Step Up for Breastfeeding: Adaptation of Kenya’s Baby Friendly Community Initiative (BFCI) to Madagascar

By: Mr. Joseph Gaithuma and Ms. Rachel Kavithe, Kavle Consulting, LLC

World Breastfeeding Week 2022

This year’s World Breastfeeding Week theme: Step Up for Breastfeeding: Educate and Support highlights the need for a Warm Chain of Support during the first 1000 days of life. Restoring breastfeeding support systems, affected by the COVID-19 pandemic, means engaging both facility and community levels to meet the global 2025 World Health Assembly Nutrition Targets  Breast milk acts as the first “food” and provides the first “vaccine” of life-saving antibodies. According to the Lancet 2016 Breastfeeding Series. scaling up breastfeeding could prevent 823,000 annual deaths in children less than 5 years of age. Governments play an important role in investing in breastfeeding- as every US $1 invested in improving breastfeeding practices results in economic returns of US $35

What can we learn about the “warm chain of support” through community and/or facility-level baby-friendly initiatives in  Kenya to improve MIYCN? 

Kenya is prioritizing efforts to protect and promote breastfeeding, via the Breastmilk Substitutes Act, breastfeeding workplace support, and via Baby Friendly Hospital (BFHI) and Baby Friendly Community Initiatives (BFCI). Kenya rolled out BFCI in 33 out of 47 counties through Kenya’s extensive community health cadre (i.e., community health extension workers and health volunteers), as delineated in the Community Health Strategy. Implementation of BFCI in Kisumu, Kenya has demonstrated success  through improved infant and young child practices (i.e. decline in prelacteal feeding, increased exclusive breastfeeding and consumption of iron-rich complementary foods).  Kenya is the first country to develop national BFCI guidelines (2016) and recently revised the BFCI implementation package (2021). In Kenya, the integration of BFCI with social protection programs and ramping up efforts for a national adaptation of the WHO BFHI package, builds on BFCI successes.

How can Kenya’s BFCI experience be adapted to other countries, like Madagascar?

In climate-change-affected Madagascar, where cyclones, floods and droughts exacerbate infectious diseases and child malnutrition and hinder access to facility health services, community-based interventions can aid in  reaching the  hard-to-reach. Madagascar has not implemented a community-based breastfeeding program since 2003, via the USAID-funded LINKAGES project, which sought to change individual behaviors and community norms related to early and exclusive breastfeeding. Currently, the 2021 Demographic and Health Survey reveals that 54.4 % of infants, 0-5 months of age,  in Madagascar are exclusively breastfed.

Today, Madagascar is building off of Kenya’s rich experience in BFCI implementation through USAID’s Food for Peace FIOVANA project led by Adventist Development and Relief Agency (ADRA) to improve breastfeeding practices at the community level. In partnership with Kavle Consulting, LLC, the ADRA-led FIOVANA project are adapting the Kenya BFCI  Training of Trainers (TOT)  to the Madagascar context, targeting facility health workers for the initial TOT who will subsequently train community health personnel.  This initial virtual training with in-person interactive group exercises will cover: background on BFCI and the 10 steps, formation of mother and community support groups, breastfeeding challenges, maternal nutrition, integration of nutrition-sensitive interventions and monitoring of BFCI indicators. This TOT will be the first of several trainings and mentoring sessions needed to improve provider competencies around breastfeeding knowledge and counselling.  Further the TOT will equip providers with information to monitor the International Code of Marketing of Breast-milk Substitutes in-country.

Stepping up for breastfeeding requires concerted efforts at community and facility level to protect and support breastfeeding

Visit our Kavle Consulting, LLC web page for more information on our work & research around nutrition program implementation.

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