1. Presented by Tebogo Morotoba Department of Health Limpopo
How to strengthen the sustainability of the ten steps to successful breastfeeding and the three items in mother baby friendly (MBFI) accredited facilities in Sekhukhune district, Limpopo Province
(Action Research Foundation for Professional Development in affiliation with Yale school of Public Health) for completion of Advanced Health Management Program
Presented by Tebogo Morotoba
Department of Health Limpopo
Sekhukhune District 1

2. Presentation outline
Aim of the Study
Background of MBFI in Sekhukhune
Why did the researcher do the action research
Findings
Recommendations
conclusion
Acknowledgements

3. The aim of the study
To address the decline in breastfeeding practices at mother baby friendly accredited facilities in Sekhukhune District, Limpopo Province, South Africa

4. Background of MBFI in Sekhukhune District
Financial year
Number of MOUs (maternity obstetrics unit)
Number of MOUs that are MBFI designated
Number of MOUs that are internally re-assessed
MOUs that passed internal re-assessment
2013/2014
16 facilities
(7 hospitals 3 CHC and 6 big clinics)
7 hospitals
1 CHC
2 big clinics 10
3 hospitals

5. Why Action Research?
MOUs that accredited mother baby friendly initiative (MBFI), six months after assessment when they are re-assessed internally step 3, 4, 5, 10 and item 2 and 3 are no longer 100% practised (according to 2013/14 internal assessment report).

6. Findings of internal assessment
2 out of 10 mothers had information about the benefits and management of breastfeeding(step 3)
Skin to skin were not frequently practised and if practised, mothers were not given reasons for the practise (step 4)

7. Findings of internal assessment
8 out of 10 Mothers were unable to demonstrate how to position and attach the baby to the breast, and also Milk expression technique (step 5)
The above necessitated Action Research to enable researchers to implement the study as part of their day-to-day work

8. What did the action researcher do?
Seven failed facilities were selected randomly for action research and mothers/caregivers were conveniently sampled during their clinic visit
Gave feedback results and discuss with each individual facility( 1 week and two days).
Action plans were drawn with each facilities(1 week and two days).
The study was conducted through a period of one year and is still continuous as part of work

9. Breastfeeding in-service training
We changed from the way we used to conduct training in a standard classroom format . We visited facilities and conduct in-service trainings in the morning before they start their daily routine.

10. Roadshows
Roads shows aimed at reaching out to other community members that include: fathers, grandmothers, traditional healers and faith based healers
It was also making pregnant women aware of what should they expect from health workers during child birth at hospitals and clinics

11. Roadshows

12. Stakeholder’s Involvement
The district executive manager was leading in stakeholder involvement by briefing stakeholders about importance of breastfeeding to the community breastfeed. There was a lot of support from the municipalities, counsellors started to talk about the importance of breastfeeding during community meetings.

13. Breastfeeding walks
The senior managers and health went out to communities to sent breastfeeding messages
The roadshows included breastfeeding walks in communities.

14. Door to Door campaigns
Convenience sampling was used to visit mothers/caregivers of 0 – 59months at their homes.
Sixteen teams we deployed and reached 120 households
Data collection, education/counselling were done.
3 villages in Tubatse subdistrict(Alverton, Dresten and gamanoke) (3 villages in Elias motswaledi (masakaneng

15. Door to door campaigns
The reason for the home visit was to explore why mothers mixed feed immediately after discharge and after three months
Common reasons for mixed feeding were cultural beliefs and crying child

16. Door to door campaigns Education on road to health booklet
Door to Door campaigns included counselling of exclusive breastfeeding of infant and young child feeding messages

17. Re-Assessment
Six months after the implementation of community mobilization
Facilities were re-assessed
Results were compared with the baseline
There was a huge improvements

18. Impact of the action research
Name MOU
Baseline results
Action research results
Philadelphia
34%
96%
Groblersdaal
30%
100%
Matlala
38%
92%
Mecklenburg
23%
Zaaiplass
42%
Kwarielaagte
53%
Nchabeleng
48%
98%

19. Action research results Tshehlwaneng 100% Burgesfort 92%
New facilities that were accredited in 2014/2015 after the community mobilization
Name MOU
Action research results
Tshehlwaneng
100%
Burgesfort
92%
Schnoord clinic
85%

20. Recommendations
It is recommended that community mobilization in a form of dialogues, door to door, stakeholder involvement and roadshows be taken in high recognition as some of the great interventions that improves the community breastfeeding practices.

21. conclusion
In this small convenience sample of facilities selected, we have seen improvements in breastfeeding practices through community mobilization as the intervention to address the decline in breastfeeding practices.

22. Acknowledgement
FPD for giving me the opportunity to study with them
Team of breastfeeding assessors in Sekhukhune district
CHC workers who participated during the roadshows and door to door campaign
DEM and HSP senior manager for their support during the action research
The district nutrition team for their dedicated effort in making sure facilities and communities understand MBFI
Facility management and staff

23. THANK YOU