Health services: Recommendations to better promote & support breastfeeding Breastfeeding Consultative Meeting 23 August 2011

KZN situation Issuing formula led to most mothers mixed feeding: highest risk of transmission & highest risk of morbidity & mortality Mothers lack adequate resources (e.g. fuel, water, refrigeration, sustainable household income) Lay counselors struggle to assist HIV positive mothers make the best infant feeding decision for the benefit of the mother and the child.

…KZN issues Mixed messages from Health workers on IYCF issues Free formula becomes the easiest route : though most dangerous and costly intervention. The Formula was associated with being HIV positive: stigma Facilities run out of stock Companies that supply formula also ran out of stock often.

Implementation actions The Head of Department approved implementation of Infant & Young Child Feeding counseling on current PMTCT interventions. This included a decision to stop issuing of free infant formula to mothers in the PMTCT programme using a phasing-out approach.

Implementation actions Meetings were held with district management to sensitize them on new IYCF policy for KZN Meeting with partners which included UKZN, , Children Rights Centre, UNICEF,WHO was held to discuss the decision with them and lobby for support in taking this forward.

Implementation actions Three day training courses for doctors were held in August 2010; February & July 2011 where this information was communicated to them. Trainer of trainers training was also held from October 2010, to capacitate district trainers to do training for all nurses in districts. The update of nurses was supported by Provincial and District Offices.

Implementation actions Retraining of all the lay counselors that counsel mothers on Infant Feeding Issues begun in October and continued until February A total of 1703 lay councilors were trained. Training & participants manuals, pocket guides, flip charts and other training tools have been developed.

Implementation actions UNICEF funded the appointment of a communication specialist for 3 months who carried out development of key messages and communicating these to communities. Messages were developed, field tested with pregnant women & mothers in various health institutions, and finalized.

Implementation actions The communication strategy has included the prepared for Radio Ads, Newspaper inserts, Corporate DVD, Community Forums, Press release & district meetings with key community stakeholders.

Implementation actions An education/information session was held with the media on November Media brief organized by MEC also addressed the IYCF policy November December 2010; Presentation to Portfolio Committee for Health

KZN Framework for Accelerating Community-based Maternal, Neonatal, Child and Women’s Health and Nutrition Interventions

Monitoring & Evaluation 2 Indicators on DHIS Early breastfeeding initiation Exclusive breastfeeding at 14 weeks QA/QI – partnership with School of Public Health Proposal

CHALLENGES Limited training of Professional Nurses Limited advocacy at community level Inadequate emphasis on M & E Documentation of process “Not a National Policy” National Support on PMTCT new guidelines not in line with KZN new Policy

Successes Extensive advocacy and consultation Management support from MEC & HOD level Partnering with Programme Managers(MCWH) Inputs from partners (UNICEF; WHO; UKZN- Paediatrics; ; Zoe Life; Children Rights; Africa Centre) Strong support processes e.g. MBFHI, budget allocation (supplementation for lactating mothers; Outside Radio Broadcasts)

THANK YOU