1. World Breastfeeding Trends Initiative (WBTi) Assessment of The Status of Global Strategy for IYCF In Pakistan Achievements and Gaps Presented By Dr Zareef Uddin Khan 12.10.2008

2. Core Group  Dr Zahid Larik, DDG MoH  Dr Zareef Uddin Khan, MoH (Coordinator)  Dr Fakhra Naheed, Consultant Nutrition  Prof K. Abbass, Pakistan Pediatric Association  Prof Tabish Hazir, Pakistan Pediatric Association  Dr Ahmed Shodual, WHO  Dr Sarita Neupane, UNICEF

3. Coordinating Partners  Ministry of Health( All National Programs)  Ministry of Population  Ministry of Planning  Ministry of Law, Justice and Human right  Provincial Health Department ( ALL Provinces )  Pakistan Pediatric Association  Society of Gynecology and Obstetrics Pakistan  UNICEF  WHO  JSI/ USIAD  DIFD  World Bank  Save the children US  Save the children UK  MI  National Rural Support Program  Plan International  Islamic Relief International  The Network protection for consumer

5.  Population= 163 Million  Population Rural 67%  Growth Rate =1.9%  Total fertility rate 4.1 births  < 5 mortality =94 1000LB  IMR= 77/1000LB  NMR =54/ 1000LB  MMR = 276 / 100000/LB Demographic Profile

6. 6 NATIONAL NUTRITIONAL SURVEY 2001-2002 CHILDREN  Nutritional Status - Underweight ---- 37.4% - Stunting ---- 40% - Wasting ---- 14.9%

7. IYCF Practices: Indicators 1 to 5 Indicator Existing status Status in 2005 Percentage of babies breastfed with in one hour of birth 28%26 % Percentage of babies <6 months of age exclusively breastfed 37.4%16% Babies are breastfed for a median duration of how many months? 1813 Percentage of breastfed babies less than 6 months old receiving other foods or drink from bottles in the last 24 hours 59%N/A Percentage of breastfed babies receiving complementary foods at 6-9 months of age 36%22%

8. IYCF Indicator 6: National Policy, Programme & Coordination Gaps Identified National Plan is not adequately Funded PC-I of Nutrition Program is not approved yet The national breastfeeding committee does not meet on a regular basis Poor Linkages with other line ministries Not a part of other national Programs Recommend ations PC-I of Nutrition Program must be approved Regular Funding from Government and NGOs, etc Regular meeting of NIFB Should be apart of all National program

9. Achievements 1. Institutionalization of Nutrition Wing since 2002. 2. Ordinance on Protection of Breast feeding and child Nutrition 2002 in Place 3. Formulation of National Infant Feeding Board followed by provincial infant feeding committees 4. There is a focus on Breast feeding on all the National preventive programs. 5. IYCF interventions are included under Child survival and development Packages 6. National, Provincial and district master are trained on newly prepared adopted modules

10. Indicator 7:Baby Friendly Hospital Initiative Gaps Identified Not Owned by Govt/ Donor driven Lack of resources Lack of Monitoring system Recommendation s Involvement of the MoH Should be a part of existing Programs Spread of information about benefits of BFHI Involvement of NGOs and other international Organizations for arrangements of resources Revitalization of BFHI in Pakistan?? More focus on Community

11. Achievements  43% of the hospitals are BFHs.  The initiative started in 2001.  The Project stopped in 2003.  Revitalization of BFHI is in Nutrition PC1.

12. Indicator 8:Implementation of the International Code Gaps Identified The International code implemented partially Not a part of Regular system Recomme ndations Need to incorporate in IYCF Policy Placement of Monitoring officer/ Inspector More involvement of Pediatricians and Gynecologists in International code implementation

13. Achievements 1.Prohibition on Baby formula and Breast milk substitutes are the part of law and are implemented. 2.Advertisement of the baby formulas has stopped in the media and Health facilities. 3.Additional rules and regulations have been formulated.

14. Indicator 9:Maternity Protection Gaps Identified Private sector is uncovered Maternity leave is very less No paternity leave No designated area for breast feeding at work place Recommendati ons Private sector must be included Maternity leave must be for >14 week One week Paternity leave Designated area for breast feeding Awareness of women about their rights to have maternity leave even in the informal and unorganized sectors.

15. Achievements 1. ILO Convention 183 ratified and enacted and being implemented in Government sector. 2. No discrimination for application for Jobs between the mothers who are breast feeding and other women.

16. Indicator 10:Health and Nutrition Care Systems Gaps Identified Inadequate emphasis on Breast feeding in the medical and nursing/paramedical etc education Inadequate time in pre-service No proper In service training program for Health facility staff Private sector is totally neglected Recommendatio ns Proper teaching on breast feeding practices in pre-service and in service training. Especially in Medical and nursing schools Private sectors should be included

17. Achievements 1.Incorporation of Nutrition and breast feeding promotion messages in the child health related programme, ARI, CDD, IMCI are very strong components.

18. Indicator 11:Mother Support & Community Outreach Gaps Identified Only LHWs providing support to mother for IYCF TBAs are never trained on breast feeding Lack of counseling skills Recommendatio ns All the community Health workers should be trained including LHW and Community Midwives TBAs Should be taken on board Special emphasis on counseling skill at community level

19. Achievements 1.LHW programme is an out reach programme, consisting of 100.000 LHWs. There basic curriculum includes Breast feeding component and also complementary feeding practices.

20. Indicator 12:Information Support Gaps Identified No BCC/IEC Strategy Only LHWs provide group education at community level No proper plan of action for dissemination of massages Lack of Coordination B/W National Programs Recommendation s Formulation of National BCC/IEC strategy Strengthening of Health Education cell MoH All health workers should be involved

21. Achievements 1. IEC material standardized 2. Distribution through LHWP has enhanced the coverage 3. Other community based alternative strategies are identified (through CMWs, etc) and opted.

22. Indicator 13:Infant Feeding and HIV Gaps Identified HIV not identified as priority Patients not diagnosed and even if diagnosed do not disclose their disease No support present for such mothers or infants Unsympathetic attitude of the health professional as well as families No Policy for HIV Patient Lack of Counseling services Lack of coordination B/W Nutrition Program and NACP Recommenda tions Formulation of National policy Counseling services Awareness about HIV must be highlighted Provision of Formula Milk????

23. Indicator 14:Infant Feeding During Emergencies Gaps Identified Plan without proper funding from Govt Donor Driven?? Inadequate Facilities Health outlet Private Sector Missing Recommendatio ns Allocation of funds from GOP Increase in number of Health facilities Private sector Involvement

24. Achievements 1.Policy on Infant feeding in emergencies is in placed 2.After Oct 8, 2005 earthquake the MoH set guidelines and policies on Breast feeding in emergencies, especially on donation of milk substitutes.

25. Indicator 15:Mechanisms of M & E System Gaps Identified Many Indicators are missing Not a part of regular monitoring system DHIS Private sector is missing Recommenda tions All important indicators should be included in DHIS Private sector should be included

26. Thank You