COMMUNITY BASED INFORMATION SYSTEMS FOR IMPROVED IYCF FLORENCE ONI, PhD PUBLIC HEALTH (NUTRITION) NUTRITION SPECIALIST, UNICEF NIGERIA SECOND WORLD BREASTFEEDING CONFERENCE 11TH – 14TH DECEMBER 2016 BIRCHWOOD HOTEL, JOHANNESBURG, AFRICA.

Introduction We know the importance of breastfeeding and infant and young child feeding (IYCF) It is not easy to improve what we do not know We know the importance of breastfeeding and infant and young child feeding (IYCF) It is not easy to improve what we do not know UNICEF

Unfortunately, we do not know the situation at the community level.

Community Based Information System Partway to Equity in IYCF Data generated at community level, information on the most disadvantaged and hardest to reach. Provide Integrated intersectoral and multidimensional information, when applied to address deprived and denied children will lead to a fair chance in life Data collection at Community level has the potential for emergence of dynamic innovation to accelerate change through new approaches to solve developmental problems Such data, information & innovation can be used by Governments and development partners to target programmes and opportunities to the most disadvantaged This approach will require commitments of governments, development partners and civil societies to shape policies and programmes for solution that will enhance fair chance for appropriate IYCF for every child UNICEF

Community-Based Information Systems (CBIS) Involves data collection, management, and analysis at the community level (effective decentralization) Engages community members Gives voice to the most disadvantaged children and women Provides community members with an avenue to health services, and hold them accountable, contributing to the goals of sustainability (Jeremie, 2014; Sabitu, 2004) Shares information with and between community-based services and health facilities Feeds into the national HMIS

Benefits of CBIS Increases awareness, understanding, and capacity at community level (Bamako initiative) Enhances knowledge of problems, assessment and application of resources for appropriate action to address problems Mobilizes communities Has the potential for emergence of dynamic innovation to accelerate change through new approaches to solve developmental problems Contributes to increased retention of organizational, human and financial resources for women and children at the community level

Standard IYCF Outcome Indicators Early initiation of breastfeeding Exclusive breastfeeding Introduction of solid, semi solid foods Minimum meal frequency Minimum diet diversity Minimum acceptable diet Continued breastfeeding at 1 and 2 years of age Most of these are only collected during population-based surveys conducted every 3-4 years So, here are the standard IYCF indicators. Most of these are only collected during population-based surveys every 3-4 years. AND they are usually not representative of the community or given to the community. They are usually only useful at the state level.

C-IYCF Process Indicators No. of community volunteers trained in C-IYCF No. of functioning C-IYCF support groups No. of C-IYCF support group meetings No. of C-IYCF support group participants, by type No. of pregnant and lactating women reached with at least one C-IYCF counselling session No. of referrals to community volunteers / support groups No. of referrals to health facilities by community volunteers No. and % of community volunteers who received a monitoring or supportive supervision visit

Data Sources C-IYCF support group registers Community Volunteer C-IYCF Monthly Summary Form C-IYCF support group registers Health management information system (HMIS) forms: Growth monitoring /Nutrition registers Immunization registers Supervision tracking BUT MIYCN often not considered during supervision

COMMUNITY INFORMATION BOARD COMMUNITY INFORMATION BOARD Our Children, Our Future Name of Community: …………………………… Year: ……..… Total Population (Adult): Male: …… Female: ……. Total number of children less than one year: …… Total number of children under five years: ……….. Number of primary schools: ………….. Children (6-12 Years) Male: ……….. Female: ……….. Children (13-15 Years) Male: ……… Female: ……… Total enrolled in primary school at start of the school years Girls: ……. Boys: …… No of Community Improved water source: …………….. S/N INDICATORS Jan-Mar Apr-Jun Jul- Sept Oct-Dec 1 Number of children born   2 Number of children registered at birth 3 Number of children under one year who have received first dose OPV at birth 4 Number of children under five years who have received DPT3 5 Number of children not gaining weight 6 Number of Orphans 7 Number of children attending primary school segregated by sex 8 Number of households with long lasting insecticide treated nets (ITNs) 9 Number of households with latrine 10 Number of functional improved community water sources 11 Number of pregnant women attending antenatal clinic 12 Number of women who died during pregnancy or within 6 weeks of delivery 13 Number of children who died within one month of birth 14 Number of children who died before five years of age 15 Number of community dialogue sessions held 16 Number of village development association meetings held 17 Number of MIYCN support groups* 18 Number of people attending MIYCN support group meetings * 19 Number of caregivers counseled one-on-one on MIYCN* * Indicators not yet included in the community information board

Data Available from HMIS (Niger State, Nigeria Data 2015) Month Indicators Underweight Rate Nutrition Treatment CMAM program admissions Child Defaulted from CMAM program Children 0-59 months weig Children below bottomline Children Exclusively breastfed Deworming medications Vitamin A 12-59m Vitamin A 6-11m January 271.2 34   10419 240 2254 1102 1191 869 February 245.5 26 13843 270 3127 2002 1677 1375 March 238.6 232 22752 461 3543 31275 69149 32557 April 537.8 16 14389 636 3835 779 551 476 May 335.8 14 15778 450 3657 619 1526 590 June 509.1 20 1 17062 714 3437 578 776 362 July 234.1 8 14890 296 2872 940 August 369.4 11 7 21450 673 3907 5357 465 431 September 454.9 36 23698 886 4971 1239 610 539 October 412 27 3 24975 874 5324 606 471 Total 360.84 399 46 179256 5500 36927 44497 77343 37966

Standard IYCF Outcome Indicators Early initiation of breastfeeding Exclusive breastfeeding Introduction of solid, semi solid foods Minimum meal frequency Minimum diet diversity Minimum acceptable diet Continued breastfeeding at 1 and 2 years of age .

National Platform (District HIS) Routine IYCF Data Flow Community 4 Community 5 Community6 Community 7 Community 8 Community9 Community 1 Facility A Facility B Facility C Community 2 Community 3 National Platform (District HIS) 1PHC/ Ward LGA

CBIS: The Nigeria Experience Community outreach register ( Under review to make it more robust to key into DHIS platform Revitalization of Village /Community and Facility Development Committees Institutionalization of CIYCF SG through community volunteers Community volunteers are linked to health facilities Re-invention of 1 PHC per Ward Ward level data collated at LGA level LGA data fed to the National platform: DHIS DHIS Platform 12 registers on the platform, 1 monthly summary

Challenges Lack of technical capacity of those collecting the data Added workload of data collection and associated activities to the health workers or volunteers assignments Addition of new responsibilities to health workers workload Integration of CBHIS to formal HMIS

Way Forward Identify and strengthen existing community systems which generate and spread information on health and nutrition for improved engagement of households and communities in making decisions and taking actions Increase capacity for data collection analysis, understanding and deriving action and taking decisions on the immediate and underlying causes of diseases and death Increase resources at local level for action Revitalize village, community and facility development committees Ensure information shared receives appropriate action Ensure information flow to district level for resource allocation and action Holistic integration of the IYCF data into the existing CBHIS

Thank you UNICEF