Ministry of Health Progress made in the implementation of Code on Marketing of Breastmilk Substitutes in Kenya 9 th IBFAN Africa Regional Conference 1 st to 4 th February 2016-Uganda Presenter : Betty Samburu Programme Manager MIYCN

Breastmilk Substitutes (Regulation and Control) Act, 2012 Outline of the presentations 1. Introduction 2. Summary of parts in the Act 3. Achievements 4. Challenges 5. Recommendations 6. Opportunities 7. Way forward

Kenya commitment to implement 9 action areas of Global Strategy for IYCF Kenya is committed to implement the 9 action areas of the global strategy in order to: promote Protect & Support breastfeeding

Importance of IYCF (BF & CF) in child survival BF & CF = single largest impact on child mortality of all preventive interventions : 19% Source: Lancet Child Survival Series 2003/2013 4

Exclusive Breastfeeding and Child Mortality in Kenya- KDHS KDHSExclusive Breast feeding rates Child mortality (<5) %115% % 74% % 52% Over years, we have seen rates of EBF increasing and a decrease in child mortality

Legal commitment–Kenyan Constitution 2010 Bill of rights Article 43 (1 ) (C) Every person has the right to be free from hunger and to have adequate food of acceptable quality Article 53 (1c, d) Every child has a right to to basic nutrition, shelter and health care parental care and protection

Enacting legislation to promote, protect and support breastfeeding in Kenya The Kenyan government was committed to implement Action 3 and 9 : operational areas of the global strategy Take action to give effect to international code of MBMS and subsequent relevant WHA resolutions Consider what new legislations or other suitable measures that may be required to give effect to the principles and aim of ICMBMS Kenya's new Law, the Breastmilk Substitutes (Regulation and control) Act 2012, finally came into force on 26 October This was a story of concerted action by civil society and UN bodies to encourage policy makers to take action

The BMS (Regulation and Control) Act Was gazetted on 26 th October 2012 Kenya Gazette Supplement No. 153 (Acts No. 34) An act of parliament whose principle objective is: 1. To provide for appropriate marketing and distribution of breast milk substitutes, 2. Safe and adequate nutrition for infants through the promotion of breastfeeding 3. Proper use of BMS where necessary and for connected purposes Government mandate - Protect, Promote and Support appropriate IYCF practices.

Scope Guided by the ICMBS and relevant WHA resolutions, the Act covers the following 1. Breast milk substitute: Any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose as per World Health Assembly Resolution Complementary food products 3. Designated products

Why BMS (R&C) ACT, 2012 ICMBS ratified by WHA in 1981 to ensure that marketing of BMS is regulated Kenya - became a signatory to ICMBS 1981 Since Code implementation was voluntary Governments were urged to implement the code through the adoption of national legislation Companies are only subject to legal sanctions for failing to abide by the code when it has been incorporated into the regulatory framework of a nation or state The BMS industry as party to the drafting and adoption of the Code, agreed to comply with its provisions irrespective of actions taken at the national level. Code violations was still widespread, in the country as Kenya had not implemented the code as a national measure and monitoring and enforcement was weak

The BMS Act covers the following Part I: Preliminary- short titles and interpretation Part II: Establishment of the National Committee on Infant and Young Child Feeding Part III: Restriction on advertisement, promotion, labeling of packaging, educational and information materials Part IV: Enforcement Part V: Miscellaneous 11

Administrative structures of the BMS Act 2012 Under the provision of the Act a committee known as national committee on infant and young child feeding was established PART II 4 (1) Functions of the Committee (Article 5 (1) a) Advise the Cabinet Secretary on the policy to be adopted in relation to infant and young child nutrition; (b) Participate in the formulation of, and recommend the regulations to be made under the BMS Act c) Perform any other functions as may, from time to time, be assigned by the Cabinet Secretary

Regulations to be developed to operationalize the Act Some clauses require regulations to prescribe: 1. Ethical interaction between the manufacturer, distributor and health workers for purposes of creating awareness (Article 6 (3 &4) 2. Donations or distributions to charitable children‘s institutions (Article 7 (1&2) 3. Demonstrating use of designated or CF product in case of special need to mothers or family members Article 8 (c) 4. Labelling of packages (Article 9) 5. Education and informational materials (Art 10(1), (3); Art 28 Enforcement 1. Appoint of authorized officers by the CS Articles 11 (1) 2. Places of entry by authorised officers Article 12 (1) 3. Powers of authorised officers Art13 -Examination, Inspection & Request for analysis or testing of products

From Enactment to Enforcement ACT enactment Draft implementation framework Gazette the national Committee on Infant and Young Child Feeding Capacity building on the Act Monitor the Act Enforce the Act Draft regulations

Achievements 1. IYCN committee established through GAZETTE NOTICE NO & NO and actively involved in finalization of regulations 2. Draft implementation framework in place to be finalized 3. Besides the day to day monitoring that is on-going; Two monitoring exercises have been conducted i.Consultant -3 counties, Nairobi, Muranga and Isiolo ii.MOH National and County-Wajir 4. Sensitization meetings for policy makers and partners 5. Three sensitization meeting for MOH and other partners 6. Finalization of BMS regulations-support from UNICEF

Achievements 8. Minimal violations in Public Facilities Monitoring in 3 counties Nairobi, Muranga and Isiolo; ◦ (16%) health facilities received samples of designated products-all from private facilities ◦ Only 1 private health facility – Nairobi received free and low cost supplies of BMS ◦ Less than a fifth (17.6%) of facilities from all the counties had written materials that violated Article 4 of the code. Of these most (89%) from Nairobi county were from private and faith based HFs. ◦ BFHI reports for external assessment showed minimal violations in the public facilities Wajir- no facility was found to violate the code ◦ However violations in products in supermarket especially in labels widespread

Challenges 1. Incomplete establishment of mechanisms for monitoring and enforcement of code related legislations 2. Capacity building related to the code is still minimal among health workers and other stakeholders 3. Lack of established monitoring structures at the county, sub county and community level Infrequent Code violations on in ◦ Labels ◦ Education and information materials ◦ Samples of fomulas in private facilities ◦ Donations ◦ Media- social media and internet

Recommendations Strengthening of IBFAN Kenya chapter to be a watchdog Support from partners in scaling up of BFHI and BFCI Capacity building for both government and nongovernment agencies to support establishment of mechanisms for code implementation Establishing roles and responsibilities for both government and non government agencies who will be responsible for monitoring and enforcement of the code Establish mechanisms for registration of designated and complementary food products

Opportunities Kenya is one of the countries identified for piloting of NetCode protocol There is opportunity to strengthen IBFAN Kenya chapter to be a watch dog Civil society alliance (CSA) commitment to support code implementation

Way forward 1. Development and validation of regulations 2. Sensitization of stakeholders 3. Development of implementation framework for the Act 4. Sensitization of policy makers and health management teams from the county and national governments 5. Appointment and training of code monitors 6. Orientation of BMS Act monitors on monitoring and enforcement 7. Monitoring of the code 8. Establishment of sustainable mechanisms for code monitoring