1. TRACT 5: MONITORING, EVALUATION AND RESEARCH GAPS

2. OBJECTIVES To brainstorm on a core set of indicators that can be used for monitoring breastfeeding strategy To brainstorm on questions that can be asked in evaluating breastfeeding strategy and practices To discuss a way forward in developing an implementation plan for monitoring and evaluation of breastfeeding Where are gaps in research to inform breastfeeding strategy

3. GUIDING QUESTION : MONITORING What set of national indicators can be collected to monitor breastfeeding strategy? How often? Can breastfeeding indicators fit ion existing routine monitoring system (DHIS)? Have those indicators been collected? Is there baseline on those indicators? What data collection methods should be used? Are there existing collection mechanisms (e.g household surveys, routine systems)? How can community health workers collect and report data on breastfeeding practices at community/household level?

4. GUIDE ON EVALUATION What are evaluation questions should be asking? How often should breastfeeding strategy be evaluated? What type of evaluations should be conducted?

5. M&E STRATEGY What should be our plan on M&E of breastfeeding Do we have resources for M&E of breastfeeding?

6. M&E Monitoring and Evaluation will be informed by the Goals and Objectives of National Breastfeeding Strategy M&E- done at various levels – Facilities – Communities – District, Provincial and National Focus on development and use of indicators to be collected using routine DHIS

7. Proposed National Indicators – Routinely collected using DHIS Early initiation of breastfeeding (within one hour) Mothers’ feeding practices on discharge (3 – 6 days) Exclusive breastfeeding at 14 weeks (24 hour recall) Continued breastfeeding at 9 months (24 hour recall) Exclusive breastfeeding at 6 months(6months Vit A visit)

8. Proposed Process indicators Breastfeeding trainings held. – Proportion of doctors, nurses, counsellors trained in breastfeeding counselling Workshops held/promotion activities

9. Proposed Community level indicator Need for monitoring child survival –targeting children outside the health facility

10. Research Gaps Kind of support that stakeholders should offer to the breastfeeding mother Assessing impacts and effects of programmes in improving child survival Type of interventions needed to upscale breastmilk banks Factors affecting and influences on breastfeeding practices among mothers

11. Surveys DHS and other 5 yearly surveys – As a source for baseline – Monitoring at population level Annual SANHANES- inclusion of indicators on nutrition and infant feeding

12. Recommendations Review of programme indicators in the DHIS including nutrition indicators. retain necessary and used indicators only Submit inputs for inclusion of feeding practices and childe survival indicators to the SANHANES survey Assessment of BFHI – all steps are carried – Facility should have dedicated officials to assess compliance by BFH whether hospital is still friendly Development of Communication strategy and involvement of community based structures and understanding of breastfeeding stance by NGO’s Breastfeeding promotion initiatives need to be budgeted and financed Create a conducive environment (legislations ) to breastfeeding Increase number of accredited Baby friendly PHC health facilities Train CHWs to collect breastfeeding information and mortality informnation