1. From Evidence to Action: The Experience of KZN Department of Health on Infant & Young Child Feeding PolicyBreastfeeding Consultative Meeting23 August 2011

3. Thank You

4. Preparatory work • Timeframe of 3 years • Advocacy begun in 2008 • Many of the studies mentioned were conducted in SA and in KZN specifically e.g. Kesho Bora • WHO Guidelines released in December 2009 • Successful PMTCT programme – Impact Assessment 2007 ff introduction of Dual Therapy

5. Prevention of postnatal MTCT therefore comes at a cost of excess deaths in uninfected infants : therefore need to consider overall outcome i.e. we need to consider how many HIV infections we prevented as well as how many infants survive - HIV-free survival.

6. KZN scenario • Worst affected by HIV (39,5% incidence on ANC attendees 2009) • More than 50% child deaths related to HIV • Severe malnutrition cases increasing (inappropriate feeding & disease) • Diarrhea & Pneumonia - 2 leading causes of death in children under 5

7. KZN scenario • 50 471 reported cases of diarrhea in children under 5 in 2009/10 – 8.5% increase from previous year • Of these 9092 (18%) were admitted to hospital • 209 920 reported cases of pneumonia in children under 5 years in 2009/10 – 4.2% increase from previous year • Of these 8 924 (4.2%) were admitted to hospital

8. Risk of Contamination of Formula Milk • SA National Study(2008) :Infant formula from sealed tins tested positive for potential pathogens, vast majority of samples tested positive after preparation implicating inadequate hygiene in feed preparation.

9. KZN situation • Issuing formula led to most mothers mixed feeding: highest risk of transmission & highest risk of morbidity & mortality • Mothers lack adequate resources (e.g. fuel, water, refrigeration, sustainable household income) • Lay counselors struggle to assist HIV positive mothers make the best infant feeding decision for the benefit of the mother and the child.

10. …KZN issues • Mixed messages from Health workers on IYCF issues • Free formula becomes the easiest route : though most dangerous and costly intervention. • The Formula was associated with being HIV positive: stigma • Facilities run out of stock • Companies that supply formula also ran out of stock often.

11. Progress on implementation On the 20th of April 2010, the Head of Department approved implementation of Infant & Young Child Feeding counseling on current PMTCT interventions. This included a decision to stop issuing of free infant formula to mothers in the PMTCT programme using a phasing-out approach.

12. Progress on implementation In February/March 2010, meetings were held with district management to sensitize them on new IYCF policy for KZN (amongst others) In August, a meeting with partners which included UKZN, 20 000+, Children Rights Centre, UNICEF,WHO was held to discuss the decision with them and lobby for support in taking this forward.

13. Progress on implementation • Three day training courses for doctors were held in August 2010; February & July 2011 where this information was communicated to them. • Trainer of trainers training was also held from October 2010, to capacitate district/PHC trainers to do training for all nurses in districts. • The update of nurses was supported by Provincial and District Offices.

14. Progress on implementation • Retraining of all the lay counselors that counsel mothers on Infant Feeding Issues begun in October and continued until February 2011. • A total of 1703 lay councilors were trained. • Training & participants manuals, pocket guides, flip charts and other training tools have been developed.

16. Progress on implementation UNICEF funded the appointment of a communication specialist for 3 months who carried out development of key messages and communicating these to communities. Messages were developed, field tested with pregnant women & mothers in various health institutions, and finalized.

17. Progress on implementation The communication strategy has included the preparation of Radio Adverts, Newspaper inserts, Corporate DVD, Community Forums, Press release Meetings with key community stakeholders were held in all districts facilitated by the communication consultant.

19. Progress on implementation • An education/information session was held with the media on November 2010. • Media brief organized by MEC also addressed the IYCF policy (amongst others) in November 2010. • December 2010; Accompanied HOD and Senior Managers for presentation to KZN Portfolio Committee for Health

20. KZN Framework for Accelerating Community-based Maternal, Neonatal, Child and Women’s Health and Nutrition Interventions

21. Progress on implementation Approval for framework implementation August 2010 Development of MCWH & N Community tools completed Advocacy Meetings held in all districts Training of Community Care Giver (CCG) Facilitators & Supervisors has commenced CCG Facilitators will cascade training of CCGs

23. Monitoring & Evaluation • 2 Indicators added to DHIS • Early breastfeeding initiation • Exclusive breastfeeding at 14 weeks • QA/QI – partnership with 20000+ • School of Public Health (registrar) Proposal

24. Breast feeding vs Formula- choicesin HIV-infected women post –deliveryUgu, Ethekwini, Umgungundlovu IYCF POLICY

27. CHALLENGES • Limited training of Professional Nurses • Limited advocacy at community level • Inadequate emphasis on M & E • Documentation of process • “Not a National Policy” • National Support visits on PMTCT new guidelines not in line with KZN new Policy

28. Successes • Extensive period of advocacy and consultation • Management support from MEC & HOD level • Partnering with Programme Managers (MCWH) • Inputs from partners (UNICEF; WHO; UKZN-Paediatrics; 20 000+; Zoe Life; Children Rights; Africa Centre) • Strong provincial support processes e.g. MBFHI, Breastfeeding Week Activities, budget allocation (supplementation for lactating mothers; Outside Radio Broadcasts)

29. Acknowledgements • MEC & HOD - leadership • Provincial Nutrition Team-commitment and dedication • Provincial MCWH Directorate -holding our hands • District Teams – Implementation • UNICEF- unwavering support

30. THANK YOU