1. Z. KUBEKA On behalf of: NDOH : CHILD, YOUTH HEALTH & NUTRITION 9 th International Baby Food Action Network (IBFAN) Africa Regional Conference 1-4 February 2016, Kampala, Uganda Translating policies into action: Is there an enabling environment for implementation of Infant and Young Child (IYCF) nutrition interventions in South Africa?

2. Outline of the Presentation Nutritional problems affecting under five children in South Africa Previous Policy decisions Processes towards policy change Progress on implementation Reviews of policies, recommendations and reports on implementation status Key facilitators, barriers and lessons learnt to strengthen implementation of evidence-based interventions 2

3. NUTRITIONAL STATUS TRENDS 1999 TO 2012

4. Past Policy Decisions Fear of HIV - lead to free formula issued in health facilities Consequences: – High health cost – Increased infant mortality – Stigma – Stock outs NEED FOR POLICY REFORM 4

5. Process Towards Policy Change IYCF policy 2007 -No Breastfeeding for HIV exposed mothers Issuing of Free Infant formula Evidence leading to policy change - 2010 WHO guidelines on HIV & Infant feeding Advocacy To present evidence - Heads of health -communities - Health workers -Consultative meeting-Tshwane declaration Review of policies - IYCF policy 2013 - PMTCT policy 2013 5

6. Commitments of the Tshwane Declaration Integration breastfeeding promotion, protection & support in all relevant policies & strategies, legislations & protocols Policy change- No issuing of free formula Systems in place to promote, protect & support Breastfeeding (HMB, KMC) Provincial implementation plans for BF All public & private facilities accredited Mother Baby friendly Adoption of the WHO 2010 guidelines on HIV & Infant feeding Promulgation of regulations for marketing of breastmilk substitutes 6

7. Progress: Revision of the Infant and Young Child Feeding Policy 2013 Includes: Provisions of the Tshwane Declaration Main Components of Infant and Young Child Feeding: Early initiation of Breastfeeding Exclusive and sustained Breastfeeding Feeding of the child in difficult circumstances Complementary feeding Responsibilities of health care personnel across the different levels of care

8. Progress: REGULATIONS R991 THE REGULATIONS RELATING TO FOODSTUFFS FOR INFANTS AND YOUNG CHILDREN R991, 6 December 2012

9. Mainstreaming of breastfeeding in all relevant policies and guidelines Includes: Breastfeeding protection, promotion and support Management of Moderate and Severe Acute Malnutrition Vitamin A supplementation Food Fortification 2013 - 2017

10. Other Policies/strategies/ guidelines governing breastfeeding support Milk Bank regulations and guidelines developed and implementation scaled up Guidelines for Maternity Care in SA Mother lodger facilities within CARMMA promoted Integrated Management of Childhood Illnesses (IMCI) aligned to revised IYCF policy & IMAM guidelines

11. Systematic reviews of policies, recommendations from reviews and reports on implementation status

12. Mid-Term Review – Recommendations on Infant and Young Child Nutrition Build the capacity of all health workers in the promotion of exclusive breastfeeding and to support mothers through the continuum of breastfeeding 0-2 years or longer. Mainstreaming Mother Baby Friendly Initiative into the South African Newborn care plan. Develop appropriate complementary feeding job- aids.

13. Implementation evaluation of Nutrition interventions – some findings and recommendations Policies, Guidelines and protocols overloading health workers implementing nutrition at facility level. Lack attention to obesity Staff shortages

14. Recommendations from the three Ministerial Committees triannial reports on maternal, perinatal and child health The Committee on Morbidity and Mortality in Children under 5 years (CoMMiC) Strengthen breastfeeding initiatives Multifaceted campaigns to promote quality early childhood nutrition Maximise the opportunities afforded by the Road to Health Booklet (see page 95) Awareness-raising activities for the community and for health workers The National Perinatal Morbidity and Mortality Committee (NaPeMMCo ) Immediate and exclusive breastfeeding As breast milk provides the best nutrition and protection for the preterm baby, districts should provide breast milk (not preterm formulas) to all preterm babies by the establishment of human milk banks. The Committee on Confidential Enquiries into Maternal Mortality (NCCEMD)

15. Key facilitators, barriers and lessons learnt to strengthen implementation of evidence –based interventions

16. Key facilitators Strong political commitment National Health Insurance Primary Health Care Re-engineering -Ward Based Outreach teams MomConnect (cell phone application launched in August 2014) - More than half a million pregnant women reached by the end of August 2015 (breastfeeding promotion messages) Mother Baby Friendly Initiative

17. Barriers Resource constraints – inadequate budget – staff shortages – Lack of supportive supervision Poor implementation of community based nutrition interventions. Poor Monitoring and Evaluation Cultural and/or social values i.e. mixed feeding Infrequent use of mass media Poor coordination between Department of Health and other Government departments delivering nutrition interventions

18. Recommendations Strengthening human resource capacity Reprioritization of resources Scaling up a core package of nutrition services at community level Increase efforts among poor performing populations. Mutual accountability at all levels Implement a social mobilisation and communication campaign

19. Lessons Learnt Policies creates a favourable environment There are key facilitators & barriers Strengthening of community based nutrition interventions-community dialogues, Learn from best practices e.g.Phila Mtwana centers in KwaZulu Natal Nutrition is cross cutting- multisectoral approach is required

20. Conclusion South Africa’s policies create a favourable environment for implementation of a multi- sectoral set of interventions.

21. Acknowledgement The following team from South Africa (National Department Health) Ann Behr- Deputy Director, Child Health- Nutrition DR S Khauchali- technical adviser to Deputy Director General- programme 3: HIV/AIDS,TB & MCWH Lynn Moeng- Chief Director, Health Promotion & Nutrition