Maretha le Roux INP Manager Developing best practices and overcoming challenges: “The Northern Cape experience” Maretha le Roux INP Manager

Outline Geography Demographics EBF in the NC Methodology Results Conclusions Acknowledgements

Geography

Districts 26 Sub-districts 17 Hospitals 33 CHCs 136 PHCs 57 Dietitians 20 Ass nutr

Demographics Indicator Value Under 5 population 112 975 Stunting *DHIS Stunting 22.8% boys; 15% girls *Shisana et al. 2013 Low Birth Weight rate 20% Teenage pregnancy rate 10% Fetal Alcohol Syndrome 12% in De Aar; 7% in Upington *Urban et al. 2008 Vitamin A deficiency 5,8 % *Faber et al. 2015

EBF rates at 14 weeks in NC *DHIS

EBF 4-8 weeks postpartum – 12/13 SAPMTCT report

Methodology 2014 MNCWH&N Mid-term review facility tool Semi-structured interviews were conducted Open ended questions – antenatal and postnatal mothers

Results Strong leadership and champions for nutrition Dietitians & nutritionists in key positions Chief dietitians report to DM Ownership & accountability Technology – w/app groups Paediatrician & interns trained DCST available in advisory capacity

Results (cont) Committed managers Regular INP meetings Perinatal meetings at facilities & districts Trainings ongoing Teamwork also other allied health workers PHC regularly visited Strong referral system Model “moms”

Results (cont) Tshwane Declaration Removal of formula from PHC facilities Clinicians, PN and CHW support Dietitians issue formula MBFI (50%) ANC checklist KMC HMB (2) with satellites (11)

Results (cont) Consistent and simplified messages “only” vs “exclusive” Mothers receive the same message Displayed IEC material

Conclusions Quality & coverage of IYCF counselling Strong nutrition staff component Functioning referral systems quality and coverage of IYCF and PMTCT counselling in the NC was found to be good and resulted in high EBF initiation rates. The presence of seven MBFI-accredited facilities and milk banks support the initiation of EBF even in LBW and very LBW infants. The strong nutrition staff component together with EBF “champions” in the NC

Acknowledgements UNICEF - Dr. A Feeley & Ms. R. Rasool NMMU - Dr. L. Steenkamp PATH – Ms. H. Mabasa National DoH – Ms. A. Behr NC DoH - Staff