Infant and Young Child Feeding in Emergencies. Operational Guidance.

Infant and Young Child Feeding in Emergencies. Operational Guidance.
VERSION 3.0 – UPDATE

The Operational Guidance on IFE
Aim To provide concise, practical guidance on how to ensure appropriate infant and young child feeding in emergencies (IFE) Scope Applies to emergency preparedness, response and recovery worldwide Target Groups Infants and young children aged 0-23 months and pregnant and lactating women (PLW) Intended for Policy-makers, decision-makers and programmers working in emergency preparedness, response and recovery across sectors and disciplines. Aim The OG-IFE aims to provide concise, practical guidance on how to ensure appropriate infant and young child feeding in emergencies. Scope The OG-IFE applies to emergency preparedness, response and recovery worldwide to minimise infant and young child morbidity and/or mortality risks associated with feeding practices and to maximise child nutrition, health and development. Target groups The target groups are infants and young children aged 0-23 months and pregnant and lactating women (PLW). Intended for: *TAILOR TO YOUR AUDIENCE* The OG-IFE is intended for policy-makers, decision-makers and programmers working in emergency preparedness and response, including governments, United Nations (UN) agencies, national and international non-governmental organisations (NGOs), donors, volunteer groups and the private/business sector. The OG-IFE is relevant across sectors and disciplines, particularly nutrition, but also health (including reproductive health, maternal, newborn and child health (MNCH), curative services, mental health and psychosocial support services (MHPSS); HIV; infectious disease management); adolescent services; water, sanitation and hygiene (WASH); food security and livelihoods (FSL); child protection; early childhood development (ECD); disability; shelter; cash transfer programmes; social protection; agriculture; and logistics.

2001 Version 1.0 2006 Version 2.0 2007 Version 2.1 2010 Addendum 2017
Updated by: The IFE Core Group Co-led: ENN and UNICEF Coordinated by: ENN Funded by: USAID/OFDA (ENN) 2001 Version 1.0 2006 Version 2.0 2007 Version 2.1 2010 Addendum 2017 Version 3.0 The OG-IFE was first developed in 2001 by operational agencies to meet an identified need for a ‘do’s and don’ts’ on infant feeding in emergencies. It is based on existing guidance, expert input and operational experience and has had a number of updates since the first iteration in The OG-IFE was endorsed in a WHA Resolution (23.23) in Version 3 has proved the most significant given the 10 year time lag between 2007 and There has been significant development in guidance, programmatic tools and resources since v2.1 (2007) which was drawn upon for the 2017 version. Endorsed WHA resolution 23.23

Experiences & resources
V 3.0 Process March 2016 IFE Core Group Meeting: Interview findings shared, gaps in content and process agreed Feb 16 – Sept 17 Consultation Dec 2017 IFE Core Group Meeting: Dissemination & roll out action plan Experts Experiences & resources IFE Core Group Gaps in content and process agreed at IFE Core Group meeting in Jan 2016. Regional practitioners had been interviewed beforehand on experiences implementing the OF-IFE, complementary feeding in emergencies (summary report available) and artificial feeding in emergencies. Findings were shared at the meeting. The development of version 3 was a consultative process, involving IFE Core Group members (working groups) and broader community of practitioners and experts across sectors, disciplines (including WASH, reproductive health, HIV) and regions. The process has also drawn heavily on agency experiences and considerable tools and resources that have developed in the 10 years since 2007 The IFE Core Group meeting in Dec 2017 will consolidate a rollout action plan and roles and responsibilities in 2018 and beyond OFDA funding ends in December 2017 The process has been closely connected to the Sphere update process SPHERE

V 3.0 What has stayed the same?
Layout Headings Most of existing guidance Terminology of IFE Availability in English, French and Arabic KEY POINTS PRACTICAL STEPS (1 – 6) 1. Endorse or develop policies 2. Train staff 3. Co-ordinate operations 4. Assess and monitor 5. Protect, promote and support optimal IYCF with integrated multi-sector interventions 6. Minimise the risks of artificial feeding EMERGENCY PREPAREDNESS ACTIONS  New KEY CONTACTS REFERENCES  Expanded DEFINITIONS  Expanded ANNEX 1: Multi-sectoral content  New ACRONYMS  New There have been no major changes to previous guidance – mostly addition / expansion The decision was taken to keep IFE (rather than IYCF-E) as an acronym for consistency with previous editions and to avoid implying a change where there is none. Note that IFE and IYCF-E mean the same. The English version is available as of September Arabic and French versions will be available by December The previous version was available in 12 languages; this will be a key target area to address in 2018.

V 3.0 Revisions - Programming
Updated to reflect latest global guidance (published and upcoming) Greater programmatic detail in all sections Greater and more balanced content to address needs of non-breastfed infants More comprehensive content on complementary feeding Introduction of new concepts e.g. human milk banks Considers situations where OG-IFE recommendations cannot be immediately met More content on emergency preparedness Summary key points updated Updated to reflect latest guidance, including WHO 2016 guidance on HIV and infant feeding and WHO 2017 Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children. Note that it also reflects discussions held on HIV and Infant Feeding in Emergencies. As part of the update process, a WHO/UNICEF/ENN meeting was convened by WHO in Sept 2016 to examine challenges of putting existing WHO HIV and Infant Feeding guidance into practice in emergencies; proceedings from the meeting informed the content of the Ops G. WHO is finalising operational guidance on infant feeding and HIV in emergencies as a key output of the meeting – coming soon. Greater programmatic detail in all sections Greater and more balanced content to address of needs of non-breastfed infants in their own right More comprehensive content on complementary feeding Considers situations where OG-IFE recommendations cannot be immediately met and how to handle this More content on emergency preparedness, including summary table of key actions. KEY POINT: Emergency preparedness is critical to a timely, efficient and appropriate IFE response. The 14 summary key points have all been revised to reflect the updated content.

V 3.0 Revisions – Roles & Responsibilities
Greater emphasis on the lead role of government in preparedness and response Greater clarity on the respective roles and responsibilities of UN agencies Greater coverage of sectors beyond nutrition and more explicit actions to take Incorporated accountability to affected populations Reflects significantly evolved operational environment Greater emphasis on the lead role of government in emergency preparedness and response Greater clarity on the respective roles and responsibilities of UN agencies Greater coverage of sectors beyond nutrition and more explicit actions to take Incorporated accountability to affected populations Reflects significantly evolved operational environment e.g. cluster approach well established, much more attention to IFE

V 3.0 Revisions – References, Resources, Terminology
More extensive list of supporting references and resources Greater referencing of recommendations and definitions More extensive list of definitions Changes, and additions, to terminology Optimal IYCF  Recommended IYCF HIV Risk Assessment Donor Human Milk Human Milk Bank Cluster Lead Agency Lipid-based nutrient supplement (LNS) As reflected in the extensive references / resources section, there has been significant development in guidance, programmatic tools and resources since v2.1 (2007). 200 resources are listed – key references are available in print; the full list is available online. Throughout the Ops Guidance, reference is made to the resources listed at the end. *CHECK UNDERSTANDING FOR NEW TERMINOLOGY AND EXPLAIN / REFER TO DEFINITIONS IF NECESSARY*

1: Endorse or develop policies
Key provisions regarding IFE should be reflected in government, multi-sector and agency policies and should guide emergency responses. 2: Train staff Sensitisation and training on IFE is necessary at multiple levels and across sectors.

3: Coordinate operations
Capacity to coordinate IFE should be established in the coordination mechanism for every emergency response. Government is the lead IFE coordination authority. Where this is not possible or support is needed, IFE coordination is the mandated responsibility of UNICEF or UNHCR, depending on context, in close collaboration with government, other UN agencies and operational partners. Where all provisions of OG-IFE cannot be immediately met, context-specific guidance on appropriate actions and acceptable ‘compromises’ should be provided by the IFE coordination authority and mandated UN agencies. Timely, accurate and harmonised communication to the affected population, emergency responders and the media is essential

4: Assess & Monitor Needs assessment and critical analysis should determine a context specific IFE response Pre-crisis data Rapid decision-making and action Early needs assessment In depth assessment Monitoring It is essential to monitor the impact of humanitarian actions and inaction on IYCF practices, child nutrition and health; to consult with the affected population in planning and implementation; and to document experiences to inform preparedness and future response.

5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
Immediate action to protect recommended infant and young child feeding (IYCF) practices and minimise risks is necessary in the early stages of an emergency, with targeted support to higher risk infants and children General Breastfeeding support Infants who are not breastfed – incl. relactation, wet nursing, donor human milk, BMS Complementary feeding Micronutrient supplementation HIV and infant feeding Infectious disease outbreaks Under infants who are not breastfed, we deal with relactation, wet nursing, donor human milk, BMS

In every emergency, it is necessary to assess and act to protect and support the nutrition needs and care of both breastfed and non-breastfed infants and young children. It is important to consider prevalent practices, the infectious disease environment, cultural sensitivities and expressed needs and concerns of mothers/caregivers when determining interventions In every emergency, it is important to ensure access to adequate amounts of appropriate, safe, complementary foods and associated support for children and to guarantee nutritional adequacy for pregnant and lactating women.

Multi-sector collaboration is essential in an emergency to facilitate and complement direct infant and young child feeding (IYCF) interventions. Actions are included for: Health Adolescent Services WASH FSL Child Protection ECD Disability Shelter Cash Social Protection Agriculture Logistics Key sectors and disciplines to sensitise and work with on IYCF include health (reproductive health; MNCH; MHPSS; HIV; infectious disease management); adolescent services; WASH; FSL; child protection; ECD; disability; shelter; cash transfer programmes; social protection; agriculture; and logistics. Examples of integrated activities are provided. WASH: Water, Sanitation and Hygiene, FSL: Food Security and Livelihoods, ECD: Early Childhood Development

6: Minimise the risks of artificial feeding
In emergencies, the use of breastmilk substitutes (BMS) requires a context-specific, coordinated package of care and skilled support to ensure the nutritional needs of non- breastfed children are met and to minimise risks to all children through inappropriate use Donations in emergencies Artificial feeding management BMS supplies BMS specification Procurement of BMS supplies, feeding equipment and support Distribution of BMS Donations of BMS, complementary foods and feeding equipment should not be sought or accepted in emergencies; supplies should be purchased based on assessed need. BMS, other milk products, bottles and teats should never be included in a general distribution.

Emergency preparedness
…is critical to a timely, efficient and appropriate IFE response Examples from Box 1: Emergency Preparedness Actions POLICY Develop preparedness plans on IFE TRAINING Prepare orientation material for use in early emergency response COORDINATION Develop terms of reference for IFE coordination in a response ASSESS AND MONITOR Prepare key questions to include in early needs assessment MULTI-SECTOR INTERVENTIONS Examine national legislation related to food and drugs, particularly importation ARTIFICIAL FEEDING Communicate government position on not seeking or accepting donations Preparedness has been integrated throughout the OG-IFE.

**INSTRUCTION SLIDE**
The following slides cover implications of the revisions in the Operational Guidance on IFE for UN Agencies including UNICEF, UNHCR, WFP and WHO. Please delete slides that are not applicable to your audience and cross reference to internal documents and processes

Implications for UNICEF
The OG-IFE offers practical guidance which assists decision-makers, planners and donors to implement UNICEF global strategy and guidance documents e.g. UNICEF/WHO Global Strategy on IYCF 1. Endorse or Develop Policies 1.1 UNICEF and WHO have key responsibilities in supporting national/sub-national policy preparedness 1.5 UNICEF and WHO have key roles to catalyse and support development of an inter- agency joint statement on IFE. Governments and agencies should have up-to-date policies which adequately address all of the following elements in the context of an emergency: protection, promotion and support of breastfeeding; the management of artificial feeding; complementary feeding; the nutrition needs of PLW; compliance with the International Code of Marketing of Breastmilk Substitutes (BMS) and subsequent relevant World Health Assembly (WHA) Resolutions (the Code); prevention and management of donations of BMS; and infant feeding in the context of public health emergencies and infectious disease outbreaks. (See Section 9 Definitions for recommended IYCF practices.) Additional context-specific provisions may be necessary, such as for refugees or internally displaced persons (IDP). Provisions may exist as a standalone policy and/or may be integrated into other relevant policies. UNICEF and WHO have key responsibilities in supporting national/sub-national policy preparedness (see Box 1 for key preparedness actions). An inter-agency joint statement, issued and endorsed by relevant authorities, may be used to highlight relevant guidance, provide context-specific rapid guidance, and harmonise communication. Development of the statement should be led by the IFE coordination authority (see 3.1); UNICEF and WHO have key roles to catalyse and support development. In preparedness, develop a draft joint statement and secure preliminary approval with relevant authorities. A model joint statement is available.

2. Train Staff UNICEF can support the identification and use of existing national expertise and networks See: Section 8 – References Breastfeeding Counselling: A Training Course. UNICEF and WHO, 1993. IYCF Counselling: An Integrated Course. UNICEF, 2006 Programming for IYCF – a Training Course. UNICEF and Cornell University. Online. Supportive Supervision / Mentoring and Monitoring for Community IYCF. UNICEF, 2013. The Community IYCF Counselling Package. UNICEF, 2013. Governments and agencies should have up-to-date policies which adequately address all of the following elements in the context of an emergency: protection, promotion and support of breastfeeding; the management of artificial feeding; complementary feeding; the nutrition needs of PLW; compliance with the International Code of Marketing of Breastmilk Substitutes (BMS) and subsequent relevant World Health Assembly (WHA) Resolutions (the Code); prevention and management of donations of BMS; and infant feeding in the context of public health emergencies and infectious disease outbreaks. (See Section 9 Definitions for recommended IYCF practices.) Additional context-specific provisions may be necessary, such as for refugees or internally displaced persons (IDP). Provisions may exist as a standalone policy and/or may be integrated into other relevant policies. UNICEF and WHO have key responsibilities in supporting national/sub-national policy preparedness (see Box 1 for key preparedness actions). An inter-agency joint statement, issued and endorsed by relevant authorities, may be used to highlight relevant guidance, provide context-specific rapid guidance, and harmonise communication. Development of the statement should be led by the IFE coordination authority (see 3.1); UNICEF and WHO have key roles to catalyse and support development. In preparedness, develop a draft joint statement and secure preliminary approval with relevant authorities. A model joint statement is available.

WFP UNICEF IDP WHO UNHCR Refugee Implications for UNICEF 3. Coordinate Operations Government is the lead coordination authority on IFE Where this is not possible, IFE coordination is the responsibility of UNICEF or UNHCR UNICEF’s coordination authority may be as: cluster lead agency within the IASC cluster approach as the UN agency with mandated responsibility for IFE In IDP responses, UNICEF is responsible for IFE coordination Governments and agencies should have up-to-date policies which adequately address all of the following elements in the context of an emergency: protection, promotion and support of breastfeeding; the management of artificial feeding; complementary feeding; the nutrition needs of PLW; compliance with the International Code of Marketing of Breastmilk Substitutes (BMS) and subsequent relevant World Health Assembly (WHA) Resolutions (the Code); prevention and management of donations of BMS; and infant feeding in the context of public health emergencies and infectious disease outbreaks. (See Section 9 Definitions for recommended IYCF practices.) Additional context-specific provisions may be necessary, such as for refugees or internally displaced persons (IDP). Provisions may exist as a standalone policy and/or may be integrated into other relevant policies. UNICEF and WHO have key responsibilities in supporting national/sub-national policy preparedness (see Box 1 for key preparedness actions). An inter-agency joint statement, issued and endorsed by relevant authorities, may be used to highlight relevant guidance, provide context-specific rapid guidance, and harmonise communication. Development of the statement should be led by the IFE coordination authority (see 3.1); UNICEF and WHO have key roles to catalyse and support development. In preparedness, develop a draft joint statement and secure preliminary approval with relevant authorities. A model joint statement is available. “In all settings, UNICEF and UNHCR will maximize synergies between their respective technical and management capacities, availability of resources and response capacities.”

2. Coordinate operations 3.2 UNICEF country offices have a key responsibility to prepare for coordination needs in an emergency and as necessary, to support government capacity and skills development in this regard. 3.8 In some emergencies, it may not be possible to meet all the provisions of the OG-IFE immediately. Critical analysis by the IFE coordination authority, government, UNICEF, WHO and, where applicable, UNHCR is essential to provide context-specific guidance on appropriate actions and acceptable compromises. 3.10 Gaps in IFE coordination capacity in an emergency response should be reported to UNICEF or UNHCR country or regional office and to agency headquarters as necessary 3.2 Ensure there is capacity to coordinate IFE within coordination mechanisms in an emergency response. Assess and support development of government coordination capacity as necessary. Determine or clarify coordination responsibilities and roles in preparedness and in early response. UNICEF country offices have a key responsibility to prepare for coordination needs in an emergency and as necessary, to support government capacity and skills development in this regard. 3.8 In some emergencies, it may not be possible to meet all the provisions of the OG-IFE immediately, such as where access to those affected is limited or impossible, or capacity is lacking to deliver necessary support. In such circumstances, critical analysis by the IFE coordination authority, government, UNICEF, WHO and, where applicable, UNHCR (see 3.1) is essential to provide context-specific guidance on appropriate actions and acceptable compromises. Adapted programming may fall short of OG-IFE recommendations and should be temporary. The unmet needs and risks of compromised programming should be used to inform proactive advocacy for humanitarian access, resourcing and capacity. Decision-making should be recorded and lessons learned should be documented and shared.

4. Monitoring 4.16 WHO and UNICEF country offices have key responsibilities to support government to develop policies and procedures to monitor for and act on Code violations. Code violations may be reported to UNICEF as the IFE coordination authority Monitor for Code violations and report them to national authorities, the IFE coordination authority, and international monitorsz (see 7.1 for contacts and reporting templates). Support government to develop policies and procedures to monitor for and act on Code violations; WHO and UNICEF country offices have key responsibilities in this regard. Typical Code violations in emergencies relate to infant formula labelling, supply management, and donations

5. Protect, Promote and Support Optimal Infant and Young Child Feeding with Integrated Multi-Sectoral Interventions UNICEF has a key responsibility to define, advocate for, and provide guidance on, essential IYCF interventions in close collaboration with government and other stakeholders (Preparedness and Recovery) UNICEF has a key role to advocate for and provide guidance on appropriate quantities of quality complementary foods and to help define essential interventions. UNICEF has a key responsibility to define, advocate for, and provide guidance on, essential IYCF interventions in close collaboration with government and other stakeholders. This responsibility extends to both preparedness and recovery, using and building on existing capacities, networks, policies and systems, and multi-sectoral engagement. In refugee settings, UNHCR holds this responsibility. The designated IFE coordinating authority should provide clear direction on complementary feeding needs and interventions. Depending on the country context, WHO, UNICEF, UNHCR, WFP and FAO may have complementary roles to play. In all contexts, UNICEF has a key role to advocate for and provide guidance on appropriate quantities of quality complementary foods and to help define essential interventions.

Complementary Feeding The designated IFE coordination authority should provide clear direction on complementary feeding needs and interventions Coordination on complementary feeding is the mandated responsibility of UNICEF or UNHCR In all contexts, UNICEF has a key responsibility to provide guidance on appropriate complementary foods and feeding practices and to help define essential interventions. See: UNICEF Core Commitments to Children in Humanitarian Action

6. Minimise the Risks of Artificial Feeding 6.6 UNICEF is likely to receive reports of offers or donations of BMS, donor human milk, complementary foods and feeding equipment and should be prepared to determine and oversee a management plan. 6.7 UNICEF is expected to be able to support planning for appropriate procurement, distribution, targeting and use of BMS and associated support 6.9 UNICEF may need to determine if and where capacity to manage artificial feeding exists in government and amongst humanitarian providers or, where capacity is limited, identify appropriate BMS provider(s) including a BMS supply chain and associated support services. 6.6 Report offers or donations of BMS, donor human milk, complementary foods and feeding equipment to UNICEF and to the co-ordinating authority who will determine and oversee a management plan (see Section 3). Plan procurement, distribution, targeting and use of BMS and associated support (artificial feeding management) in close consultation with the coordination authority and UNICEF (if UNICEF is not acting as the coordinating agency, see Section 3). In accordance with mandates, WHO and UNHCR also have key roles. Establish terms of reference, roles and responsibilities for artificial feeding management in preparedness See References Section 7.6 Artificial Feeding – BMS Supplies and Feeding Equipment The IFE coordination authority and/or UNICEF should determine if and where capacity to manage artificial feeding exists in government and amongst humanitarian providers. Where capacity is limited, the coordination authority and/or UNICEF should identify appropriate BMS provider(s) including a BMS supply chain and associated support services. In the absence of an appropriate provider, the coordinating agency and/or UNICEF will ensure coordinated provision of BMS supplies. The coordinating authority/UNICEF will provide clear terms of reference, technical support and close oversight of procurement, monitoring and use.

6. BMS Supplies UNICEF and / or the coordinating agency, will ensure coordinated provision of BMS supplies in the absence of an appropriate provider. “In non-refugee settings and in accordance with UNICEF policy, UNICEF will only procure infant formula as the provider of last resort and on the request of the host government and/or the national humanitarian coordination structure.” Seek agreement from UNICEF HQ Nutrition Section and Supply Division See: UNICEF SOP on BMS (under development)

Implications for UNHCR
WFP UNICEF IDP WHO UNHCR Refugee Implications for UNHCR 3. Coordinate Operations Government is the lead coordination authority on IFE Where this is not possible, IFE coordination is the responsibility of UNICEF or UNHCR In IDP responses - UNICEF In refugee responses – UNHCR Governments and agencies should have up-to-date policies which adequately address all of the following elements in the context of an emergency: protection, promotion and support of breastfeeding; the management of artificial feeding; complementary feeding; the nutrition needs of PLW; compliance with the International Code of Marketing of Breastmilk Substitutes (BMS) and subsequent relevant World Health Assembly (WHA) Resolutions (the Code); prevention and management of donations of BMS; and infant feeding in the context of public health emergencies and infectious disease outbreaks. (See Section 9 Definitions for recommended IYCF practices.) Additional context-specific provisions may be necessary, such as for refugees or internally displaced persons (IDP). Provisions may exist as a standalone policy and/or may be integrated into other relevant policies. UNICEF and WHO have key responsibilities in supporting national/sub-national policy preparedness (see Box 1 for key preparedness actions). An inter-agency joint statement, issued and endorsed by relevant authorities, may be used to highlight relevant guidance, provide context-specific rapid guidance, and harmonise communication. Development of the statement should be led by the IFE coordination authority (see 3.1); UNICEF and WHO have key roles to catalyse and support development. In preparedness, develop a draft joint statement and secure preliminary approval with relevant authorities. A model joint statement is available. “In all settings, UNICEF and UNHCR will maximize synergies between their respective technical and management capacities, availability of resources and response capacities.”

3. Coordinate Operations 3.8 In some emergencies, it may not be possible to meet all the provisions of the OG- IFE immediately. Critical analysis by the IFE coordination authority, government, UNICEF, WHO and, where applicable, UNHCR is essential to provide context-specific guidance on appropriate actions and acceptable compromises. 3.10 Gaps in IFE coordination capacity in an emergency response should be reported to UNICEF or UNHCR country or regional office and to agency headquarters as necessary. Technical or coordination issues regarding IFE in the context of UNHCR operations should be addressed to the appropriate UNHCR regional or country office. Where necessary, contact the Public Health Section at UNHCR HQ:

5. Protect, promote and support optimal infant and young child feeding with integrated multi-sector interventions* 5.1 In refugee settings, UNHCR has the responsibility to define, advocate for and provide guidance on essential IYCF interventions in close collaboration with government and other stakeholders This responsibility extends to both preparedness and recovery, using and building on existing capacities, networks, policies, systems and requires multi-sector engagement. *See: IYCF Framework – UNHCR and Save the Children, 2017

5. Protect, promote and support optimal infant and young child feeding with integrated multi-sector interventions 5.20 The designated IFE coordination authority should provide clear direction on complementary feeding needs and interventions. Government is the lead coordination authority to guide the response on complementary feeding. Where this is not possible or support is needed, coordination on complementary feeding is the mandated responsibility of UNICEF or UNHCR, depending on context, in close collaboration with government, other UN agencies and operational partners. UNHCR Operational Guidance on the Use of Special Nutritional Products to Reduce Micronutrient Deficiencies and Malnutrition in Refugee Populations. UNHCR, UCL, ENN, English.

6. Minimise the risk of artificial feeding 6.6 Offers or donations of BMS donor human milk, complementary foods and feeding equipment may be reported to UNHCR. UNHCR should de prepared to determine and oversee a context specific management plan to minimise risks. 6.7 UNHCR has key responsibilities in artificial feeding management. 6.11 In refugee settings and in accordance with UNHCR policy*, UNHCR will only source infant formula after review and approval by its HQ technical units. 6.25 WFP in consultation with UNICEF and UNHCR is responsible for controlling the distribution of milk powders and BMS in general rations *See: UNHCR Policy Related to the Acceptance, Distribution, and Use of Milk Products in Refugee Settings. 2006 UNHCR IYCF Practices: Standard Operating Procedures for the Handling of Breastmilk Substitutes (BMS) in Refugee Situations for Children 0-23 months. 2015

Implications for…WFP 3. Coordinate Operations WFP is responsible for mobilising food assistance in emergencies in a manner that upholds the provisions of the OG-IFE.

Implications for…WFP 5. Multisectoral Interventions
5.1 WFP has a responsibility to ensure that the nutrition of infants and young children and PLW is considered in food assistance response and that necessary data are gathered to inform related programming. 5.20 WFP has a responsibility to provide/enable access to appropriate nutrient-rich food for children aged 6-23 months and PLW when significant food and nutrient gaps are identified. Managing the Supply Chain of Specialised Nutritious Foods. WFP, 2013

Implications for…WFP 5.23 Complementary food support options/considerations include: Cash or voucher schemes to purchase nutrient-rich foods and/or fortified foods that are locally available. Distribution of nutrient-rich foods or fortified foods at household level. Provision of multiple-micronutrient fortified foods to children aged 6-23 months and PLW through BSFP Home fortification with micronutrient supplements, e.g. MNPs or other supplements. Livelihood programmes and safety net programmes for families with children < 2 and/or PLW. Use of animal milk and products. (see 5.25) Provision of non-food items and cooking supplies (including domestic energy); Access to communal food preparation areas where household facilities are lacking; Advice on safe food handling; Protected eating and playing spaces. Provision of multiple-micronutrient fortified foods to children aged 6-23 months and PLW through blanket supplementary feeding. Examples include fortified blended foods such as SuperCereal plus and SuperCereal (or local variations of this type of fortified porridge), and lipid-based nutrient supplements (small to medium quantity) (see 9). Home fortification with micronutrient supplements, such as micronutrient powders (MNPs) or other supplements. Note that MNPs should not be provided where there is blanket distribution of multiple-micronutrient fortified foods (see 5.29). 5.25 Where animal milk is a significant feature of child diets, such as in pastoral communities, it is important to establish how to safely include milk products as part of a complementary diet. Milk products can be used to prepare complementary foods for all children over six months of age. Recommend to breastfeeding mothers not to displace or substitute breastmilk with animal milk. Pasteurised or boiled animal milk may be provided to non-breastfed children over six months of age and to breastfeeding mothers to drink in controlled environments (such as where milk is provided and consumed on site (wet feeding)). Animal milk should not be distributed outside of such controlled environments (see 5.15 and 6.25).

Implications for…WFP Micronutrient Supplementation
5.29 For children aged 6-59 months, multiple-micronutrient supplements may be necessary to meet nutrition requirements where fortified foods are not being provided, in conjunction with other interventions to improve complementary foods and feeding practices. In malaria-endemic areas, the provision of iron in any form, including MNPs, should be implemented in conjunction with measures to prevent, diagnose and treat malaria. Provision of iron through these interventions should not be made to children who do not have access to malaria prevention strategies; prompt diagnosis of malaria illness; and treatment with effective antimalarial drug therapy. Vitamin A supplementation is recommended for children aged 6-59 months. For PLW, iron and folic acid or multiple-micronutrient supplementation should be provided in accordance with the latest guidance. Joint Statement on Preventing and Controlling Micronutrient Deficiencies in Populations affected by an Emergency. WHO, WFP and UNICEF, 2007.

Implications for…WFP 6. Donations
6.6 Report offers or donations of BMS, donor human milk, complementary foods and feeding equipment to UNICEF or UNHCR as appropriate, and to the IFE coordination authority, who will determine and oversee a context-specific management plan to minimise risks. Donations involving WFP food assistance should also be reported to WFP 6.25 WFP in consultation with UNICEF and UNHCR is responsible for controlling the distribution of milk powders and BMS in general rations Use of milk in WFP operations. Position paper. WFP, June 2017.

Implications for…WHO Endorse or develop policies: 2. Train staff
The OG-IFE offers practical guidance which assists decision-makers, planners and donors to implement WHO global strategy and guidance documents e.g. UNICEF/WHO Global Strategy on IYCF Endorse or develop policies: Key responsibility in supporting national/sub-national policy preparedness Key role to catalyse and support development of an inter-agency joint statement Support development/updating and dissemination of key IFE policy guidance Support enactment of the Code and WHO guidance on ending inappropriate promotion of foods for infants and young children into national legislation Develop national legally binding policies regarding private sector engagement in emergency response 2. Train staff WHO country offices may provide information on existing national expertise and networks Note: The WHO logo needs to be replaced on all the slides

Implications for…WHO 3. Coordinate Operations
WHO is responsible for supporting Member States to prepare for, respond to and recover from emergencies with public health consequences. WHO may be called upon to provide to provide context-specific guidance on appropriate actions and acceptable compromises when it is not possible to meet the provisions of the OG-IFE. Note: Suggest to focus on what WHO can do rather than highlight the responsibility of other agencies on this slide since it has already been mentioned before. “In some emergencies, it may not be possible to meet all the provisions of the OG-IFE immediately, such as where access to those affected is limited or impossible, or capacity is lacking to deliver necessary support. In such circumstances, critical analysis by the coordinating body, government, UNICEF, WHO and, where applicable, UNHCR (see 3.1) is essential to provide context-specific guidance on appropriate actions and acceptable compromises. Adapted programming may fall short of OG-IFE recommendations and should be temporary. The unmet needs and risks of compromised programming should be used to inform proactive advocacy for humanitarian access, resourcing and capacity. Decision-making should be recorded and lessons learned should be documented and shared.”

Implications for…WHO 4. Monitoring
WHO and UNICEF country offices have key responsibilities in supporting government to develop policies and procedures to monitor for and act on Code violations. Code violations may be reported to WHO at country or regional level (Contacts) 5. Integrated multi-sector interventions Support integration of Ten Steps to Successful Breastfeeding (WHO/UNICEF BFHI) into maternity services Ensure complementary feeding interventions comply with the WHO Guidance on ending inappropriate promotion of foods for infants and young children Note: The 10 steps has changed to my knowledge – need to follow up on this. 4. Monitoring 4.16 Monitor for Code violations and report them to national authorities, the IFE coordination authority, and international monitors. Support government to develop policies and procedures to monitor for and act on Code violations; WHO and UNICEF country offices have key roles to play in this regard. Typical Code violations in emergencies relate to infant formula labelling, supply management, and donation. 5.20 The designated IFE coordination authority should provide clear direction on complementary feeding needs and interventions. Depending on the country context, UNICEF, UNHCR, WHO, WFP and FAO may have complementary roles to play. In all contexts, UNICEF has a key role to advocate for and provide guidance on appropriate quantities of quality complementary foods and to help define essential interventions See References Section 8.6 Multi-sector Interventions – Complementary Feeding.

Implications for…WHO 5. Integrated multi-sector interventions (cont.)
Ensure that national/sub-national policies on HIV and Infant Feeding are in line with latest WHO recommendations: 2010 Guidelines on HIV and Infant Feeding: Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. 2016 Guideline Updates on HIV and Infant Feeding 2017 HIV and Infant Feeding in Emergencies: Operational Guidance (coming soon) WHO named as go-to agency for up-to-date advice during infectious disease outbreaks

Implications for…WHO 5. Integrated multi-sector interventions (cont.)
Artificial Feeding Management Key responsibility in supporting appropriate procurement, distribution, targeting and use of BMS and associated support, in close consultation with the IFE coordination authority and/or UNICEF.  Terms of reference, responsibilities and roles for artificial feeding management for use by the IFE coordination authority to be established in preparedness. Plan procurement, distribution, targeting and use of BMS and associated support (artificial feeding management) in close consultation with the IFE coordination authority and UNICEF (where UNICEF is not acting as the IFE coordination authority). In accordance with mandates, WHO and UNHCR also have key roles. Establish terms of reference, roles and responsibilities for artificial feeding management for use by the IFE coordination authority, in preparedness. See References Section 8.7 Artificial Feeding – BMS Supplies and Feeding Equipment.

Appropriate and timely support of infant and young child feeding in emergencies (IFE) saves lives, protects child nutrition, health and development and benefits mothers.

INSTRUCTION SLIDE You may find it useful to have a discussion on how the revised guidance can be dissemination within your working group / cluster / agency etc. Suggestions have been made for roll out at: Individual agency level National level Regional level Select the appropriate slide. Suggested roll out actions will have to be contextualised prior to presenting. Following the discussion, it is recommended to set SMART objectives and work out a timeline to implement the recommended roll-out actions. Consider what resources are required to support the roll-out.

Recommendations for dissemination (Agency)
Wide dissemination of Ops Guidance on IFE within <agency> What does this mean for you and your agency? Roles, responsibilities, agency activities, programming, strategies, position papers etc. Training for technical staff from health, nutrition and other sectors Sensitisation for all staff including senior management and communication, logistics, resource mobilization, rapid response and volunteer teams Inclusion of V 3.0 in induction reading materials, agency resource libraries, training materials etc. Dissemination and roll out to regional, country and field offices Update training materials Training: Target especially nutrition, health, adolescent services, WASH, FSL, CP, ECD, disability, cash transfer, social protection, agriculture and logistics staff. Sensitisation: relevant personnel across sectors to support IFE, including those dealing directly with affected women and children; those in decision-making positions; those whose operations affect IYCF; those handling any donations; and those mobilising resources for the response. Target groups for sensitisation include sector/cluster leads, donors, rapid-response personnel, government staff, camp managers, communications teams, logisticians and volunteers, among others. Note that this should not be limited to induction for nutrition staff but also technical staff working in other sectors as well as support services (finance, admin logistics etc.) and senior management.

Recommendations for dissemination(National/Cluster)
Wide dissemination to <NiEWG / nutrition cluster members, all other sectors, intercluster, relevant government agencies and authorities, advocacy groups, policymakers> What does this mean for you? Preparedness and response plans, roles and responsibilities etc. Dissemination of / sensitisation on update Translation of Operational Guidance on IFE text into local language Adaptation of Operational Guidance on IFE to local context Incorporation of V 3.0 revisions into national guidance & policy Inclusion into background reading materials Check at regional / HQ level if translation already exists / is in process

Recommendations for dissemination (Regional)
Wide dissemination of Ops Guidance on IFE at <regional level> What does this mean for you? Preparedness and response plans, roles and responsibilities etc. Training and sensitisation for regional offices Translation into regional languages Dissemination to country offices Incorporation of V3.0 updates into regional strategies, funding etc. Arabic, English and French will be available

Appropriate and timely support of infant and young child feeding in emergencies (IFE) saves lives, protects child nutrition, health and development and benefits mothers.

Infant and Young Child Feeding in Emergencies. Operational Guidance.

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Infant and Young Child Feeding in Emergencies. Operational Guidance.

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Presentation on theme: "Infant and Young Child Feeding in Emergencies. Operational Guidance."— Presentation transcript:

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