WBT in South Asia Dr.S.K.Roy Senior Scientist, ICDDR’B and Secretary, BBF

WBT ? WBT is an innovative initiative of the International Baby Food Action Network (IBFAN) Asia Pacific for tracking, assessing and monitoring in response to the global need for focus on infant nutrition and survival. This need is more critical in developing countries

Phases WBT involves a three phase process The first phase involves initiating national assessment of the implementation status of the. The process brings governments and other civil society partners together to analyze the situation in their country and find out gaps During the second phase, the WBT uses these findings for scoring, colour-rating and grading each indicator and each country as per IBFAN Asia Pacific's Guidelines for WBT, to inform where it currently is. WBT also ranks countries in order of their performance

cont.. During the third phase, the WBT encourages repeat assessment after 3-5 years to analyze trends in each indicator as well as the overall breastfeeding rates in a country, as well as the impacts of particular interventions over a period of time

Initiation of BF 0-29% scores as 3/Red; 30-49% as 6/Yellow; 50-89% scores as 9/Blue; % scores as 10/Green. CountryResultScore& ColourRemark AfghanistanN/A Bangladesh24% India15.8% Nepal31% BhutanN/A Pakistan26% Sri Lanka75% MaldivesN/A

Exclusive Breastfeeding Key:0-11% scores as 3/Red; 12-49% as 6/Yellow; 50-89% scores as 9/Blue; % scores as 10/Green. CountryResultScoreRemark AfghanistanN/A Bangladesh46% India46.9% Nepal68% BhutanN/A Pakistan50% Sri Lanka58% Maldives10%

Median duration of Breastfeeding 0-17 months scores as 3/Red; as 6/Yellow; scores as 9/Blue; or beyond scores as 10/Green. CountryResult (month) ScoreRemark AfghanistanN/A Bangladesh32 India25.4 Nepal30 BhutanN/A Pakistan13 Sri Lanka26 MaldivesN/A

Bottle Feeding 0-100% scores as 3/Red; 5-29% as 6/Yellow; 3-4% scores as 9/Blue; 0-2% scores as 10/Green. CountryResultScoreRemark AfghanistanN/A Bangladesh22% India13.7% Nepal3% BhutanN/A PakistanN/A Sri Lanka12% Maldives21%

Complementary Feeding - 59% scores as 3/Red; 60-79% as 6/Yellow; 80-94% scores as 9/Blue; % scores as 10/Green. CountryResultScoreRemark Afghanistan29% Bangladesh71% India35% Nepal66% BhutanN/A Pakistan22% Sri Lanka98% Maldives85%

National Policy, Program and Coordination : Concerns national policy,plan of action, funding and coordination issues. CountryResultScoreRemark Afghanistan Bangladesh India Nepal Bhutan Pakistan Sri Lanka Maldives

CountryResultScoreRemark Afghanistan Bangladesh India Nepal Bhutan Pakistan Sri Lanka Maldives Baby Friendly Hospital Initiative: Concerns percentage BFHI hospitals, training, standard monitoring, assessment and reassessment systems.

CountryResultScoreRemark Afghanistan Bangladesh India Nepal Bhutan Pakistan Sri Lanka Maldives Implementation of International Code Concerns implementation of the Code as law, monitored and enforced.

CountryResultScoreRemark Afghanist an Banglades h India Nepal Bhutan Pakistan Sri lanka Maldives Maternity Protection Concerns paid maternity leave, paid breastfeeding break, national legislation encouraging work site accommodation for breastfeeding and/or childcare and ratification of ILO MPC No 183.

CountryResultScoreRemark Afghanistan Bangladesh India Nepal Bhutan Pakistan SriLanka Maldives Health and Nutrition Care Concerns health provider schools and pre-service education programmes, standards and guidelines for mother-friendly structure

CountryResultScoreRemark Afghanistan Bangladesh India Nepal Bhutan Pakistan Srilanka Maldives Community Outreach :Concerns skilled counseling services on infant and young child feeding, and its access to all women.(During pregnancy and after birth)

CountryResultScoreRemark Afghanistan Bangladesh India Nepal Bhutan Pakistan Srilanka Maldives Information Support Concerns national IEC strategy for improving infant and young child feeding, actively implemented at local levels.

CountryResultScoreRemark Afghanist an Banglades h India Nepal Bhutan Pakistan Srilanka Maldives HIV and Infant Feeding Concerns policy and programmes to address infant feeding and HIV issue and on-going monitoring

CountryResultScoreRemark Afghanist an Banglades h India Nepal Bhutan Pakistan Srilanka Maldives Infant feeding During emergency emergencies integrated into pre-service and in-service training for emergency management.

CountryResultScoreRemark Afghanist an Banglades h India Nepal Bhutan Pakistan Srilanka Maldives Monitoring and evaluation Concerns monitoring, management and information system (MIS) as part of the planning and management process.

Country wise Gaps IndicatorCountry Initiation of BF Nepal, Afghanistan, Pakistan, India, Bangladesh EBF Afghanistan India Bangladesh Median Duration of BF Afghanistan, Pakistan India Bottle Feeding Afghanistan,Madives, Pakistan India Bangladesh Srilanka CF Nepal, Afghanistan, Pakistan India Bangladesh National policy, Program and Coordination Nepal, Afghanistan, Pakistan India, Bhutan Bangladesh BFHI Nepal, Afghanistan Pakistan India Bhutan Srilanka Implementation of Code Afghanistan, Maldives Bhutan Maternity protection Nepal, Afghanistan, Maldives Pakistan India Bhutan Srilanka Cont.

Health & Nutrition CareNepal, Afghanistan Pakistan India Bhutan Bangladesh Community outreachNepal, Afghanistan Bhutan India Bangladesh Information supportNepal, Bhutan India Bangladesh IF and HIVNepal, Afghanistan, Maldives Pakistan India Bhutan Bangladesh Srilanka IF during emergenciesNepal, Afghanistan, Maldives Pakistan India Bhutan Monitoring and Evaluation Nepal, Afghanistan Pakistan India Bhutan Bangladesh, Srilanka Country wise Gaps(cont.)

Country Total score(out of 150) RankCategory Afghanistan307thD Bangladesh91.52ndB India686thC Nepal71.55thC Bhutan307thD Pakistan75.54thC Sri Lanka1161stB Maldives88.53rdC WBTi at a glance

What to do?

Afghanistan 1. Develop a plan of action with committed funds, implemented through an effective decentralised mechanisms 2. As a priority, implement all articles of the Code, enact a national legislation with effective enforcement and proper monitoring 3. Initiate action on infant feeding in HIV programmes and infant feeding during emergency situations 4. Strengthen efforts to implement BFHI for hospitals and link it with

BANGLADESH 1)Mainstream IYCF in the child health and development programmes. 2)Take urgent action, to enhance timely initiation of breastfeeding within one hour, like a campaign to save babies through this action. 3) Establish a clear mechanism for coordination at national level, with clear terms of reference to monitor the progress on indicators. 4)Support maternity protection in private as well as informal/unorganized sector. 5)IYCF indicators like early initiation (within one hour) and exclusive breastfeeding (0-6 months) should be monitored and published on a regular basis under surveillance reports

Nepal 1) Mainstream IYCF in the child health and development programmes. 2) Proper monitoring and reassessment system for BFHI in hospitals should be in place. 3) There is a need to address maternity protection through legislation to allow at least 14 weeks of paid maternity leave in all sectors and encourage work site accommodation for breastfeeding and for child care in work places. 4) Infant feeding counseling should be integrated into over all infant and child health strategy to scale up its coverage to national level.

Pakistan 1)Mainstream IYCF in the child health and development programmes. 2)There is a need to address maternity protection through legislation to allow at least 14 weeks of paid maternity leave in all sectors and encourage work site accommodation for breastfeeding and for child care in work places. 3)Monitoring and evaluation component of the infant and young child-feeding programme needs improvement.

Srilanka 1) There is a need for proper monitoring and reassessment system for BFHI. 2)Implement all articles of the Code as Law with proper monitoring systems in place. 3) There is a need to ensure maternity protection in informal/ unorganized sector also, aim for 6 months maternity leave. 4) Strengthen infant feeding and HIV issue in national policy and programmes 5)Monitoring and evaluation component of the infant and young child-feeding programme needs improvement.

Bhutan 1) Establish a National Breastfeeding Committee, linking IYCF with all other sectors like health, nutrition, information etc. Effectively, headed by a Coordinator 2) Make infant feeding counseling accessible to all women, during pregnancy and after child birth, by integrating counseling services into an over all infant and child health strategy. It should be backed by skills training of all frontline workers. To sustain this service strengthen the pre- service curriculum

Maldives 1)Establish plan of action with resources to implement actions on gaps in the national nutrition strategic plans 2) Enact a legislation for implementation of the Code 3)Address maternity protection through national legislation to allow at least 14 weeks of paid maternity leave in all sectors 4)Strengthen community outreach services for Breastfeeding and complementary feeding support and counseling 5) Regularly monitor all IYCF indicators (early initiation within one hour, exclusive breastfeeding for 6 months, bottle feeding, median duration of breastfeeding and complementary feeding) at country level and publish these in surveillance reports

India 1) Mainstream IYCF in the child health and development programmes 2) Develop a plan of action with committed funds, implemented through an effective state and national level mechanism. Check policies and programmes of various departments of the Central government and of States governments for consistency and impact on infant feeding practices 3)Make infant feeding counseling accessible to all as a key component in “service delivery”, both in health facilities and at family level. It should be backed by skill 4)Ensure effective implementation of IMS Act by establishing proper monitoring and accountability mechanism

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