF held in Kabul in March 2009, in particular, the Public Nutrition officers, and representatives of the MoPH Health Promotion Department, Community-Based Health Care Department, Integrated Management of Childhood Illnesses Department, MAIL, MRRD, MoWA, MoC, UNICEF, FAO, WHO, WFP, NGO’s (IbnSina, CHA, STEP, Save the Children US, Save the Children UK, AADA, CAF, TDH, NAC, AMI, Health Net, IMC, SHDP), Malalai Maternity Hospital and JICA. Their recommendations have been incorporated in the present document. Finally, the PND and IYCF working group expresses their appreciation of the support provided by the MoPH Policy and Planning Department, the Consultative Group on Health and Nutrition, the Technical Advisory Group and the Executive Board. * The IYCF Working Group members who contributed to the Policy and Strategy formulation and

preparation of the National Consensus Workshop included: Dr. Zarmina Safi, Dr. Mohammad Qasem Shams, Dr. Humayoun Ludin, Dr. Ahmad Wali Aminee, Dr. Ahmad Khalid, and other technical officers from the Public Nutrition Department; Dr. Stanekzai, Emily Levitt (PhD), Dr. Farooq Mujadidi, Charlotte Dufour, Dr. Razia, Dr. Sharifi, Dr. Paul Ickx, Dr. William Newbrander, Tom Schaetzel and Mary Ann Anderson from BASICS; Akbar Sharestani, Mahbooba Abawi and Silvia Kaufmann (FAO); Anna-Leena Rasanen and Jamshid Zewari (WFP); Dr. Adela Mubasher and Dr. Annie Begum (WHO); Henry Mdebwe and Dr. Shah Mahmood (UNICEF); Dr. Nowroz and Dr. Tariq Ihsan (Save the Children US); Dr. Sayed Qubad and Ali Maclaine (Save the Children UK).

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[ 7 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` � � 4 � 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 9 [2.3. Goal and objective of the National IYCF Policy and Strategy................................... 122.2. Vision for the IYCF Policy and Strategy.................................................................... 12

2.4. Purpose of the Infant and Young Child Feeding Policy and Strategy ........................ 122.5. Policy components ...................................................................................................... 13V > a > = > b C Q M c L A L D L C D L G A G B d Q O C S D B O O E L A I > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > V > b e R M H S L W O d Q O C S D B O O E L A I D G S L e X G A D K S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > ? > f S O G B R G X X O Q R L C M B G Q X H M C C A E Q O S Y O R D G B D K O J G E O G B g C Q h O D L A I G B i Q O C S D g L M hj H d S D L D H D O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > k > J G A D L A H O E d Q O C S D B O O E L A I D G D l G c O C Q S C A E d O c G A E > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > a > @ A D Q G E H R D L G A G B S G M L E m S O X L n S G M L E B G G E S C D S L e X G A D K S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = kV > a > o > P Q G X G D L G A G B X L R Q G A H D Q L O A D n Q L R K B G G E S C A E C Y Y Q G Y Q L C D O S H Y Y M O X O A D C D L G A > > > > > > > > > > = kV > a > p > g C D O Q A C M K O C M D K C A E A H D Q L D L G A > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = aV > a > U > J K L M E Q O A L A O e R O Y D L G A C M M c E L B B L R H M D R L Q R H X S D C A R O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = aV > a > q > @ A B C A D C A E F G H A I J K L M E N O O E L A I L A b X O Q I O A R L O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = a

.6. Guiding Policy principles ........................................................................................... 162r 7 s $ 5 / $ " 6 1 � 5 ` 5 � # � $ 4 � " t u $ 4 # / � \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " 7 7 7 7 7 7 7 7 7 7 7 7 7 7 9 v3.1. Advocacy, regulations and guidelines ........................................................................ 18? > = > = > w L S S O X L A C D L G A x C E W G R C R c C A E Q O S G H Q R O X G d L M L y C D L G A B G Q D K O z C D L G A C M @ A B C A D C A EF G H A I J K L M E N O O E L A I P G M L R c C A E j D Q C D O I c { > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = U? > = > V > b A B G Q R O X O A D G B D K O J G E O G B g C Q h O D L A I G B i Q O C S D g L M h j H d S D L D H D O S > > > > > > > > > > > > > > > > > > > > > > = q? > = > ? > T Y Y M L R C D L G A G B D K O g C D O Q A L D c P Q G D O R D L G A T R D > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = q? > = > k > | C Q X G A L y L A I x S D Q O A I D K O A L A I C A E R G X Y M O D L A I @ A B C A D C A E F G H A I J K L M E N O O E L A I} H L E O M L A O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = q? > = > a > T Y Y M L R C D L G A G B @ A B C A D C A E F G H A I J K L M E N O O E L A I L A b X O Q I O A R L O S } H L E O M L A O S > > > > > > > = q3.2. Behaviour change through awareness raising, counselling and community support . 20? > V > = > | C Q X G A L y O E P H d M L R T l C Q O A O S S ~ C L S L A I > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > V Z? > V > V > J G H A S O M M L A I D K Q G H I K R G X X H A L D c S H Y Y G Q D I Q G H Y S C A E L A D O Q W O A D L G A S > > > > > > > > > > > > > > > > > > > > V =? > V > ? > @ A D O I Q C D L G A G B @ A B C A D C A E F G H A I J K L M E N O O E L A I L A A G A n K O C M D K R G X X H A L D c n M O W O ML A D O Q W O A D L G A S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > V V3.3. Integration of Infant and Young Child Feeding promotion & counselling in the Basic Package of Health Services & Essential Package of Hospital Services ............................... 22? > ? > = > b e Y C A S L G A G B i C d c n N Q L O A E M c | G S Y L D C M @ A L D L C D L W O D G X G Q O K O C M D K B C R L M L D L O S > > > > > > > > > > > > V V? > ? > V > @ A D O I Q C D L G A G B @ A B C A D C A E F G H A I J K L M E N O O E L A I R G H A S O M M L A I L A C M M K O C M D K B C R L M L D L O SV V? > ? > ? > � Q C L A L A I G B K O C M D K S D C B B G A @ A B C A D C A E F G H A I J K L M E N O O E L A I > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > V ?� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

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.3. Estimated budget......................................................................................................... 244.2. Coordination mechanisms........................................................................................... 2448 7 � � � 4 $ � 5 4 � " / � ! � / � ; / $ 4 � � 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 [ 85.1. Regular monitoring and evaluation............................................................................. 25

5.3. Progress Reviews ........................................................................................................ 255.2. Operational research ................................................................................................... 25� � � � 9 � % ; � $ % 2 ^ / 4 � 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 [ <� � � � [ � 3 � " 4 � / � _ 5 / # � � 5 � � � / � 6 % 4 % 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 [ �� � � � r � � � 5 � u � / � 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 r [� � � � � � � % $ 4 # / $ ! � � % $ % � 1 $ ^ \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " % $ 5 / $ " 6 7 7 7 7 7 7 7 7 r <� � � � 8 � \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " � 1 5 � � % 1 � 5 � 1 " ^ / � 4 % $ / � 7 7 7 7 7 7 7 7 7 7 7 7 7 � [� � � � < � � � t 5 � � # # � ! ! \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " 4 � ! 4 � / $ � 5 % 7 7 7 7 7 7 � r

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\ # u 5 � � 4 � " \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " u 5 / � $ 4 � % 4 % % % � $ 4 / � $ � / � ^ 4 � $ ^ � / � $ ^/ � ! � ; $ 5 4 $ 4 � � s � $ � 5 s $ 5 / $ " 6 � 0 � � $ 4 � � 1 5 ! ; � 4 � " � ^ 4 � ! # � 5 $ / � 4 $ 6 7Afghanistan has the

3rd highest child mortality rate in the world (191 per thousand live births), with 327,000 children under 5 dying each year1. Malnutrition is a major underlying cause of child mortality and morbidity in Afghanistan, because poor nutritional status compromises a child’s ability to resist and recover from infections. Of the 327,000 children under age five who die each year in Afghanistan, at minimum 114,450 (35%) would have survived if they had been adequately nourished to support a strong immune system to fight infections. Malnutrition also affects children’s ability to learn in school and to become productive adults. Prevention of malnutrition and associated diseases would significantly reduce households’ health care costs. The economic costs of malnutrition to households and to the country undermine development efforts. � � ! 5 � ; $ 5 4 $ 4 � � 4 � 4 $ % � / 5 4 � ; % 1 � 5 # % 4 % ^ 4 " ^ � 6 u 5 � / � � $ 4 � � 1 " ^ / � 4 % $ / �

. According to the National Nutrition Survey (MoPH, 20042) and other surveys3, between 6 to 15% of children under 5 suffer from acute malnutrition (wasting), and over 50% from chronic malnutrition(stunting). Over 70% of children under 5 are iron and/or iodine deficient (MoPH, 2004). \ # u 5 � u 5 \ ] 2 _ u 5 / � $ 4 � % / 5 / # / � � 5 � / ; % � 1 ; � ! 5 � ; $ 5 4 $ 4 � � 4 � � 1 " ^ / � 4 % $ / �

. Around 40% of admissions in therapeutic feeding units (for the treatment of severe acute malnutrition) are under 6 months of age, pointing to breastfeeding problems as a primary cause. Furthermore, nutritional survey results show that acute malnutrition is highest in children 6-29 months of age. These data suggest that nutrition interventions should focus in this age group, and that improving feeding of children under 2 years of age would lead to significant reductions in malnutrition rates. Improvements in early childhood nutrition also contribute to improved health outcomes in later life. ` � $ � $ 4 / � 4 # u / � $ � 1 4 # u 5 � � 4 � " \ ] 2 _ 7

A review of child survival interventions in 42 countries revealed that promotion, support and protection of exclusive breastfeeding for the first six months of a child’s life prevents 13% of all deaths under 5 years in countries with a high child mortality rate4. The review also showed that continued breastfeeding up to two years with appropriate introduction of solid/semi-solid foods at six months (complementary feeding) contributes to a 6% reduction in child mortality. \ � $ 5 � / $ 4 � � / � 5 � ; 4 5 # � $ % � � \ ] 2 _ 7

In 2002, the Fifty-fifth World Health Assembly and the UNICEF Executive Board endorsed The Global Strategy for Infant and Young Child Feeding. According to clauses 36 and 37 of the Global Strategy, “The primary obligation of governments is to formulate, implement, monitor and evaluate a comprehensive national policy on infant and young child feeding” and “a detailed action plan should accompany the

1 UNICEF. (2006). Afghanistan Statistics. Accessed at: http://www.unicef.org/infobycountry/afghanistan_statistics.html 2 MOPH, UNICEF, CDC and Tufts University. (2004). National Nutrition Survey. Atlanta, GA: CDC. 3 MOPH Public Nutrition Policy and Strategy (2003) 4 WHO. (2003). Global Strategy for Infant and Young Child Feeding. Geneva: WHO. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

6

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �comprehensive policy”. For this reason, the Public Nutrition Department of MoPH has elaborated the present IYCF Policy and Strategy for 2009-2013. The present document is the result of an extensive consultation process facilitated by the Public Nutrition Department and USAID/BASICS, UNICEF, WHO, WFP, FAO), NGOs, MoPH Departments (HPD, CBHC & IMCI), MAIL, MRRD, MoWA and MoC. The recommendations from a National Consensus-building Workshop on IYCF, conducted in March, are incorporated here. 2 � # u � # � $ / 5 4 $ 6 � 4 $ ^ � $ ^ 5 � � ` � ` � � 4 � 4 % / � ! s $ 5 / $ " 4 % 7

The present document is designed to complement the MoPH Policies and Strategies on Child and Adolescent Health, Public Nutrition, Reproductive Health, as well as the Health and Nutrition Communication Strategy, by describing specific policy issues and strategic approaches related to Infant and Young Child Feeding, in accordance with the Global Strategy on IYCF. 9 7 [ 7 � 1 4 � 4 $ 4 � � % � 1 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` 5 / � $ 4 � %� / 5 � 6 4 � 4 $ 4 / $ 4 � � � 1 0 5 / % $ 1 ! 4 � "Early initiation of breastfeeding within the first hour of birth is recommended so that infants receive the ‘first milk’ (colostrum), which is rich in immunological factors and nutrients required by the neonate. Colostrum is available to the child only during the earliest days postpartum.� � � � ; % 4 � 0 5 / % $ 1 ! 4 � " � � � < # � � $ ^ % �Exclusive breastfeeding refers to a breast milk-only diet for the infant during the first six months of life. Other liquids (i.e. water, tea, juices, and ritual liquids) and solid/semi-solid foods are to be avoided. Exclusive breastfeeding has been shown to be associated with a reduced incidence of diarrhoea, respiratory infections and allergies. Promotion of exclusive breastfeeding is a key child survival strategy in resource-constrained countries5. 2 � � $ 4 � ; ! 0 5 / % $ 1 ! 4 � " � ; � $ 4 � [ 6 / 5 % �Continued breastfeeding at a sustained high level at least for the first year and continued breastfeeding until two years and beyond is beneficial for both infants’ nutrition and mothers’ lactational amenorrhea (cessation of menses during lactation), a natural method of birth spacing. � u u 5 � u 5 4 / $ � � # u � # � $ / 5 6 1 ! 4 � " � 4 � $ 5 � ! ; � $ 4 � � � 1 % � � 4 ! � % # 4 � % � � 4 ! 1 � � ! % �Children 6-24 months old are to continue breastfeeding adding “nutritionally adequate, safe and appropriate”

R G X Y M O X O A D C Q c B G G E S until age two years during their transition to the family

diet6. These first foods are termed ‘complementary’ because they are to be given as a complement (addition) to breast milk. After the age of six months breast milk provides some but not all of the nutrients a child needs for healthy growth and development and additional foods from the family food supply are required for the child. Complementary feeding is essential to provide needed nutrients, specifically iron, zinc, vitamin A, energy and protein for the growing infants that are in insufficient quantities in breast milk to meet the nutrient requirements for health and growth.

5 WHO collaborative study team on the role of breastfeeding on the prevention of infant mortality. (2000). Effect of breast feeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet, 355 (9202). 6 WHO. (2001). Guiding Principles for Complementary Feeding of the Breastfed Child. Geneva: WHO. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

7

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Complementary foods should not replace breastfeeding as a source of nourishment for the child. They are therefore

A G D �weaning’ foods, because children are encouraged to fully

continue breastfeeding during this period and should not be referred to as such. These foods are also different from ‘supplementary’ foods (given from outside sources to the household as a therapeutic treatment to a sick child for a short period of time). : 5 / % $ � 4 � � s ; 0 % $ 4 $ ; $ % � : � s � �

any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose. These include infant formula, other milk products, therapeutic milk, and bottle-fed complementary foods marketed for children up to 2 years of age and complementary foods, juices, teas marketed for infants under 6 months. 9 7 r 7 s 4 $ ; / $ 4 � � � � / � 6 % 4 %� � � � � �   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ° ± £ ² ¤ ¬ ² ¯ ³ ¬ ¡ ´ ¢ © « £ ¡ ¬ ³ ¤ £ ¡Formative research and field experience show that most caregivers do not follow appropriate IYCF, as demonstrated by the data presented in Table 1, below. Furthermore, the data presented in Table 1 must be interpreted with caution for the following reasons: the indicators used in different surveys are not systematically the same and thus not always comparable; data can be affected by “responder bias”, whereby interviewees say they do the recommended practice even if they do not; finally, there are considerable variations across regions, making it difficult to extrapolate provincial data to the rest of the country and to interpret national averages. The lack of appropriate data on IYCF is in itself a problem that needs to be addressed. µ ¶ · ¸ ¹ º »

¼ ½ ¹ ¾ ½ ¿ ¹ À Á Â Ã Ä ¾ ½ ¹ Å ¾ ¹ Ã Ä ¸ Æ Ã Á Ç È É Ê Ë Ì ¾ ¶ Í Æ ¿ Í ¹ Ã ¿ Ç Î Â Ï Ð ¶ Ç ¿ Ã Æ ¶ Ç. Ñ Ò Ó Ô Õ Ö × Ó Ó Ø Ù Ú Û Ü Ý Þ ß à Ó Þ Ó Ú Ö Ô Ò áâ Ó Ó Ø Ù Ú Ûã Ý ä Ò å Ó æ ç Ó Ô Ò è Ü Ý é Ó Ò Ô Û Ó Ñ Ò Ó Ô Õ Ö × Ó Ó Ø Ù Ú ÛÙ Ú Ù Ö Ù Ô Ö Ù Ý Ú ê Ñ âÔ Þ Ý Ú Ûë ì í Þ Ý î ï Ñ â Ô Öð á Ó Ô Ò ï Ñ â Ô Öñ á Ó Ô Ò Õ ò Û Ó Ý ×Ù Ú Ö Ò ÝÝ × Ü â ï × Ó ØÔ Ö Ö ó Ô ÖÔ Û Ó

AHS (2006) National 37% in 1st hour 70% --- --- 6-9 mos.

28%

HHS (2006) National N/A 40% 71% -- 6 mos. 27%

MICS (2003) National 92.7% in 1st day N/A 91% 54% 6-9 mo. 28%

UNICEF (2003) Herat 59.2% in 1st hour;

82.2% use colostrum

19.4% 93% 34% 6-9 mo. 71%

UNICEF/CDC (2002)

Badghis N/A 95% 96% 52% 6 mo 21%

UNICEF/MoPH (2003)

Parwan N/A 12.5% 64% 63% 6-9 mo. 40%

SC/US (2002) Jowzjan ~ 50% fed colostrum

0% “most mothers had introduced foods or liquids at 4 mo.”

There are indications that the data presented in Table 1 actually over-estimate adequate IYCF practices. Field experience and formative research show that common inadequate feeding practices include the following: � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

8

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �  ¡ ¬ ¤ ¬ £ ¤ ¬ § ¡ § ¢ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © �Breastfeeding is rarely initiated in the first hour of birth

The use of ritual pre-lacteal foods (such as ghee, butter, tea, or even dirt) is common

Colostrum is often discarded, as it is considered to be dirty (because people believe it has stayed in the breast for 9 to 10 months.)

Many mothers do not know correct positioning and attachment of the infant to the breast, which limits optimal suckling and breast milk production.

õ ö ² ­ ¨ ³ ¬ ÷ ¯ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © ¨ ¡ ¤ ¬ ­ ø ù § ¡ ¤ « ³:

True exclusive breastfeeding is believed to be extremely rare, as caregivers often give tea, sugared water or soaked bread before the age of six months (data in Table 1 most likely report “predominant breastfeeding” rather than “exclusive breastfeeding)

Many mothers believe they have “insufficient milk”, which is often due to poor positioning and attachment. The perception of milk insufficiency often leads them to use formula milk, but most caregivers do not know how to prepare the milk to ensure it has the right consistency; bottle feeding is frequent and poor hygiene of the bottles and teats leads to infections

Many caregivers give pacifiers and teats to suckle; these are a source of infection and can affect the child’s attachment to the breast and suckling.

ª § ¡ ¤ ¬ ¡ ¨ ¯ ¥ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © �Most mothers continue to breastfeed for at least one year, and even beyond; however, they are very likely to wean the child early if they become pregnant while lactating.

It is common for mothers to stop or reduce breastfeeding when they or the child is ill; the cessation of suckling reduces their breast milk production and often leads them to wean the child early as they feel their milk is insufficient. ª § ù ú ­ ¯ ù ¯ ¡ ¤ £ ± û ¢ § § ¥ ³ üComplementary foods are often introduced either too early or too late

The consistency and composition of complementary foods is inadequate: they often consist of watery soups that do not meet infants’ energy requirements; the foods lack protein and micronutrient-rich foods.

Complementary feeds are often given infrequently and in insufficient quantities.

Young children are often fed from the family dish, which is seldom adapted to their own requirements (too diluted, or too thick, etc.)

Caregivers do not know to increase the frequency and density of complementary foods as the child grows older.

ý £ ¤ ¯ ± ¡ £ ­ ¡ ¨ ¤ ± ¬ ¤ ¬ § ¡ þ « ¯ £ ­ ¤ « £ ¡ ¥ ÿ ¯ ­ ­ � ô ¯ ¬ ¡ ©Infant and young child feeding is affected by mother’s health, nutritional status and mental well-being. Maternal mortality rates are amongst the highest in the world (national estimate: 1600 per 100,000 live births) and the prevalence of underweight among non-pregnant Afghan women 15-49 years of age was 21%, which is a high prevalence of adult underweight based on the WHO classification7. Furthermore, nearly 50% of women are estimated to be iron deficient and nearly 80% are likely to suffer from iodine deficiency8. Food taboos limiting women’s intake of nutrient-rich foods during pregnancy and lactation are common. Mother’s

7 (WHO, 1995). 8 MOPH, UNICEF, CDC and Tufts University. (2004). National Nutrition Survey. Atlanta, GA: CDC. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

9

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �health is affected by early marriages and pregnancies, low birth spacing and a high workload. Their capacity to care for their child is affected by their limited education, lack of peer support, pressure from family members to comply with traditional practices, high workload, and limited resources (in particular diverse foods). Furthermore, many women suffer from poor mental health, with a high incidence of stress and depression linked to the insecure political situation and other social factors. This can affect mothers’ relationship with their child, and has been found to be a common cause of breastfeeding problems, mothers’ “milk insufficiency”, and consequently undernutrition, especially amongst infants under 6 months.   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ õ ù ¯ ± © ¯ ¡ ² ¬ ¯ ³ {In addition to challenges associated with chronic poverty and limited development, the Afghan population is exposed to recurrent emergencies, related to conflict and natural disasters (earthquakes, floods, droughts). Emergency responses and food distributions are therefore common. Several emergency providers become involved in donations and distributions of Breast Milk Substitutes (BMS), such as commercial milk formula, which undermine efforts by the MoPH to promote exclusive breastfeeding and adequate IYCF. � � � � � �   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³ ¬ ù ú ­ ¯ ù ¯ ¡ ¤ ¯ ¥ ³ ¬ ¡ ² ¯ � � � � The Ministry of Public Health (in particular the Public Nutrition Department) and its partners have been very active since 2002 to promote improved IYCF in Afghanistan. Current initiatives are described in Table 2, below.

µ ¶ · ¸ ¹ � » È Ç ¿ Æ ¿ ¶ Æ ¿ ½ ¹ Ã ¶ � � ¾ ¹ Ã Ã ¿ Ç Ï È É Ê Ë ¿ Ç Î Â Ï Ð ¶ Ç ¿ Ã Æ ¶ Ç Ã ¿ Ç Í ¹ � � � � � Ý ß Ù å ò å Ö Ù é Ù Ö á � Ô Ù Ú ß Ô Ò Ö Ú Ó Ò Õ

IEC materials on IYCF MoPH/NGOs, UNICEF, FAO, WHO, WFP

IMCI Mother Card on IYCF MoPH/NGOs/WHO/BASICS

Afghan Family Nutrition Guide MAIL/MoPH/NGOs/FAO

Improved IYCF and Recipe Manual developed through formative research

MAIL/MoPH/FAO

Introduction of nutrition education, including IYCF, in agriculture projects, literacy classes and schools

MAIL/FAO/NGOs

� ç Ü â æ Û Ó Ú Ó Ò Ô à èPositive Deviance / Hearth SC-US/MoPH

Baby-Friendly Hospital Initiative MoPH/UNICEF/

Breastfeeding counselling: 3000 counsellors and 80 master trainers trained at national and provincial levels

MoPH/UNICEF/WHO/NGOs

Re-lactation support for mothers in TFUs ACF/MoPH

Growth monitoring and promotion (pilot) BASICS/MoPH/NGOs

40 Provincial Nutrition and Reproductive Health Officers trained on Maternal Nutrition

MoPH/Tech Serv

Breastfeeding promotion campaign:

Mass media campaign

Celebration of World Breastfeeding Week

MoPH/NGOs/MoReligious Affairs/MOWA/UNICEF/WHO/WFP

Afghanistan has adopted the � � � � � � � � � � � � � �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � MoPH / MoJ/UNICEF/IBFAN/International Code Documentation Centre

Ñ Ò Ó Ô Õ Ö × Ó Ó Ø Ù Ú Ûß Ò Ý Þ Ý Ö Ù Ý ÚSouth Asia Breastfeeding Forum 3, 2006 in Kabul MoPH/MoFA/WABA/IBFAN/WHO/UNICEF

Development of IMCI Complementary Feeding Card MoPH/WHO/UNICEF Ü Ý Þ ß à Ó Þ Ó Ú Ö Ô Òá â Ó Ó Ø Ù Ú Û

Integration of cooking demonstrations in health, agriculture & education projects (using manual)

MAIL/FAO/NGOs/MoPH

Supplementation as part of BPHS/EPHS MoPH/MI/UNICEF/NGOs

Iodised Salt; Fortified flour (iron, B-vitamins) MoPH/MoC/MoMines/Private Sector

� Ù å Ò Ý Ú ä Ö Ò Ù Ó Ú Ö ÕDiet diversification: horticulture, poultry, livestock… MAIL

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -10

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

However, the effectiveness and impact of these interventions has been limited by:

Limited outreach at community and household levels

Limited scale and coverage

Lack of staff and resources for outreach (in particular female staff)

Limited knowledge and skills of relevant staff

Low community mobilization

Illiteracy

Limited resources and capacity for technical support and supervision at national and provincial levels

The present National IYCF Policy and Strategy are designed to address priority issues for improving IYCF and overcome the constraints that are limiting current interventions’ impact.

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -11

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � [ 7 9 7 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` � � 4 � 6 s $ / $ # � $ All Afghan infants and young children have the right to benefit from optimal breastfeeding and complementary feeding and caring practices to protect them from all forms of undernutrition and its adverse consequences. [ 7 [ 7 � 4 % 4 � � 1 � 5 $ ^ \ ] 2 _ ` � � 4 � 6 / � ! s $ 5 / $ " 6All Afghan children benefit from optimal infant and young child feeding and caring practices and all caregivers have the knowledge, skills and resources required for optimal infant and young child feeding and care. [ 7 r 7 � � / � / � ! � 0 � � $ 4 � � 1 $ ^ � / $ 4 � � / � \ ] 2 _ ` � � 4 � 6 / � ! s $ 5 / $ " 6The IYCF Policy and Strategy is designed to contribute to the objectives of the Afghanistan National Health and Nutrition Sector Strategy 2008-20139 of reducing child and maternal mortality and malnutrition. Its overall goal is the same as the overall goal of the Public Nutrition Policy and Strategy, namely:

. � 5 ! ; � / � � 1 � 5 # % � 1 ; � ! 5 � ; $ 5 4 $ 4 � �,

$ ^ 5 0 6 4 # u 5 � � 4 � " $ ^ " 5 � � $ ^ �! � � � u # � $ / � ! ^ / � $ ^ � 1 � 1 " ^ / � 4 � 1 / � $ % / � ! 6 � ; � " � ^ 4 � ! 5 � � $ ^ 5 � ; " ^ 4 # u 5 � � ! 4 � 1 / � $/ � ! 6 � ; � " � ^ 4 � ! 1 ! 4 � " u 5 / � $ 4 � % 7 The objective of the Infant and Young Child Feeding Policy, and its associated Strategy is: . � 4 � � 5 / % $ ^ u 5 � � $ / " � 1 � ^ 4 � ! � / 5 " 4 � 5 % / ! � u $ 4 � " / u u 5 � u 5 4 / $ 4 � 1 / � $ / � ! 6 � ; � "� ^ 4 � ! 1 ! 4 � " / � ! � / 5 4 � " u 5 / � $ 4 � %

(by 20%, by 2013). Strategic components and approaches to achieve this objective are described in section 3 of the present document. [ 7 � 7 ` ; 5 u � % � 1 $ ^ \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` � � 4 � 6 / � ! s $ 5 / $ " 6The purpose of the present Policy and Strategy is to describe the Government of Afghanistan’s position on IYCF, in accordance with the Global Strategy on IYCF. All key stakeholders directly or indirectly involved in IYCF, notably health sector professionals, NGOs, UN agencies, military, and private sector, are responsible, and will be held accountable, for respecting the present Policy. This document also clarifies the strategies that need to be adopted and interventions to be implemented to achieve the policy objectives. It will serve to support advocacy and resource mobilization, as well as coordination between the main implementing partners (MoPH Departments, BPHS partners, NGOs, UN, private sector, communities). Finally, it provides guidance on how to monitor the protection and promotion of optimal IYCF in Afghanistan.

9 Health and Nutrition Sector Strategy, 1387-1391(2007/8-2012/13), MoPH-Afghanistan. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

12

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �[ 7 8 7 ` � � 4 � 6 � � # u � � � $ % Nine policy components have been identified. The implementation of these policy components will be supported by the “guiding policy principles” described in section 2.6, the strategies and activities described in Section 3, and in relevant guidelines. � � � � � � õ £ ± ­ û ¬ ¡ ¬ ¤ ¬ £ ¤ ¬ § ¡ § ¢ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ ©

Women of child-bearing age, in particular pregnant women, are to be educated on, and supported in, initiating breastfeeding within one hour of childbirth, and feeding colostrum to their newborn child. (This includes promotion of skin-to-skin contact within a half-hour of childbirth).

Newborn infants should not be given any food or drink other than breast milk unless X O E L R C M M cindicated. Pre-lacteal feeds of any kind should not be provided to the

newborn.

Mothers should be assisted in correct positioning of the child and how to maintain optimal lactation. � � � � � � õ ö ² ­ ¨ ³ ¬ ÷ ¯ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © ¤ § ³ ¬ ö ù § ¡ ¤ « ³Women of child-bearing age, in particular pregnant women and lactating women, are to be educated on the importance and benefits of exclusive breastfeeding (for the first 6 months after birth), and supported in providing only breast milk to their baby for the first six months of life.

Mothers should be encouraged to breastfeed on demand.

Caregivers should be strongly discouraged from giving artificial teats or pacifiers to breastfeeding infants.

� � � � � � � ³ ¯ § ¢ ² § ù ù ¯ ± ² ¬ £ ­ ¢ § ± ù ¨ ­ £ £ ¡ ¥ ± ¯ ³ ú ¯ ² ¤ § ¢ ¤ « ¯ ª § ¥ ¯ § ¢ ý £ ± � ¯ ¤ ¬ ¡ © § ¢ ± ¯ £ ³ ¤ ý ¬ ­ � ! ¨ ô ³ ¤ ¬ ¤ ¨ ¤ ¯ ³Suitable cows' milk based commercial formula should be recommended only if a mother is not able to breastfeed for medical reasons, or if the infant is orphaned and wet-nursing is not possible.

Caregivers using Breast Milk Substitutes should be educated on appropriate preparation of formula milk and measures required to reduce the risk of contamination. The feeding by cup should be promoted.

All Breast Milk Substitute Providers (whether private, non-profit, or public) should comply with all measures stipulated in the Code of Marketing of Breast Milk Substitutes that has been endorsed by the Government of Afghanistan. � � � � " � ª § ¡ ¤ ¬ ¡ ¨ ¯ ¥ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © ¤ § ¤ ÿ § û ¯ £ ± ³ £ ¡ ¥ ô ¯ û § ¡ ¥Women of child-bearing age, in particular pregnant and lactating women, are to be educated on the benefits of, and supported in, maintaining high levels of breastfeeding � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

13

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �in the first year of the child’s life and continuing breastfeeding until two years of age, even if they become pregnant or ill during lactation. � � � � � �   ¡ ¤ ± § ¥ ¨ ² ¤ ¬ § ¡ § ¢ ³ § ­ ¬ ¥ # ³ ¯ ù ¬ � ³ § ­ ¬ ¥ ¢ § § ¥ ³ £ ¤ ³ ¬ ö ù § ¡ ¤ « ³All parents should be educated before the child reaches the age of six months about when and how to introduce appropriate complementary foods.

Complementary feeding should be: $ D L X O M c %introduced at the appropriate age (generally six months), when the

need for energy and nutrients exceeds what can be provided through exclusive and frequent breastfeeding; $ C E O & H C D O %

providing sufficient energy, protein and micronutrients (vitamins & minerals) to meet the growing child’s nutritional needs; $ S C B O %

hygienically stored and prepared, and fed to the child with clean hands using clean utensils and not bottles or teats; $ Y Q G Y O Q M c B O E %

given according to the child’s signals of hunger or fullness, and that meal frequency and feeding method are suitable for the child’s age. These methods include actively encouraging the child to consume sufficient food using fingers, spoon or self-feeding, even during illness.

Complementary foods should be increasing in consistency, diversity and frequency of feeding as children grow up.

Caregivers should be educated and supported in ensuring optimal hygiene during complementary food preparation and consumption (including hand-washing of the caregiver and child)

Promoted complementary foods should be locally available, affordable to low-income households, nutritionally balanced, and culturally acceptable. � � � � ø � ° ± § ù § ¤ ¬ § ¡ § ¢ ù ¬ ² ± § ¡ ¨ ¤ ± ¬ ¯ ¡ ¤ � ± ¬ ² « ¢ § § ¥ ³ £ ¡ ¥ £ ú ú ± § ú ± ¬ £ ¤ ¯³ ¨ ú ú ­ ¯ ù ¯ ¡ ¤ £ ¤ ¬ § ¡Caregivers should be encouraged and supported to feed the child micronutrient-rich foods, in particular those rich in: $ Iron & zinc: Animal flesh (i.e. sheep, beef, goat), legumes (beans, chick pea,

lentil), certain green vegetables (i.e. spinach, ladyfinger/okra), and dried fruits and nuts. $ Vitamin A: meat, eggs, and various coloured fruits and vegetables (to be given with some oil or fat, as vitamin A is fat-soluble).

Children above 6 months should receive appropriate micronutrient supplements as per the national protocols.

All family members should be encouraged to use iodized salt.

All family members should be encouraged to use fortified flour where available.

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -14

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � ' � ý £ ¤ ¯ ± ¡ £ ­ « ¯ £ ­ ¤ « £ ¡ ¥ ¡ ¨ ¤ ± ¬ ¤ ¬ § ¡Women of child-bearing age, in particular pregnant and lactating mothers, should be educated on their nutritional requirements (including increased requirements during pregnancy and lactation) and supported in meeting these nutritional requirements.

All pregnant and lactating women should be provided with micronutrient supplements as per national protocols.

Family and community members should be encouraged to support pregnant and lactating mothers in ensuring they meet their nutritional requirements, rest sufficiently, and have the time required to feed their infant and young children optimally.

� � � � ( � ª « ¬ ­ ¥ ± ¯ ¡ ¬ ¡ ¯ ö ² ¯ ú ¤ ¬ § ¡ £ ­ ­ û ¥ ¬ ¢ ¢ ¬ ² ¨ ­ ¤ ² ¬ ± ² ¨ ù ³ ¤ £ ¡ ² ¯ ³3 � � : 4 5 $ ^ � 4 " ^ $ � 3 : � � 0 / 0 4 % �caregivers of LBW babies should be encouraged

to apply the same IYCF practices as for other children; Kangaroo Mother Care (Aghosh-e Garm-e Madar) should be promoted._ ! 4 � " % 4 � � � ^ 4 � ! 5 � �

sick children should continue breastfeeding and be fed appropriate complementary foods if above six months; the frequency of feeds, and amounts and density of feeds should be adjusted to the sick child’s increased nutritional requirements and limited appetite (e.g. smaller feeds more frequently).� � % u 4 $ / � 4 � ! 4 � 1 / � $ % � � ^ 4 � ! 5 � / � ! # � $ ^ 5 % �

should a lactating mother and/or her child be ill, health facilities should be able to accommodate both mother and child, and health staff should support the mother to continue breastfeeding and provide adequate complementary feeding. s � 5 � 6 # / � � � ; 5 4 % ^ ! � ^ 4 � ! 5 �

: children suffering from severe acute malnutrition should be referred to the appropriate treatment facility and receive treatment as per national protocols. Mothers who have breastfeeding difficulties should receive breastfeeding counselling and, when necessary, mothers (or if mother deceased an appropriate other e.g. grandmother) should be supported to re-lactate. This is particularly important for infants under 6 months of age. \ � 1 / � $ % � 1 � \ � � u � % 4 $ 4 � # � $ ^ 5 %

: HIV-positive mothers should be counseled on the risks and benefits associated with breastfeeding and formula-feeding in the case of HIV-AIDS, so as to make an informed choice on the feeding method they choose.

� � � � ) �   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ õ ù ¯ ± © ¯ ¡ ² ¬ ¯ ³In all emergency situations, relief interventions and emergency service providers must comply with the policy components and principles described in the IYCF Policy.

Further the above parties should adhere to the Code of Marketing of Breast Milk Substitutes as a minimum requirement and the internationally endorsed Operational Guidance for Infant and Young Child Feeding in Emergencies. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

15

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Mothers should be provided with the additional support, counselling, and resources, required to protect and promote optimal IYCF in emergency situations.

Donated (free) or subsidised supplies of Breast Milk Substitutes, bottles and teats, are prohibited in order to ensure that breastfeeding is not undermined. [ 7 < 7 � ; 4 ! 4 � " ` � � 4 � 6 u 5 4 � � 4 u � %

The design of the IYCF policy and strategy has been inspired by the 7 Working Principles of the MoPH for 2005-2009, and guiding principles described in the ANDS Health and Nutrition Sector Strategy. The following principles are of particular importance for Infant and Young Child Feeding. Their application to IYCF is described below. ° ± § ù § ¤ ¬ ¡ © « ¯ £ ­ ¤ « û ­ ¬ ¢ ¯ ³ ¤ û ­ ¯ ³ £ ¡ ¥ ¥ ¬ ³ ² § ¨ ± £ © ¬ ¡ © ú ± £ ² ¤ ¬ ² ¯ ³ ú ± § ÷ ¯ ¡ ¤ § ô ¯ « £ ± ù ¢ ¨ ­IYCF counselling and promotion of optimal IYCF are at the heart of the IYCF Policy and Strategy. Promotion of IYCF cannot be limited to awareness raising. It requires transfer of practical skills (e.g. through breastfeeding counselling and participatory cooking sessions adapted to mothers’ circumstances), peer support, and assistance to caregivers in mobilizing the resources required to apply IYCF (time, food, etc.).ª § ù ù ¨ ¡ ¬ ¤ û ú £ ± ¤ ¬ ² ¬ ú £ ¤ ¬ § ¡ £ ¡ ¥ ² § ù ù ¨ ¡ ¬ ¤ û � ô £ ³ ¯ ¥ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³Optimal ICYF should also be promoted and appropriate counselling provided at the community level. Community ownership, support of community leaders and active participation of caregivers and their families are essential for effectiveness and sustainability. õ ¡ ³ ¨ ± ¬ ¡ © ¯ * ¨ ¬ ¤ £ ô ­ ¯ £ ² ² ¯ ³ ³ ¤ § þ £ ¡ ¥ ú ± § ÷ ¬ ³ ¬ § ¡ § ¢ þ * ¨ £ ­ ¬ ¤ û þ ô £ ³ ¬ ² þ ¯ ³ ³ ¯ ¡ ¤ ¬ £ ­ « ¯ £ ­ ¤ « ³ ¯ ± ÷ ¬ ² ¯ ³Equitable access to IYCF counselling requires that optimal IYCF practices should be promoted at all levels of the health system. All health workers have a responsibility for promoting optimal IYCF and should be trained to fulfil these responsibilities. ! ¨ ³ ¤ £ ¬ ¡ £ ô ¬ ­ ¬ ¤ û �IYCF education and counselling should promote the use of local resources to ensure efficiency, affordability, sustainability and replicability. Should supplementary rations be distributed as part of emergency food aid or supplementary feeding programmes, ration providers should also inform beneficiaries of the nutritional value of local foods and establish linkages to agriculture and food security projects (see below).  ¡ ¤ ¯ ± � ³ ¯ ² ¤ § ± £ ­ ² § ­ ­ £ ô § ± £ ¤ ¬ § ¡ üOptimal IYCF should be promoted by a broad range of stakeholders beyond the health sector. The Ministry of Public Health will work in partnership with other ministries, in particular the ministries of: Agriculture Irrigation and Livestock (MAIL), Women’s Affairs (MoWA), Rehabilitation and Rural Development (MRRD), Education (MoE), Religious Affairs (MoRA), Labour and Social Affairs (MoLSA), Justice (MOJ), Trade and Commerce (MoTC), and Ministry of Interior (MoI) to promote IYCF and the application of the Code of Marketing of BMS. At the community level, optimal IYCF can be promoted through a broad range of development interventions, including literacy courses, agriculture projects, community development interventions, etc. Linkages to food security interventions are of particular importance.! ² £ ­ ¬ ¡ © � ¨ ú § ¢ ¯ ÷ ¬ ¥ ¯ ¡ ² ¯ � ô £ ³ ¯ ¥ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

16

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Interventions that have proven to be effective for promoting optimal IYCF should be implemented nationwide.

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -17

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � The IYCF Policy and Strategy is designed to contribute to the objectives of the Afghan National Health and Nutrition Sector Strategy and the overall goal of the Public Nutrition Policy and Strategy by focusing on the following objective: . � 4 � � 5 / % $ ^ u 5 � � $ / " � 1 � ^ 4 � ! � / 5 " 4 � 5 % / ! � u $ 4 � " / u u 5 � u 5 4 / $ 4 � 1 / � $ / � ! 6 � ; � "� ^ 4 � ! 1 ! 4 � " / � ! � / 5 4 � " u 5 / � $ 4 � %

(by 20% by 2013)7

This objective will be achieved through the following three strategy components:

1.T Y Y M L R C D L G A G B @ F J N P G M L R c C A E j D Q C D O I c S H Y Y G Q D O E d c C E W G R C R c x D O R K A L R C M I H L E C A R OC A E M C l O A B G Q R O X O A D

.

2.J C Q O I L W O Q S h A G l G Y D L X C M @ F J N Y Q C R D L R O S C A E C Q O S H Y Y G Q D O E L A Y Q G W L E L A I G Y D L X C M R C Q OC A E X G d L M L y L A I D K O Q O S G H Q R O S Q O & H L Q O E B G Q @ F J N x D K Q G H I K @ b J m i J J C A E R G X X H A L D cS H Y Y G Q D L A D O Q W O A D L G A S >

3.@ F J N Y Q G X G D L G A C A E R G H A S O M M L A I L S O B B O R D L W O M c L X Y M O X O A D O E C S Y C Q D G B D K O i P | j C A Eb P | j L A C M M K O C M D K B C R L M L D L O S

.

Capacity-building of various categories of personnel involved in implementation will be an integrated component of each strategic priority/output. Advocacy and resource mobilization will be essential to enable the implementation of the activities required to achieve these outputs. An advocacy and resource mobilization plan will therefore be developed. The activities to be implemented to achieve these outputs/strategic priorities are described below. r 7 9 7 � ! � � � / � 6 � 5 " ; � / $ 4 � � % / � ! " ; 4 ! � 4 � % The implementation of the IYCF Policy and Strategy entails that sufficient resources and political support are mobilized, that supportive legislation and regulations are enforced, and that adequate guidelines are developed and applied. � � � � � � + ¬ ³ ³ ¯ ù ¬ ¡ £ ¤ ¬ § ¡ þ £ ¥ ÷ § ² £ ² û £ ¡ ¥ ± ¯ ³ § ¨ ± ² ¯ ù § ô ¬ ­ ¬ , £ ¤ ¬ § ¡ ¢ § ± ¤ « ¯ - £ ¤ ¬ § ¡ £ ­  ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ° § ­ ¬ ² û £ ¡ ¥ ! ¤ ± £ ¤ ¯ © û üThe implementation of the National IYCF Disseminate the National IYCF Policy and Strategy will require several supportive steps to be implemented. They include:

Dissemination of the strategy amongst all key stakeholders (MoPH, MAIL, MoJ, MoMI, MoEd, MoRA, MoWA, NGO’s, private sector). This can be done by preparing a policy brief (e.g. leaflet) to be distributed to key decision-makers, relevant Government officials and civil servants, NGOs, UN agencies, Provincial Reconstruction Teams (PRT), and private sector stakeholders. Participation in relevant meetings and forums to disseminate information on the IYCF policies will also be important.

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -18

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Regular updating of the IYCF action plan and preparation of a resource mobilization plan, in collaboration with technical partners, donors and relevant MoPH departments to mobilize funds (including proposal preparation).

Reviewing MoPH nutrition-related policies, strategies and guidelines and make sure IYCF policy priorities and strategies are adequately reflected in these documents � � � � � � õ ¡ ¢ § ± ² ¯ ù ¯ ¡ ¤ § ¢ ¤ « ¯ ª § ¥ ¯ § ¢ ý £ ± � ¯ ¤ ¬ ¡ © § ¢ ± ¯ £ ³ ¤ ý ¬ ­ � ! ¨ ô ³ ¤ ¬ ¤ ¨ ¤ ¯ ³

The Government of Afghanistan has adopted the Code of Marketing of Breast Milk Substitutes, which is now officially approved by the Ministry of Justice, endorsed by the Cabinet, signed by the President and published in the Official Gazette. It is now essential to put in place enforcement mechanisms to ensure the Code is respected. This requires the establishment of a National Committee responsible for defining enforcement mechanisms and monitoring the application of the Code and disseminating information on the Code and related regulations to all key stakeholders (Provincial Departments of Health, Provincial Reconstruction Teams, private sector, all health facilities, MoWA, NGOs, etc.). Code monitors shall be trained (with technical assistance from IBFAN). � � � � � � ´ ú ú ­ ¬ ² £ ¤ ¬ § ¡ § ¢ ¤ « ¯ ý £ ¤ ¯ ± ¡ ¬ ¤ û ° ± § ¤ ¯ ² ¤ ¬ § ¡ ´ ² ¤The Maternity Protection Act has been passed by the Ministry of Labour and Social Affairs. It stipulates that working mothers are entitled to a paid 13 week maternity leave and are allowed 2 hours / day for (paid) breastfeeding breaks while they are lactating. Enforcement and monitoring mechanisms must now be defined to ensure that employers respect mothers’ rights. This also entails disseminating information to women on their rights so they can encourage their employers to apply them. Guidelines could be developed for relevant Government departments and employers, as well as guidance for mothers, to support the application of the Maternity Protection Act. � � � � " � . £ ± ù § ¡ ¬ , ¬ ¡ © þ ³ ¤ ± ¯ ¡ © ¤ « ¯ ¡ ¬ ¡ © £ ¡ ¥ ² § ù ú ­ ¯ ¤ ¬ ¡ ©   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥® ¯ ¯ ¥ ¬ ¡ © / ¨ ¬ ¥ ¯ ­ ¬ ¡ ¯ ³The MoPH and its partners have already produced a number of training materials, namely on breastfeeding counselling, BFHI, and complementary feeding (including improved recipes and participatory cooking sessions). However, a comprehensive and harmonized set of guidelines, providing guidance on how IYCF can be promoted in different circumstances (e.g. in health facilities, at community-level, in emergencies, etc.) is lacking. These guidelines should therefore be developed and used to inform the development of training packages adapted to the needs of various audiences (e.g. different categories of health staff; personnel working in other sectors such as education and agriculture). Training activities and related material development are specified under outputs 2 and 3. � � � � � � ´ ú ú ­ ¬ ² £ ¤ ¬ § ¡ § ¢   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ õ ù ¯ ± © ¯ ¡ ² ¬ ¯ ³/ ¨ ¬ ¥ ¯ ­ ¬ ¡ ¯ ³The present IYCF policy clearly stipulates the obligation of emergency service providers to respect the IYCF policy statements in all situations, and in particular to avoid free distributions of infant formula or other Breast Milk Substitutes and respect the Code. Afghan guidelines on IFE should be developed, based on the internationally endorsed Operational Guidance on IFE. These guidelines should preferably be part of the general IYCF guidelines mentioned under 3.1.4. Until finalisation of the national guidelines emergency service providers should adhere to the Operational Guidance on IFE. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

19

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �The IYCF policy and IFE guidelines should be disseminated to all relevant stakeholders, in particular the Disaster Management Committee, the PRTs, NGOs and Provincial Development Councils, and the MoPH should monitor that the policy and guidelines are applied in emergency situations. r 7 [ 7 : ^ / � 4 � ; 5 � ^ / � " $ ^ 5 � ; " ^ / � / 5 � % % 5 / 4 % 4 � " � � � ; � % � � 4 � " / � ! � � # # ; � 4 $ 6% ; u u � 5 $Improving IYCF practices essentially involves promoting behaviour change, whereby families adopt improved breastfeeding and complementary feeding practices. Behaviour change requires caregivers to have the necessary:

knowledge

motivation

skills

resources

supportive environment

The following strategic approaches will be implemented to promote and support behaviour change. (Note: activities conducted under output 3 will also contribute to behaviour change). These strategic approaches are complementary and all necessary: none alone can lead to sustainable behaviour change. For example, awareness raising must be accompanied by personalised counselling and peer support at community level and in health facilities. � � � � � � . £ ± ù § ¡ ¬ , ¯ ¥ ° ¨ ô ­ ¬ ² ´ ÿ £ ± ¯ ¡ ¯ ³ ³ 0 £ ¬ ³ ¬ ¡ ©Currently the Ministry of Public Health Public Nutrition Department and Healthy Behaviour Department are organizing a large National Breastfeeding Communication Campaign. It will be launched during the National Breastfeeding Week in August (1st - 7th) 2009. This campaign will use various media (posters, leaflets, TV & radio spots, integration of message in TV series, etc.) and is being implemented in partnership with NGOs and other ministries, such as MAIL, MoWA, MoRA, MRRD, and MoE. Furthermore, the Ministry of Public Health has been implementing World Breastfeeding Week since 2003 with a broad range of partners. It will continue to do so annually. The present IYCF Policy and Strategy plans to expand the National Breastfeeding Communication Campaign to cover complementary feeding and IYCF as a whole. Messages on complementary feeding should notably focus on the amount of foods to be given, the composition and frequency of feeds. Appropriate caring practices, and health and hygiene practices related to feeding, should also be promoted. In addition to the campaign, regular awareness raising activities will be conducted on IYCF in partnership with media, other ministries, religious leaders and community leaders. (see Logical Framework in Annex 2 for detailed activities). Ideally, KAP surveys (Knowledge Attitude Practice surveys) should be conducted in areas selected to cover regional and cultural diversity. This would also provide useful baseline information and help refine the messages. Reference should also be done to existing formative research carried out by MoPH, UNICEF, Save the Children and FAO. Monitoring KAP surveys should also be conducted in selected areas to assess the impact of awareness-raising activities. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

20

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Public awareness activities will increase caregivers’ knowledge and also help mobilize community leaders to build their support for community-level interventions described below. � � � � � � ª § ¨ ¡ ³ ¯ ­ ­ ¬ ¡ © ¤ « ± § ¨ © « ² § ù ù ¨ ¡ ¬ ¤ û ³ ¨ ú ú § ± ¤ © ± § ¨ ú ³ £ ¡ ¥ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³It is essential that education and counselling activities be conducted at the community-level to support behaviour change. In addition to knowledge and skills regarding adequate breastfeeding, complementary feeding and care, mothers require peer support, time, and access to the resources required for optimal child feeding (in particular diverse foods). It is therefore essential to also involve other family members in IYCF promotion, in particular men. Counselling and generating this support can be best done through the establishment of community support groups associated with a wide range of community development interventions. Various models and approaches can be used, such as the establishment of “Baby-Friendly Communities”, or “Mother Support Groups. The groups can be established through existing circles such as literacy classes, family health action groups, women’s shuras, etc. As far as possible, IYCF counselling should be conducted through existing groups and platforms. Flexibility is required to build on local opportunities, to adapt to different cultural settings and better respond to local caregivers’ needs. Community support groups can be facilitated by a woman volunteer from the community, with experience of working with women and women’s groups, such as literacy teachers, E C K L C S

, CHW’s, heads of women’s S K H Q C S

, etc10. They would be trained on breastfeeding counselling, preparation of improved local recipes and participatory cooking sessions. Resources for participatory cooking sessions would be mobilized by community members themselves, for example with each woman bringing some food and utensils to the session. (See detailed activities in the logical framework in Annex 2). z G D O { D K L S l G Q h E G O S A G D A O O E D G d O L X Y M O X O A D O E D K Q G H I K D K O K O C M D K S O R D G Q C A E d c K O C M D Kl G Q h O Q S G A M c > T I Q L R H M D H Q O � | G X O b R G A G X L R S 1 B B L R O Q S 2 x D O C R K O Q S C A E l G X O A 2 S S K H Q C S R C Al G Q h L A Y C Q D A O Q S K L Y l L D K g G P | D G L X Y M O X O A D D K O S O C R D L W L D L O S > z H D Q L D L G A R G H A S O M M L A I L S M L h O M cD G d O X G Q O O B B O R D L W O l K O A C S S G R L C D O E l L D K G D K O Q E O W O M G Y X O A D C R D L W L D L O S D K C D L A R Q O C S O l G X O A 2 SI O A O Q C M h A G l M O E I O x Q O S G H Q R O S C A E R G A B L E O A R O > 3 S O O C M S G ? > V > ? 4 The support groups can be linked to and/or initiated from hospitals and health facilities participating in the Baby-Friendly Hospital Initiative. An essential component of the community support activities should be support to households in diversifying their household food production and / or income, so as to enable them to access the ingredients required for optimal feeding. This can be done by implementing activities such as vegetable gardens and orchards, poultry rearing, goat keeping, bee-keeping (honey for income), and food processing. Such projects should be implemented side-by-side with IYCF counselling. For example, demonstration gardens should be established in hospitals (in particular where TFUs exist) and other health centres. If direct implementation is difficult, linkages and partnerships should be sought with other partners implementing food security projects.

10 It is important to avoid introducing salaries or incentives of facilitators as this could undermine the sustainability and replicability of the intervention. Rather, mechanisms can be explored whereby volunteers receive in kind contributions from the women they are assisting. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

21

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � � �   ¡ ¤ ¯ © ± £ ¤ ¬ § ¡ § ¢   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ ¡ § ¡ � « ¯ £ ­ ¤ «² § ù ù ¨ ¡ ¬ ¤ û � ­ ¯ ÷ ¯ ­ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³As far as possible, IYCF promotion should be integrated in “non-health” community-level interventions, in particular agriculture and education programmes. For example, participatory cooking sessions can be held as part of agricultural extension activities and food processing work with women producer organizations. IYCF message can be integrated in school and literacy trainings, and where possible, participatory cooking sessions can be held as practical work during literacy classes. (See activities in Annex 2). r 7 r 7 \ � $ " 5 / $ 4 � � � 1 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " u 5 � # � $ 4 � � 5 � � ; � % � � 4 � "4 � $ ^ : / % 4 � ` / � � / " � 1 � / � $ ^ s 5 � 4 � % 5 � % % � $ 4 / � ` / � � / " � 1 � � % u 4 $ / �s 5 � 4 � %Promotion of appropriate IYCF is already an integral part of the public nutrition component of the Basic Package of Health Services and Essential Package of Hospital Services. However, BPHS partners, health facility managers and health staff require further support to enhance the quality, appropriateness, and coverage. The following activities are suggested to strengthen IYCF activities, in particular coverage, as part of the BPHS and EPHS. � � � � � � õ ö ú £ ¡ ³ ¬ § ¡ § ¢ £ ô û � ® ± ¬ ¯ ¡ ¥ ­ û . § ³ ú ¬ ¤ £ ­   ¡ ¬ ¤ ¬ £ ¤ ¬ ÷ ¯ ¤ § ù § ± ¯ « ¯ £ ­ ¤ «¢ £ ² ¬ ­ ¬ ¤ ¬ ¯ ³The Baby-Friendly Hospital Initiative is currently being implemented in five hospitals (in Kabul and Eastern region), which have yet to be fully certified as Baby-Friendly. Priorities for applying the BFHI in Afghanistan include:

Supporting health facilities in completing the entire BFHI process, in particular applying the 10th step to successful breastfeeding, i.e. establishment of breastfeeding support groups. This will notably be achieved through activities described under output 2 (see section 3.2.2).

Expanding the coverage of BFHI certified facilities to more hospitals, and to health facilities providing MCH services.

Detailed activities for expanding the coverage of BFHI are described in the logical framework in Annex 2. � � � � � �   ¡ ¤ ¯ © ± £ ¤ ¬ § ¡ § ¢   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ © ² § ¨ ¡ ³ ¯ ­ ­ ¬ ¡ © ¬ ¡ £ ­ ­« ¯ £ ­ ¤ « ¢ £ ² ¬ ­ ¬ ¤ ¬ ¯ ³Messages about adequate IYCF are currently disseminated as part of health and nutrition education sessions in most health facilities and through CHWs. However, these messages will not likely generate behaviour change if not accompanied by counselling. It is therefore important to integrate IYCF counselling (including breastfeeding demonstration and participatory cooking sessions) as part of health education activities in health facilities, in particular Comprehensive Health Centres and Basic Health Centres. This can be done by establishing IYCF corners in health facilities, or conducting IYCF counselling as part of “child health corners”. It is also absolutely essential that breastfeeding counselling and re-lactation assistance are part of the management of acute malnutrition, whether it is provided in Therapeutic Feeding Units or Community-based Management of Acute Malnutrition. Mothers of severely malnourished � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

22

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �children should also participate in cooking sessions on improved complementary feeding practices. Furthermore, there should be at least one referral centre at each province for referral of complicated and difficult lactation and IYCF cases. It may not be realistic, at this stage, to expect mobile teams and community-health workers to conduct actual counselling (except if part of community support activities described in section 3.3.2), but they should at least provide information to caregivers on adequate IYCF practices. All BPHS partners and hospitals are encouraged to implement these activities, and BPHS donors encouraged to provide the funds required for their implementation. Technical support can be provided by the Public Nutrition Department and its technical partners. These activities will be supported by those described in section 3.3.3. � � � � � � 6 ± £ ¬ ¡ ¬ ¡ © § ¢ « ¯ £ ­ ¤ « ³ ¤ £ ¢ ¢ § ¡   ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ­ ¥ ® ¯ ¯ ¥ ¬ ¡ ©Training of all health staff on appropriate IYCF practices and good IYCF counselling skills is absolutely essential for the integration of IYCF in health services. This should be done by integrating IYCF into the curricula of all medical and paramedic education institutions including community midwifery school and postgraduate programs (esp. residency training programs in paediatrics, obstetrics and gynaecology). Furthermore, IYCF should be part of in-service trainings for different staff categories, including doctors, nurses, midwives, community midwives, and CHWs. This can notably be done as part of the IMCI trainings. At least two MCH staff in each facility should be trained on IYCF counselling, and all CHWs and outreach staff should be trained to conduct education on IYCF. (See detailed activities in Annex 2)

� 7 9 7 \ � % $ 4 $ ; $ 4 � � / � 1 5 / # � � 5 � / � ! # / 4 � u / 5 $ � 5 % The implementation of the IYCF Policy and Strategy will be supervised and monitored by the Ministry of Public Health Public Nutrition Department, at central level, and at provincial level, through Public Nutrition Officers. The Public Nutrition Department receives technical and financial support from technical agencies, in particular WHO, UNICEF, FAO, WFP, USAID/BASICS, IBFAN, BPNI, WABA, Micronutrient Initiative, and other punctual sponsors (e.g. IAEA). These partners can notably assist the PND in mobilizing human and financial resources required to implement the IYCF Policy and Strategy. Implementation of the IYCF Policy and Strategy, in particular at community-level and health-facility level will be done through partnerships with the BPHS partners, and other NGO’s working with communities. Collaboration with the private sector, and emergency service providers (including the military) will be essential, notably to ensure the Code of Marketing of BMS is respected. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

23

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� 7 [ 7 2 � � 5 ! 4 � / $ 4 � � # � ^ / � 4 % # %Effective coordination mechanisms are essential to support the effective implementation of the IYCF Policy and Strategy. Coordination should be managed through existing coordination bodies and mechanisms, strengthening them if and as required. An IYCF Working Group is already established at the central level, under the leadership of the MoPH Public Nutrition Department. It includes representatives of the main stakeholders listed above. It should be strengthened and its Terms of Reference revised so as to include overseeing the implementation of IYCF Policy & Strategy, monitoring the application of the policy priorities and activities, and taking strategic decisions concerning its implementation. Furthermore, a Committee for monitoring the application of the Code of Marketing of Breast Milk Substitutes is in the process of being established, under the leadership of the Public Nutrition Department. Effective coordination mechanisms should be established at the provincial level to oversee district and community level activities, namely for the public awareness activities, the establishment of IYCF community support activities, and trainings. This can include the preparation, implementation and supervision of IYCF provincial work plans, where possible. Provincial committees can also be responsible for monitoring the application of IYCF policies, in particular the Code of Marketing of BMS. � 7 r 7 � % $ 4 # / $ ! 0 ; ! " $The total estimated budget for the implementation of this four-year strategy is over 7 v � � � � � � � �

. The table below provides a summary budget by the main components and a detailed budget is provided in annex 4. z G D O { D K L S d H E I O D E G O S A G D L A R M H E O Q O I H M C Q P H d M L R z H D Q L D L G A w O Y C Q D X O A D S D C B B C A E S H Y Y G Q DR G S D S > J H Q Q O A D M c x G A M c G A O X O E L R C M E G R D G Q L S Q O S Y G A S L d M O B H M M n D L X O B G Q S H Y O Q W L S L A I @ F J N L S S H O S xC D D K O R O A D Q C M M O W O M > T A G D K O Q D l G D O R K A L R C M S D C B B C Q O Q O & H L Q O E D G C E O & H C D O M c S H Y Y G Q D D K O @ F J NS D Q C D O I c L X Y M O X O A D C D L G A x D G I O D K O Q l L D K C S S G R L C D O E S H Y Y G Q D R G S D S 3 R G X Y H D O Q x D Q C A S Y G Q D x O D R > 4 >

Ê Á 8 Ì Á Ç ¹ Ç Æ 9 Ä � Ï ¹ Æ ¾ ¹ : Ä ¿ ¾ ¹ �; < = > ? @ A @ B C D E B F G ? H I @ > J C D F G @ K B ? @ J B C L M N N M � �1.1 National IYCF Policy & Strategy $46 000

1.2 The Code of Marketing of BMS $425 500

1.3 Maternity protection $35 000

1.4 IYCF Guidelines $38 000

1.5 Infant and Young Child Feeding in Emergencies O < P B Q H R @ > G E A Q H J F B > J S T U V$6 147 000

2.1 Public Awareness Raising $1 634 000

2.2 Establishment of community support groups and interventions $2 382 000

2.3 Integration of IYCF in non-health community-level interventions W X Y Z Y [ [ [\ < S T U V @ J P = ] ^ _ ` = ] ^ L º a º a a � �3.1 Expansion of BFHI $562 000

3.2 Integration of IYCF counselling in all health facilities $652 500

3.3 Training of health staff in IYCF $503 200Ê ¼ b c d e µ e µ ¼ µ Î d L f N � g � � �� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -24

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -25

Effective monitoring and evaluation must also be established to assess progress towards the strategy objectives. Monitoring and evaluation should be supported by regular monitoring, progress reviews, and eventually, operational research. Indicators for monitoring the objectives, components and strategic approaches are proposed in Annex 2. (Note: these indicators may be slightly modified when survey and M&E tools are designed). 8 7 9 7 � " ; � / 5 # � � 4 $ � 5 4 � " / � ! � / � ; / $ 4 � �Adequate M&E tools (including self-assessment tools) should be developed to support effective monitoring of the IYCF Policy and Strategy. Indicators should, as far as possible, be integrated in the HMIS, national monitoring checklists, and third party evaluations. Furthermore, relevant staff (in particular PNO’s) should be trained on the use of the M&E tools and measures to take corrective action. Regular monitoring of field activities by MoPH staff (in particular Provincial Nutrition Officers) will be essential. Monitoring can also be done by integrating IYCF indicators in surveys, such as the MICS survey, and other studies. It will be necessary to assess whether there are any specific operational research needs and develop an operational research plan accordingly. 8 7 [ 7 t u 5 / $ 4 � � / � 5 % / 5 � ^Formative research has already been carried out on breastfeeding practices in 2002 and 2003 (notably with UNICEF and Save the Children support), and on complementary feeding practices and recipes (by FAO and MAIL in 2006). However, new operational research needs may arise during the IYCF Policy and Strategy implementation. If there are research needs, an operational research plan should be developed and resources mobilized to implement it. 8 7 r 7 ` 5 � " 5 % % � � 4 � %The information generated by the M&E system should be used to regularly assess progress on the implementation of the IYCF Policy and Strategy and make necessary adjustments in the implementation plan. Furthermore, progress should be reported to the relevant authorities and stakeholders, for issues of accountability, but also to maintain / generate motivation to pursue implementation. A national review workshop should be conducted annually (including the preparation of the following annual work plan). Progress on the implementation of the IYCF Policy and Strategy should also be reviewed at the regional level through regional workshops. Progress can be reviewed at least once a year at the provincial level using the Provincial Health Coordination Committee (PHCC) or other forums. Finally, information on this progress should be shared through the Consultative Group on Health and Nutrition (CGHN), as well as other through media, such as “Sehat” and “Salamaty” journals.

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ate

info

rmat

ion

on t

he

IYC

F p

oli

cies

. 2

.R

egula

r updat

ing o

f IY

CF

act

ion p

lan a

nd p

repar

atio

n o

f a

reso

urc

e m

obil

izat

ion p

lan t

o s

uppo

rt t

he

imp

lem

enta

tio

n o

f th

e IY

CF

Po

licy

& S

trat

egy

3.

Rev

iew

Mo

PH

rel

ated

sub

-poli

cies

, st

rate

gie

s an

d g

uid

elin

es a

nd

mak

e su

re I

YC

F h

as b

een

ref

lect

ed i

n t

hes

e d

ocu

men

ts

Ç� ½� ¶º ½¶ÊÉ ·ÃÌ ½¿À ¹È¶ÊÆ Ã½·Ä¿ÉÀ̧Ì- Ï» Ä¿À ¿ Ï¿ ½Ä

4.

Est

abli

sh a

Nat

ional

Co

mm

itte

e fo

r th

e E

nfo

rcem

ent

of

the

Code

5.

Est

abli

sh e

nfo

rcem

ent

mec

han

ism

s fo

r th

e C

od

e of

Mar

ket

ing o

f B

MS

6

.D

isse

min

ate

info

rmat

ion

on t

he

Co

de

(in

clud

ing

tra

nsl

atio

ns)

and

rel

ated

leg

isla

tio

n t

o a

ll k

ey s

takeh

old

ers

(Pro

vin

cial

Dep

artm

ents

of

Hea

lth,

PR

Ts,

pri

vat

e se

ctor,

all

h

ealt

h f

acil

itie

s, M

OW

A, N

GO

s, e

tc.)

th

roug

h p

ost

ers,

lea

flet

s, a

nd

work

shop

s 7

.T

rain

ing

of

Cod

e m

on

ito

rs (

IBF

AN

)

É ·¿ ½Ã¹À ¿ ,Ñö¿ ½¾¿À ¶¹

8.

Est

abli

sh e

nfo

rcem

ent

mec

han

ism

s an

d d

evel

op

gu

idel

ines

fo

r th

e im

ple

men

tati

on

of

the

Mat

ern

ity P

rote

ctio

n A

ct

9.

Info

rm w

ork

ing

wo

men

of

thei

r ri

gh

ts u

nd

er t

he

Mat

ern

ity P

rote

ctio

n A

ct (

e.g

. th

rough

lea

flet

s an

d r

adio

; ca

n b

e p

art

of

IYC

F P

ubli

c A

war

enes

s C

amp

aign)

Â)�*µ ÏÀº ½À̧ ¹½Ä

10.

Rev

iew

ex

isti

ng

in

tern

atio

nal

gu

idel

ines

and

nat

ion

al t

rain

ing

pac

kag

es a

nd d

evel

op

a c

om

pre

hen

siv

e an

d c

oh

eren

t se

t o

f h

arm

on

ized

guid

elin

es c

over

ing I

YC

F p

oli

cy a

nd

pri

ori

ties

and

str

ateg

ic i

nte

rven

tio

ns,

nam

ely

: IY

CF

pro

mo

tio

n i

n d

iffe

ren

t h

ealt

h f

acil

itie

s (i

ncl

ud

ing B

FH

I gu

idel

ines

); I

YC

F p

rom

oti

on

at

com

mu

nit

y l

evel

; In

fan

t an

d

Youn

g C

hil

d F

eed

ing

in E

mer

gen

cies

; Im

ple

men

tati

on

of

the

Cod

e, e

tc.

11.

Dis

sem

inat

e g

uid

elin

es t

o t

he

rele

van

t st

akeh

old

ers,

an

d c

on

du

ct t

rain

ing

s on

th

eir

imp

lem

enta

tio

n (

c.f.

als

o t

rain

ing

act

ivit

ies

und

er o

utp

uts

2 a

nd 3

)  ¹Ê ·¹¿ ·¹º) ¶ ϹÈ��À̧º* ½½ºÀ ¹ÈÀ ¹/ нÃȽ¹¾À ½Ä

12.

As

par

t of

the

Afg

han

IY

CF

gu

idel

ines

, d

evel

op

a s

ecti

on

on I

YC

F i

n E

mer

gen

cies

bas

ed o

n t

he

inte

rnat

ion

ally

en

do

rsed

Op

erat

ion

al G

uid

ance

for

IFE

1

3.

Dis

sem

inat

e th

e IF

E G

uid

elin

es t

o a

ll r

elev

ant

stak

eho

lder

s (i

ncl

ud

ing t

he

Dis

aste

r M

anag

emen

t C

om

mit

tee,

th

e P

RT

, N

GO

s a

nd

Pro

vin

cial

Dev

elopm

ent

Co

un

cils

) an

d

ensu

re t

hey

are

im

ple

men

ted

in

em

erg

ency

sit

uat

ion

s.

� ¶ÐѶ¹½¹¿ ·¹º Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ¹ºÀ ¾·¿ ¶ÃÄ

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� ­© �­®Ú ¦̈­«Û ¬¡�ÜÝ ¤¤Ü¡ ­«³ ¨�¡ ¢²�­ÜÞ ® ±�® ¤«² ¯Þ ¤¥® ¤ § ¤±ßààá29

� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �­¡ �® �­ ¯°¡ ­¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬

��������0� ����� #�� 1 ��&���� '� ���������� �� ��� ��� !����� �� � �

���#�� � ������ '� �������'�" � � 2� ���% ��� �!��� ��3!� ��� � ���� ��� �3!�� �����

�% ��!�% �4�5 6�� �����''!�� � � !������ �� ��#���� ��

70%

of

Afg

han

ad

ult

an

d a

dole

scen

t pop

ula

tio

n

is a

war

e of

key

IY

CF

pra

ctic

es

90%

sh

ura

mem

ber

s aw

are

of

good

IY

CF

Nu

mb

er o

f IY

CF

co

mm

un

ity

sup

port

gro

ups

esta

bli

shed

an

d o

per

atio

nal

Num

ber

of

wom

en r

ecei

vin

g s

atis

fact

ory

b

reas

tfee

din

g c

oun

sell

ing

õö ô÷778íòö 9: ì;ì:

Nu

mb

er o

f m

oth

ers

hav

ing

par

tici

pat

ed i

n a

t le

ast

5 p

arti

cipat

ory

co

ok

ing

ses

sio

ns

TB

D

TB

D

0

0

TB

D

70%

9

0%

1

500

2000

0

2000

0

Nat

ion

al N

utr

itio

n

Surv

ey (

&/

or

KA

P

surv

eys)

H

MIS

M

on

itori

ng

vis

its

Impac

t as

sess

men

t an

d s

urv

eys

Sec

uri

ty

Po

liti

cal

and

com

mu

nit

y

suppo

rt

Res

ourc

es

mo

bil

ised

Strategic Approaches

+ Ï»̧À ¾Î <·Ã½¹½ÄÄË ·À ÄÀ ¹È

1.

Imp

lem

ent

the

Nat

ion

al B

reas

tfee

din

g C

om

mu

nic

atio

n C

amp

aig

n (

to b

e la

un

ched

duri

ng

Worl

d B

reas

tfee

din

g W

eek

1-7

Aug

ust

2009

) 2

.C

eleb

rate

Worl

d B

reas

tfee

din

g W

eek a

nnual

ly

3.

Exp

and

th

e N

atio

nal

Bre

astf

eed

ing

Co

mm

un

icat

ion

Cam

pai

gn

to

co

ver

co

mp

lem

enta

ry f

eed

ing a

nd

IY

CF

as

a w

ho

le, an

d c

ondu

ct r

egu

lar

IYC

F a

war

enes

s ac

tiv

itie

s:

Iden

tifi

cati

on a

nd m

ob

iliz

atio

n o

f k

ey p

artn

ers

for

pub

lic

awar

enes

s ac

tiv

itie

s, n

amel

y M

oP

H,

MA

IL, M

oW

A,

Mo

RA

, M

oE

, M

RR

D a

nd p

ub

lic

med

ia.

Conduct

sam

ple

bas

elin

e K

AP

surv

eys,

wher

e po

ssib

le (

refe

rrin

g t

o f

orm

ativ

e re

sear

ch c

onduct

ed i

n 2

002 a

nd 2

003)

Iden

tifi

cati

on a

nd d

efin

itio

n o

f h

arm

on

ized

mes

sag

es t

o b

e u

sed

by a

ll s

tak

eho

lder

s, u

nder

MoP

H P

ND

lea

d.

Dev

elo

pm

ent

of

adeq

uat

e m

ater

ials

, in

clu

din

g p

ost

ers,

lea

flet

s, r

adio

and

TV

spo

ts

Tra

inin

g o

f re

lev

ant

stak

eho

lder

s on

th

e IE

C m

essa

ges

(in

clu

din

g k

ey h

ealt

h s

taff

-cf

lin

k t

o o

utp

ut

4-,

rel

igio

us

lead

ers,

co

mm

un

ity l

ead

ers,

jou

rnal

ists

, et

c.)

Imp

lem

enta

tio

n o

f P

ub

lic

Aw

aren

ess

Act

ivit

ies

thro

ugh

th

e v

ario

us

med

ia i

den

tifi

ed

Po

st-a

war

enes

s ra

isin

g m

on

ito

rin

g s

urv

ey (

KA

P)

/ Ä¿ ·»̧À Ä� н¹¿ ¶Ê ¾¶ÐРϹÀ ¿ ,Ä ÏÑѶÿ Èö ÏÑÄ·¹ºÀ ¹¿ ½Ã Á½¹¿À ¶¹Ä1

.Id

enti

fica

tio

n o

f o

ppo

rtun

itie

s fo

r es

tab

lish

ing

IY

CF

co

mm

un

ity s

uppo

rt g

roup

s, o

n t

he

bas

is o

f ex

isti

ng n

etw

ork

s an

d p

roje

cts

(e.g

. h

ealt

h s

hu

ras,

wo

men

’s s

hu

ras,

Gro

wth

M

on

itori

ng

and

Pro

mo

tio

n, et

c.)

and

/or

inte

gra

ting

IY

CF

co

un

sell

ing

in e

xis

tin

g c

om

mu

nit

y d

evel

op

men

t ac

tiv

itie

s.

2.

Mo

bil

izat

ion

of

eld

ers

and

com

mu

nit

y l

ead

ers

to e

stab

lish

su

ppo

rt f

or

the

com

mu

nit

y s

up

port

gro

up

s an

d/o

r co

mm

un

ity-b

ased

IY

CF

cou

nse

llin

g

3.

Iden

tify

fac

ilit

ato

rs w

ho c

an p

rov

ide

cou

nse

llin

g a

t co

mm

un

ity l

evel

, th

rou

gh

co

mm

un

ity s

uppo

rt g

roup

s an

d/o

r o

ther

dev

elop

men

t in

terv

enti

on

s (e

.g.

CH

W,

dah

ia, li

tera

cy

teac

her

, hea

d o

f w

om

en’s

shura

, et

c.)

and d

eter

min

e th

eir

trai

nin

g n

eed

s 4

.D

evel

op

men

t of

trai

nin

g m

ater

ials

and

job

aid

s fo

r co

mm

un

ity-l

evel

IY

CF

co

un

sell

ors

and

su

ppo

rt g

roup

fac

ilit

ato

rs

5.

Tra

inin

g o

f IY

CF

coun

sell

ors

and

/or

sup

port

gro

up f

acil

itat

ors

on

ad

equ

ate

IYC

F c

oun

sell

ing

and

psy

cho

-so

cial

su

ppo

rt s

kil

ls

6.

Pro

vid

e IY

CF

co

un

sell

ors

and

/or

sup

port

gro

up

fac

ilit

ato

rs w

ith t

he

reso

urc

es r

equ

ired

to

cond

uct

ad

equ

ate

cou

nse

llin

g (

e.g. B

F c

ou

nse

llin

g k

it;

cook

ing

set

;)

7.

Pro

vid

e re

gu

lar

assi

stan

ce a

nd

su

per

vis

ion

to

IY

CF

supp

ort

gro

up

s an

d I

YC

F c

oun

sell

ors

op

erat

ing

at

com

mu

nit

y l

evel

.

8.

Mo

nit

or

the

imp

lem

enta

tio

n o

f co

un

sell

ing s

essi

on

s an

d p

arti

cip

ato

ry c

ookin

g s

essi

on

s 9

.E

stab

lish

lin

kag

es a

nd

par

tner

ship

s w

ith f

ood

sec

uri

ty p

roje

cts

aim

ing

to

div

ersi

fy h

ou

seh

old

food

pro

du

ctio

n a

nd

in

com

e g

ener

atio

n (

if l

oca

lly i

n p

lace

) or

mobil

ize

reso

urc

es a

nd e

xper

tise

to i

mple

men

tati

on f

ood s

ecuri

ty i

nte

rven

tions

if t

hey

are

not

in p

lace

.

 ¹¿ ½È÷¿À ¶¹¶ÊÂ)�*À ¹¹¶¹ =� ½·¸ ¿� ¾¶ÐРϹÀ ¿ , =¸ ½ Á½À̧ ¹¿ ½Ã Á½¹¿À ¶¹Ä1

.E

stab

lish

po

ol

of

IYC

F t

rain

ers

in M

AIL

and

tra

in e

xte

nsi

on w

ork

ers

(in

par

ticu

lar

wo

men

) on

IY

CF

co

un

sell

ing

2

.In

teg

rati

on

of

IYC

F m

essa

ges

and

par

tici

pat

ory

coo

kin

g s

essi

on

s in

agri

cult

ura

l p

roje

cts

3.

Incl

ude

IYC

F i

n t

he

curr

icu

la o

f li

tera

cy t

rain

ing a

nd t

rain

lit

erac

y t

each

ers

on I

YC

F.

� ¶ÐѶ¹½¹¿ ·¹º Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ¹ºÀ ¾·¿ ¶ÃÄ

Æ ·Ä½À̧ ¹½Ç ·ÃȽ¿É ½·¹Ä¶ÊËÀ

ÄÌ ÄÍ

� ­© �­®Ú ¦̈­«Û ¬¡�ÜÝ ¤¤Ü¡ ­«³ ¨�¡ ¢²�­ÜÞ ® ±�® ¤«² ¯Þ ¤¥® ¤ § ¤±ßààá30

� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �­¡ �® �­ ¯°¡ ­¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬

Á½ÃÀÊÀ ¾·¿À ¶¹·ÄÄ ÏÐÑ¿À ¶¹

��������>úûüý ?ø÷7÷öò ÷íõíó ô÷8íëì:: ò í@ò ëìùù ìôöò ;ì: 9ò 7?: ì7ìíö ìó õë?õøö

÷ù öA ìBCðD õíóECðD ò íõ::A ìõ: öAù õôò: òöò ìë

Nu

mb

er o

f fa

cili

ties

cer

tifi

ed a

s B

aby-f

rien

dly

50%

of

the

EP

HS

fac

ilit

ies

and h

ealt

h c

entr

es

(CH

C&

BH

C)

pro

vid

e IY

CF

co

un

sell

ing

as

par

t o

f th

e M

CH

ser

vic

es.

(=7

00

)

50%

of

do

ctors

, nurs

es, co

mm

un

ity m

idw

ives

and

C

HW

s d

emo

nst

rate

co

rrec

t co

un

sell

ing

sk

ills

on

IY

CF

Av

erag

e n

um

ber

of

wo

men

rec

eiv

ing

bre

astf

eed

ing c

oun

sell

ing

per

mo

nth

per

co

un

sell

or

in h

ealt

h s

erv

ices

Nu

mb

er o

f h

ealt

h f

acil

itie

s co

ndu

ctin

g

par

tici

pat

ory

co

ok

ing

dem

on

stra

tio

ns

5 i

n p

roce

ss

TB

D

4,0

00

(%

T

BD

)

Chec

k w

ith

coun

sell

or

Chec

k w

ith

FA

O

>3

0

>50%

5

0%

>3

/mo

nth

/ co

un

sell

or

>1

00

Mo

PH

rep

ort

s T

rain

ing

rep

ort

s H

MIS

Sec

uri

ty

Po

liti

cal

support

R

esourc

es

mo

bil

ised

Strategic Approaches

/ FÑ·¹ÄÀ ¶¹¶ÊÆ ·» , =* ÃÀ ½¹º̧ ,G ¶ÄÑÀ ¿ ·Â̧ ¹À ¿À ·¿À Á½¿ ¶Ð¶Ã½� ¶ÄÑÀ ¿ ·¸ Ä·¹º Ľ¸ ½¾¿ ½º� ½·¸ ¿�Ê ·¾À̧À ¿À ½ÄÑö ÁÀºÀ ¹ÈÉ�G Ľà ÁÀ ¾½Ä1

.R

evie

w l

esso

n l

earn

ed f

rom

th

e cu

rren

t B

FH

I 2

.T

rain

pool

of

BF

ass

esso

rs/a

dvoca

tes

at t

he

cen

tral

and

reg

ion

al l

evel

. 3

.D

evel

op t

oo

ls, co

ndu

ct a

sses

smen

t/re

-ass

essm

ent

to c

erti

fyin

g h

ealt

h f

acil

itie

s as

Bab

y-f

rien

dly

4

.T

rain

hea

lth f

acil

ity s

taff

on m

easu

res

requ

ired

to

co

mp

ly w

ith

BF

HI

crit

eria

and

im

ple

men

t th

ese

mea

sure

s 5

.S

up

erv

ise

and m

on

ito

r fa

cili

ties

and

pro

vid

e ce

rtif

icat

es f

or

faci

liti

es c

om

ply

ing

wit

h B

FH

I cr

iter

ia

 ¹¿ ½È÷¿À ¶¹¶ÊÂ)�* ¾¶ ϹĽ¸̧À ¹ÈÀ ¹·¸̧� ½·¸ ¿�Ê ·¾À̧À ¿À ½Ä

6.

Dev

elo

p g

uid

elin

es a

nd e

stab

lish

IY

CF

corn

ers

in h

ealt

h f

acil

itie

s, i

ncl

ud

ing b

reas

tfee

din

g c

oun

sell

ing

an

d p

arti

cip

atory

co

ok

ing

ses

sio

ns

(N.B

. ca

n b

e p

art

of

chil

d h

ealt

h

corn

er)

7.

En

sure

IY

CF

co

un

sell

ing

is

par

t of

hea

lth

edu

cati

on a

ctiv

itie

s, i

ncl

ud

ing b

reas

tfee

din

g d

emo

nst

rati

on

and

par

tici

pat

ory

co

ok

ing

ses

sions

8.

En

sure

bre

astf

eed

ing

co

un

sell

ing

an

d r

e-la

ctat

ion a

ssis

tan

ce a

re p

art

of

the

man

agem

ent

of

acu

te m

aln

utr

itio

n (

in T

FU

and

CM

AM

) 9

.Id

enti

fy a

t le

ast

on

e re

ferr

al c

entr

e in

eac

h p

rov

ince

fo

r re

ferr

al o

f co

mp

lica

ted a

nd d

iffi

cult

lac

tati

on

an

d I

YC

F c

ases

. Ç Ã·À ¹À ¹È¶Ê� ½·¸ ¿� Ä¿ ·ÊÊ ¶¹Â)�*

10.

Inte

gra

te I

YC

F i

nto

th

e cu

rric

ula

of

all

med

ical

an

d p

aram

edic

edu

cati

on

in

stit

uti

on

s in

clu

din

g c

om

mu

nit

y m

idw

ifer

y s

choo

l an

d p

ost

gra

du

ate

pro

gra

ms

(esp

. re

siden

cy t

rain

ing

pro

gra

ms

in p

aed

iatr

ics,

obst

etri

cs a

nd

gyn

aeco

log

y).

1

1.

Dev

elo

p t

rain

ing p

ack

ages

and

job

aid

s on

IY

CF

for

dif

fere

nt

hea

lth

sta

ff c

ateg

ori

es,

incl

ud

ing

: d

oct

ors

, nurs

es,

mid

wiv

es, co

mm

un

ity m

idw

ives

, an

d C

HW

s 1

2.

Inte

gra

te I

YC

F t

rain

ing m

odule

s as

par

t of

in-s

erv

ice

trai

nin

gs,

in

par

ticu

lar

for

MC

H s

taff

, C

HW

s &

mid

wiv

es (

e.g

. as

par

t of

C-I

MC

I tr

ain

ing)

1

3.

Dis

trib

ute

pri

nte

d m

ater

ial

and

job

aid

s to

all

fac

ilit

ies,

in

clu

din

g f

or

CH

Ws

and

co

mm

un

ity m

idw

ives

as

par

t o

f C

-IM

CI

1

4.

Tra

in a

nd

est

abli

sh p

ool

of

trai

ner

s at

th

e n

atio

nal

lev

el a

nd

in

“ea

ch r

egio

n”

on

MB

FI

and I

YC

F,

in p

arti

cula

r by t

rain

ing P

rov

inci

al N

utr

itio

n O

ffic

ers

on I

YC

F

15.

Tra

in a

t le

ast

2 M

CH

sta

ff o

f ea

ch h

ealt

h f

acil

ity.

16.

Tra

in o

ut-

reac

h s

taff

to

en

able

th

em t

o i

nte

gra

te I

YC

F i

n o

ut-

reac

h s

ervic

es.

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� ¶ÐѶ¹½¹¿ ÄM Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂN

O PQ RST UT VW XYVZ[S \]T R̂W XZ[T_ VST V̂W

K `K( ·¿À ¶¹·Â̧)�*+ ¶À̧ ¾ ,Í- ¿ ÷¿ ½È ,

Dis

sem

inat

e th

e N

atio

nal

IY

CF

Po

licy

an

d S

trat

egy a

mo

ng

st a

ll k

ey

stak

eho

lder

s

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Reg

ula

r upd

atin

g o

f IY

CF

act

ion

pla

n

and p

rep

arat

ion o

f a

reso

urc

e m

ob

iliz

atio

n p

lan

X

X

X

X

X

Rev

iew

Mo

PH

rel

ated

sub

-poli

cies

, st

rate

gie

s an

d g

uid

elin

es

X

X

X

X

X

K `HÇ� ½� ¶º ½¶ÊÉ ·ÃÌ ½¿À ¹È¶ÊÆÉ-

Est

abli

sh a

nd

reg

ula

r m

eeti

ng

s of

Nat

ion

al C

om

mit

tee

for

the

En

forc

emen

t o

f th

e C

od

e

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Est

abli

sh e

nfo

rcem

ent

mec

han

ism

s

X

Dis

sem

inat

e in

form

atio

n o

n t

he

Co

de

and r

elat

ed l

egis

lati

on

X

X

Tra

inin

g o

f C

od

e m

on

ito

rs

X

X

Mo

nit

or

Co

de

imp

lem

enta

tio

n

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

K `LÉ ·¿ ½Ã¹À ¿ ,Ñö¿ ½¾¿À ¶¹

Est

abli

sh e

nfo

rcem

ent

mec

han

ism

s an

d d

evel

op

guid

elin

es

XX

Info

rm w

ork

ing

wo

men

of

thei

r ri

gh

ts

und

er t

he

Mat

ern

ity P

rote

ctio

n A

ct

X

X

X

X

X

X

X

X

X

X

X

X

X

X

K `aÂ)�*µ ÏÀº ½À̧ ¹½Ä

Dev

elo

p I

YC

F g

uid

elin

es

X

X

X

X

Dis

sem

inat

e g

uid

elin

es a

nd

co

ndu

ct

trai

nin

gs

on t

hei

r im

ple

men

tati

on

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

K `b ¹Ê ·¹¿ ·¹º) ¶ ϹÈ��À̧º* ½½ºÀ ¹ÈÀ ¹/ нÃȽ¹¾À ½Ä

Dev

elo

p I

FE

Gu

idel

ines

& i

nte

gra

te i

n

IYC

F g

uid

elin

es

X

X

X

X

Dis

sem

inat

e th

e IF

E G

uid

elin

es &

m

on

ito

r ap

pli

cati

on

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

� ­© �­®Ú ¦̈­«Û ¬¡�ÜÝ ¤¤Ü¡ ­«³ ¨�¡ ¢²�­ÜÞ ® ±�® ¤«² ¯Þ ¤¥® ¤ § ¤±ßààá32

� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �­¡ �® �­ ¯°¡ ­¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬ HIIJHIKIHIKKHIKHHIKL

� ¶ÐѶ¹½¹¿ ÄM Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂN

c Pd Ve \fT R[YUe \̂ZVR̂ghi j

H `K+ Ï»̧À ¾Î <·Ã½¹½ÄÄË ·À ÄÀ ¹È

Imp

lem

ent

the

Nat

ion

al B

reas

tfee

din

g

Co

mm

un

icat

ion

Cam

pai

gn

X

X

Cel

ebra

te W

orl

d B

reas

tfee

din

g W

eek

X

X

X

X

X

Exp

and

to

IY

CF

as

a w

ho

le,

and c

ond

uct

re

gu

lar

IYC

F a

war

enes

s ra

isin

g:

Mo

bil

izat

ion

of

key

par

tner

s

X

X

X

X

X

Bas

elin

e K

AP

surv

eys

X

X

X

X

X

Iden

tifi

cati

on o

f m

essa

ges

X

X

X

X

X

Dev

elo

pm

ent

of

mat

eria

ls

X

X

X

X

Tra

inin

gs

on

the

IEC

mes

sag

es

X

X

X

X

Imp

lem

ent

Pu

bli

c A

war

enes

s

X

X

X

X

X

X

X

X

X

X

X

X

X

Impac

t m

on

ito

rin

g s

urv

ey (

KA

P)

X

X

X

H `H/ Ä¿ ·»̧À Ä� н¹¿ ¶Ê ¾¶ÐРϹÀ ¿ ,Ä ÏÑѶÿ Èö ÏÑÄ·¹ºÀ ¹¿ ½Ã Á½¹¿À ¶¹Ä

Iden

tifi

cati

on o

f o

ppo

rtun

itie

sX

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Mo

bil

izat

ion

of

com

mu

nit

y l

ead

ers

Id

enti

fy f

acil

itat

ors

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Dev

elo

p t

rain

ing m

ater

ials

& j

ob a

ids

X

X

X

X

Tra

inin

g o

f IY

CF

coun

sell

ors

and

fa

cili

tato

rs &

pro

vid

e re

sou

rces

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Reg

ula

r as

sist

ance

an

d m

on

ito

rin

g

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Est

abli

sh l

ink

ages

wit

h f

ood

sec

uri

ty

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

k õø@ìö í87l ìø÷ù ë8??÷øö @ø÷8?ëm

2

0

1

00

300

800

1500

H `L ¹¿ ½È÷¿À ¶¹¶ÊÂ)�*À ¹¹¶¹ =� ½·¸ ¿�¾¶ÐРϹÀ ¿ , =¸ ½ Á½À̧ ¹¿ ½Ã Á½¹¿À ¶¹Ä

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abli

sh p

oo

l o

f IY

CF

tra

iner

s in

MA

IL

and t

rain

ex

tensi

on w

ork

ers

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Inte

gra

tion

of

IYC

F m

essa

ges

and

p

arti

cip

atory

co

ok

ing

ses

sions

in

agri

cult

ura

l p

roje

cts

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Incl

ud

e IY

CF

in

lit

erac

y c

urr

icu

la

X

X

X

X

X

Tra

in l

iter

acy

tea

cher

s o

n I

YC

F

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

� ­© �­®Ú ¦̈­«Û ¬¡�ÜÝ ¤¤Ü¡ ­«³ ¨�¡ ¢²�­ÜÞ ® ±�® ¤«² ¯Þ ¤¥® ¤ § ¤±ßààá33

� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �­¡ �® �­ ¯°¡ ­¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬ HIIJHIKIHIKKHIKHHIKL

� ¶ÐѶ¹½¹¿ ÄM Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂN

n ghi jT ^dQopq rQop

L `K/ FÑ·¹ÄÀ ¶¹¶ÊÆ*GÂ

Rev

iew

les

son

lea

rned

fro

m c

urr

ent

BF

HI

X

X

Dev

elo

p t

oo

ls t

o a

sses

s B

FH

I st

atu

s

X

X

X

X

X

Tra

in p

ool

of

BF

ass

esso

rs/a

dvoca

tes

at

the

cen

tral

an

d r

egio

nal

lev

el

X

X

X

X

X

X

X

X

Co

nd

uct

ass

essm

ents

/re-

asse

ssm

ents

on

B

FH

I st

atu

s of

hea

lth

fac

ilit

ies

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Tra

in h

ealt

h f

acil

ity s

taff

on B

FH

I

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Mo

nit

or

faci

liti

es a

nd

pro

vid

e ce

rtif

icat

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X

X

X

X

X

X

X

X

X

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k õø@ìö ë?ìø9ìõø

5

10

15

20

30

L `H ¹¿ ½È÷¿À ¶¹¶ÊÂ)�* ¾¶ ϹĽ¸̧À ¹ÈÀ ¹·¸̧� ½·¸ ¿�Ê ·¾À̧À ¿À ½Ä

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p g

uid

elin

es o

n I

YC

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orn

ers

X

X

X

Est

abli

sh I

YC

F c

orn

ers

in h

ealt

h f

acil

itie

s

X

X

X

X

X

X

X

X

X

X

X

X

X

X

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sure

IY

CF

co

un

sell

ing

is

par

t of

hea

lth

ed

uca

tion

act

ivit

ies

X

X

X

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X

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re b

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rela

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the

man

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X

X

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X

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F r

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X

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k õø@ìö ës 9ìõøêA ìõ: öAù õôò: òöò ìëîòöAúûüý

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200

400

700

Ç Ã·À ¹À ¹È¶Ê� ½·¸ ¿� Ä¿ ·ÊÊ ¶¹Â)�*

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gra

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F i

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tio

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inst

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Dev

elo

p t

rain

ing p

ack

ages

and

job

aid

s on

IY

CF

fo

r d

iffe

ren

t h

ealt

h s

taff

cat

ego

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Inte

gra

te I

YC

F t

rain

ing m

odule

s as

par

t of

in-s

ervic

e tr

ainin

gs

X

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Tra

in a

nd

est

abli

sh p

oo

l o

f tr

ain

ers

at t

he

nat

ional

lev

el a

nd i

n “

each

reg

ion

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X

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X

X

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X

X

X

X

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X

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trib

ute

pri

nte

d m

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ial

and

job

aid

s to

al

l fa

cili

ties

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� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �­¡ �® �­ ¯°¡ ­¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬

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� ¶¶ÃºÀ ¹·¿À ¶¹Ð½¾� ·¹À ÄÐÄ

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1

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1

1

1

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1

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1

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1

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sh e

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É ¶¹À ¿ ¶ÃÀ ¹È·¹º ½ Á·¸ Ï·¿À ¶¹

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elo

p a

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op

t IY

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mo

nit

ori

ng t

oo

ls

for

use

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nt

level

s X

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ild

cap

acit

y o

f th

e st

aff

to u

se

mo

nit

ori

ng t

ools

and

tak

e co

rrec

tiv

e ac

tio

n

X

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rpora

te I

YC

F s

elec

ted i

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ators

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nat

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on

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yst

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Inco

rpo

rate

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CF

mai

n i

nd

icat

ors

in

n

atio

nal

surv

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(in p

arti

cula

r M

ICS

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Incl

ud

e IY

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in

IM

CI

and C

BH

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super

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kli

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ndu

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egu

lar

mo

nit

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its

on

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u ѽ÷¿À ¶¹·¸ ýĽ·Ã¾�

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� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � The cost for each component of the IYCF strategy is provided below, broken down by activity and type of resources. *N.B. The “Potential Sources of support” (column 6) are not donors but technical assistance providers (through which donor funding can be channelled in addition to direct support to MoPH) Ü Ý Þ ß Ý Ú Ó Ú Ö Õ v Õ Ö Ò Ô Ö Ó Û Ù åÔ ß ß Ò Ý Ô å ó Ó Õ w Ó Õ Ý ä Ò å Ó Õ Ú Ó Ó Ø Ó Ø æ á Ó Ô Ò ð è x ä Þ y Ó ÒÝ × ä Ú Ù Ö Õ z Ú Ù Ö å Ý Õ Ö Õ ò Þ Ý ä Ú Ö Ú Ó Ó Ø Ó Øæ Ö Ý Ö Ô à è { Ý Ö Ó Ú Ö Ù Ô àã Ý ä Ò å Ó Ý ×Õ ä ß ß Ý Ò Ö |} ~ � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �ð î ð x Ô Ö Ù Ý Ú Ô à � ç Ü â { Ý à Ù å á� ã Ö Ò Ô Ö Ó Û á

Translation (Dari & Pashtoo) 2 $1 500 $3 000 BASICS

Printing (English, Pashtoo and Dari)

3 $1 000 $3 000 BASICS

Disseminate the National IYCF Policy and Strategy amongst all key stakeholders

PND staff &support costs MoPH

PND staff &support costs MoPH Regular updating of IYCF action plan and preparation of a resource mobilization plan

Technical assistance (4 months over 4 years)

4 $10 000 $40 000 � � � � � } ~ } � � í ë ë ë

ð î ñ � ó Ó Ü Ý Ø Ó Ý ×� Ô Ò � Ó Ö Ù Ú Û Ý × Ñ � ã

PND staff &support costs MoPH

Technical assistance (4 months over 4 years)

4 $10 000 $40 000 IBFAN, UNICEF?

Support to Committee est & regular meetings (2/year, 4 years)

8 $1 000 $8 000 UNICEF + IBFAN

Establishment and regular meetings of National Committee for the Enforcement of the Code

National meeting (2009) 1 $7 000 $7 000 UNICEF+IBFAN

PND staff &support costs MoPH Establish enforcement mechanisms � � � � � � � � � � � � � � � � �

IBFAN?

Translation (in English & Pashto)

� � � � � � � � � UNICEF

Printing costs (in dari & pashto)

� � � � � � � � �

Disseminate information on the Code and related legislation

PND staff &support costs MOPH

Training of Code monitors Annual trainings in 5 regions, each year

15 $4 000 $60 000 UNICEF

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -36

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Bi-annual field visits by provincial staff to each district (incremental coverage)

1 380 $200 $276 000 UNICEF + IBFAN

Annual visit by central level staff to each province (incremental coverage)

69 $500 $34 500

PND staff &support costs MoPH

Monitor Code implementation

BPHS/EPHS staff time BPHS donors � � � � � } ~ �

� � ñ � � ë ë

ð î � � Ô Ö Ó Ò Ú Ù Ö á ß Ò Ý Ö Ó å Ö Ù Ý Ú

PND staff & support costs MoPH Establish enforcement mechanisms & develop guidelines

Technical assistance 1 $10 000 $5 000

PND staff & support costs

Dissemination of info through media

1 $10 000 $10 000

Inform working women of their rights under the Maternity Protection Act

Sensitization workshops for employers (1/region/year, 4 years; 1 day)

20 $1 000 $20 000 � � � � � } ~ � � � � ë ë ë

ð î � � ç Ü â � ä Ù Ø Ó à Ù Ú Ó Õ

Develop IYCF guidelines International consultant 2 months

2 $10 000 $20 000

Translation (Dari and Pashto) 2 $1 500 $3 000 Disseminate guidelines and conduct trainings on their implementation

Publication costs (in Eng, Dari and Pashto)   � � � � �� � � � � � � � ¡ ¢ � � � � £ ¤ ¥ ¦� � � � § ¨

3 $5 000 $15 000 BASICS, WHO, UNICEF? � � � � � } ~ ©

� � ª ë ë ë

ð î � � Ú × Ô Ú Ö Ô Ú Ø ç Ý ä Ú ÛÜ ó Ù à Ø â Ó Ó Ø Ù Ú Û Ù Úê Þ Ó Ò Û Ó Ú å Ù Ó Õ

Develop IFE Guidelines & integrate in IYCF guidelines

� � � � � � � � � � � � � � � �  � � ¡ � � � � � � � � ¨ « � � � � � � � � �

Disseminate the IFE Guidelines & monitor application

« � � � � � � � � � � � � � � « � � � � � � � � � � ¬ � ò ­ ð ® ¯ ° ° ¯ ± ±

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -37

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Ü Ý Þ ß Ý Ú Ó Ú Ö Õ v Õ Ö Ò Ô Ö Ó Û Ù åÔ ß ß Ò Ý Ô å ó Ó Õ w Ó Õ Ý ä Ò å Ó Õ Ú Ó Ó Ø Ó Ø æ á Ó Ô Ò ð è x ä Þ y Ó ÒÝ × ä Ú Ù Ö Õ z Ú Ù Ö å Ý Õ Ö Õ ò Þ Ý ä Ú Ö Ú Ó Ó Ø Ó Øæ Ö Ý Ö Ô à è { Ý Ö Ó Ú Ö Ù Ô àã Ý ä Ò å Ó Ý ×Õ ä ß ß Ý Ò Ö | � ~ ² � ³ � ´ � � � � � ³ � � � � � � � µ � ¶ñ î ð { ä y à Ù å ò · Ô Ò Ó Ú Ó Õ Õw Ô Ù Õ Ù Ú Û

PND staff time & support costs

MOPH

Material development

Dissemination through media

Transport costs

Implement the National Breastfeeding Communication Campaign (1 year: 2009-2010)

campaign staff costs?

$150 000 UNICEF & WHO

PND staff time & support costs

MOPH Celebrate World Breastfeeding Week

Materials and campaign implementation (lumpsum, 4 years)

4 $100 000 $400 000 UNICEF & WHO

PND staff time & support costs

MoPH

Technical assistance (1 international or national consultant, as per need, e.g. 6 months total)

6 $10 000 $60 000

Baseline KAP survey 1 $100 000 $100 000

Development of materials 1 $100 000 $100 000

Trainings on messages (1 training / region, 4 years)

20 $4 000 $80 000

Field work (staff & transport) in each province, 4 years

136 $4 000 $544 000

Dissemination through media 1 $100 000 $100 000

Expand to IYCF as a whole, and conduct regular IYCF awareness raising (2010-2013):

Impact monitoring survey 1 $100 000 $100 000

UNICEF, WHO, FAO, WFP

� � � � � � ~ } � ð í � � ë ë ë

�

PND staff & support costs MoPH ñ î ñ ê Õ Ö Ô y à Ù Õ ó Þ Ó Ú Ö Ý ×å Ý Þ Þ ä Ú Ù Ö á Õ ä ß ß Ý Ò ÖÛ Ò Ý ä ß Õ Ô Ú Ø Ù Ú Ö Ó Ò é Ó Ú Ö Ù Ý Ú Õ

Technical assistance (6 months total)

6 $10 000 $60 000

Design / review of training materials & job aids (Technical assistance) -team for 2 months

2 $3 000 $6 000

Translation (Dari & Pashto) 2 $1 000 $2 000

Develop training materials & job aids

Printing (Dari & Pashto) 2 $6 000 $12 000

BASICS, FAO, UNICEF, FAO, WHO, WFP (MDG-Fund)

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -38

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Training of IYCF counsellors and facilitators & provide resources

Regional trainings (2/year in each region, 4 years)

40 $4 000 $160 000

Regular assistance and monitoring

Field visists (1/district/2months)

7 140 $300 $2 142 000 ¸ � � � � � � � ¹ � � � � � � � § � � ¹ � � � �� � � � � � �

TOTAL 2.2. � ñ � ª ñ ë ë ë

ñ î � � Ú Ö Ó Û Ò Ô Ö Ù Ý Ú Ý × � ç Ü â Ù ÚÚ Ý Ú ì ó Ó Ô à Ö ó å Ý Þ Þ ä Ú Ù Ö á ìà Ó é Ó à Ù Ú Ö Ó Ò é Ó Ú Ö Ù Ý Ú Õ

PND / MAIL / MoE staff and support costs

MoPH/MAIL/MoE

Technical assistance (6 months over 4 years)

6 $10 000 $60 000

Establish pool of IYCF trainers in MAIL and train extension workers

Master trainings (3) and regional trainings (1/region/year for 3 years)

18 $4 000 $72 000

FAO, with support from UNICEF, WHO, and BASICS

Provincial trainings for field staff (1/province + refresher)

68 $4 000 $272 000 Integration of IYCF messages and participatory cooking sessions in agricultural projects

Monitoring visits (at least 1/district/year; incremental)

690 $300 $207 000

FAO, with UNICEF, WHO, and BASICS

Include IYCF in literacy curricula

Preparation of literacy materials / job aids / training materials

1 $200 000 $200 000

Train literacy teachers on IYCF

Provincial trainings for literacy teachers (1/District + refresher course)

660 $2 000 $1 320 000

FAO, Habitat, UNICEF � � � � � � ~ �

º � } � } » » » � ¬ � ò ­ ñ

� í ð � ¼ ë ë ë Ü Ý Þ ß Ý Ú Ó Ú Ö Õ v Õ Ö Ò Ô Ö Ó Û Ù åÔ ß ß Ò Ý Ô å ó Ó Õ w Ó Õ Ý ä Ò å Ó Õ Ú Ó Ó Ø Ó Ø æ á Ó Ô Ò ð è x ä Þ y Ó ÒÝ × ä Ú Ù Ö Õ z Ú Ù Ö å Ý Õ Ö Õ ò Þ Ý ä Ú Ö Ú Ó Ó Ø Ó Øæ Ö Ý Ö Ô à è { Ý Ö Ó Ú Ö Ù Ô àã Ý ä Ò å Ó Ý ×Õ ä ß ß Ý Ò Ö | \ < S T U V @ J P = ] ^ _ ` = ] ^½ ¾ º e ¿ Ì ¶ Ç Ã ¿ Á Ç Á Â 9 Ë À È

Technical assistance (4 mo)

4 $10 000 $40 000 UNICEF, WHO?

PND staff and support costs

MOPH

Review lesson learned from current BFHI

External assessment of BFHI (incremental)

80 $1 000 $80 000 UNICEF, WHO

Develop tools to assess PND staff time MOPH � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -39

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Technical assistance (2 months)

2 $10 000 $20 000 UNICEF, WHO

BFHI status

Print materials 1 $30 000 $30 000

PND staff time & support costs

MOPH Train pool of BF assessors/advocates at the central and regional level Trainings for assessors at

regional level (1 training/region/year, 4 yrs)

20 $4 000 $80 000 UNICEF, WHO

PND staff time MOPH

Provincial trainings (2/province)

68 $4 000 $272 000 UNICEF, WHO

Train health facility staff on BFHI

EPHS/BPHS staff time BPHS

PND staff time & support costs

MOPH

EPHS/BPHS staff time BPHS

Monitor facilities, conduct assessments / reassessments, and provide certificates

Monitoring visits (1/province/year; incremental)

80 $500 $40 000 UNICEF, WHO Á > I H ? \ < ;

L M Â � � � �

½ ¾ � È Ç Æ ¹ Ï ¾ ¶ Æ ¿ Á Ç Á Â È É Ê ËÍ Á Ä Ç Ã ¹ ¸ ¸ ¿ Ç Ï ¿ Ç ¶ ¸ ¸ Ð ¹ ¶ ¸ Æ ÐÂ ¶ Í ¿ ¸ ¿ Æ ¿ ¹ ÃÃ Ä Å Ä Æ Ç È É Ê Ë Ì Ä Æ Ë Í Ä Î Ç ÍÏ Ð Ñ Ò Ó Ç Ô Í Ä Ô Î Õ È Ö Ô × Ç ØÏ Ð Ñ Ò É Ê Ë Ì Ä Æ Ë Í Ä Î Ù Ö Ú Ç Å Ä Û Ü Ä Ä Ö Ú Ç Å Ä

Technical support to BPHS/EPHS partners by PND staff

MoPH

EPHS/BPHS staff time BPHS

Establish IYCF corners in health facilities & identify at least one IYCF referral center / province (training covered in 3.3)

2 visits in each facility for establishment (assessment and support)

3 420 $100 $342 000

PND staff time and support costs

MoPH

EPHS/BPHS staff time BPHS

Bi-annual field visits by provincial staff to each district (incremental coverage)

1 380 $200 $276 000

Ensure IYCF counselling is part of health education activities and management of acute malnutrition (training covered in 3.3)

Annual visit by central level staff to each province (incremental coverage)

69 $500 $34 500 Á > I H ? \ < O

L Â M � M � � � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -

40

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �½ ¾ ½ µ ¾ ¶ ¿ Ç ¿ Ç Ï Á  Р¹ ¶ ¸ Æ ÐÃ Æ ¶   Á Ç È É Ê ËPND staff and support costs

Technical assistance 6 $10 000 $60 000

Material development 4 $20 000 $80 000

Integrate IYCF into the curricula of medical and paramedic education institutions

Training of trainers (for faculty professors; 4/year)

16 $4 000 $64 000

MoPH; UN MDG-Fund, Univ of Massachussetts

PND staff and support costs

MoPH

Technical assistance 4 $10 000 $40 000

Develop training packages and job aids on IYCF for different health staff categories

Material development 4 $20 000 $80 000

UNICEF, WHO, FAO, WFP

PND staff and support costs

MOPH

Regular MoPH training MoPH?

Integrate IYCF training modules as part of in-service trainings

Additional training to complement regular in-service training (1/province)

34 $4 000 $136 000 UNICEF, WHO, BASICS

PND staff and support costs

MOPH Train and establish pool of trainers at the national level and in “each region Training costs (1 training

year 1 + 3 refresher courses)

4 $4 000 $16 000 UNICEF, WHO, FAO

PND staff and support costs

MOPH Distribute printed material and job aids to all facilities transport costs 34 $800 $27 200 UNICEF,

WHO Á > I H ? \ < \

L M � ½ � � �

µ ¼ µ Î d ½

L º a º a a � � Ê ¼ b c d e µ e µ ¼ µ Î d

L f N � g � � �

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -41

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

´ ¢ © « £ ¡ ù £ ¤ ¯ ± ¬ £ ­ ³ Ý £ ÷ £ ¬ ­ £ ô ­ ¯ ¬ ¡ + £ ± ¬ £ ¡ ¥ # § ± ° £ ³ « ¤ § Þ ü Breastfeeding Counselling Training Package translated in Dari Baby-Friendly Hospital Initiative training package translated in Dari/Pashto Code of Marketing of Breast Milk Substitutes (2009) Translated in Dari/Pashto/English � K O T B I K C A N C X L M c z H D Q L D L G A } H L E O

(MAIL, MoPH, FAO, 2007) | O C M D K c N G G E x | C Y Y c i C d c x ß L W O M c N C X L M c { @ X Y Q G W O E ~ O R L Y O S C A E N O O E L A I P Q C R D L R O S B G QT B I K C A g G D K O Q S C A E J K L M E Q O A

(MAIL, MoPH, FAO, UNICEF, 2008), and relevant training materials (FAO) WHO/UNICEF Global Strategy on Infant and Young Child Feeding, translated in Dari and Pashto.   ¡ ¤ ¯ ± ¡ £ ¤ ¬ § ¡ £ ­ ± ¯ ¢ ¯ ± ¯ ¡ ² ¯ ³ üWHO/UNICEF Global strategy on Infant and Young Child Feeding (2002): http://www.who.int/nutrition/topics/global_strategy/en/ Code of Marketing of Breast Milk Substitutes (1981) http://www.who.int/nutrition/publications/code_english.pdf Operational Guidance on Infant and Young Child Feeding in Emergencies (IFE Core Group): http://www.ennonline.net/pool/files/ife/ops-guidance-2-1-english-010307.pdf

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -42

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -43

� / 5 � 6 4 � 4 $ 4 / $ 4 � � � 1 0 5 / % $ 1 ! 4 � " � Proportion of children born in the last 24 months

who were put to the breast within one hour of birth

Children born in the last 24 months who were put to the breast within one hour of birth Children born in the last 24 months

T E E L D L G A C M L A E L R C D G Q S X C c L A R M H E O {Children born in the last 24 months who were put to the breast within 24 hours of birth

Children born in the last 24 months

Children born in the last 24 months who received colostrum (not discarded) Children born in the last 24 months

� � � � ; % 4 � 0 5 / % $ 1 ! 4 � " ; � ! 5 % 4 � # � � $ ^ % �Proportion of infants 0-5 months of age

who are fed exclusively on breast milk

Infants 0-5 months who received only breast milk during the previous day Infants 0-5 months of age - § ¤ ¯ ü

Using the previous day recall period will overestimate the proportion of infants who are exclusively breastfed. Some infants who are given other liquids irregularly may not have received them the day before the survey. T A C E E L D L G A C M L A E L R C D G Q X C c L A R M H E O {` 5 ! � # 4 � / � $ 0 5 / % $ 1 ! 4 � " ; � ! 5 % 4 � # � � $ ^ % �

Proportion of infants 0-5 months of agewho have breast milk as their main source of nourishment. This indicator recognizes that the infant receives certain liquids (water, tea, watery liquids, ritual fluids).

Infants 0-5 months of age who received breast milk as a main source of nourishment Infants 0-5 months of age \ � $ 5 � ! ; � $ 4 � � � 1 % � � 4 ! � % # 4 � % � � 4 ! � 5 % � 1 $ 1 � � ! % � 2 � # u � # � $ / 5 6 1 ! 4 � " � �

Proportion of infants 6-8 months of age who receive solid, semi-solid or soft foods

Infants 6-8 months of age who ate solid, semi-solid or soft foods in the previous day Infants 6-8 months of age

2 � � $ 4 � ; ! 0 5 / % $ 1 ! 4 � " / $ � � 6 / 5 � Proportion of children 12-15 months of age

who are fed breast milk

Children 12-15 months of age who were fed breast milk in the previous day Children 12-15 months of age

2 � � $ 4 � ; ! 0 5 / % $ 1 ! 4 � " / $ $ � � 6 / 5 % � Proportion of children 20-23 months of age

who are fed breast milk

Children 20-23 months of age who were fed breast milk in the previous day Children 20-23 months of age