EXECUTIVE SUMMARYBy Pauline KisangaIBFAN Africa ConsultantIBFAN Africa conducted a two day workshop from 12-13 November 2009, to orient the government of Cameroon on how to conduct periodic monitoring and evaluation of infant and young child feeding practices, policies and programmes using a simple to use World Breastfeeding Trends Initiative tool (the WBTi). The workshop was held at the Royal Palace Hotel Bonaberi-Douala for 14 participants who came from the government and different nutrition advocacy NGO’s and being gender sensitive, included men, women and youth groups. The workshop was facilitated by an international consultant to IBFAN Africa, Mrs. Pauline Kisanga and nationally organized and coordinated by the Coordinator of Cameroon Link who is also IBFAN coordinator of IBFAN groups in Cameroon.
The objectives of the workshop were to:1.Sensitise participants on the Global strategy on Infant and Young Child Feeding and how it is linked to the WBTi tool;
2.Impart knowledge and skills on the application of the WBTi tool for monitoring and evaluation as well as for advocacy and action to improve IYCF;
3.Discuss unique national situations as regards the tool;
4.Identify sources of representative local data and methods of its gathering;
5.Develop an Action Plan for the first national assessment.
The workshop achieved its objectives and beyond as it was able to conduct a preliminary rough score of the country (81/150 or 54% of achievement) on implementation of the Global strategy; it came up with a concrete plan to complete the country assessment from 13th November to 18 of December; and it already begun utilizing the draft assessment results to advocate for further action using the national TV and internet Cameroon Link blog. The National Coordinator of Camlink and IBFAN consultant appeared on national TV immediately after the workshop and made a call for further action on this subject.
Among the achievements observed on implementation of Global Strategy nationally are:
1.Excellent initiation of breastfeeding with one hour of birth (95.6).
2.Cameroon has a national Code on the Marketing of Breastmilk Substitutes, even though it is not enforced and it has no sanctions.
3.Many health facilities in Cameroon practice kangaroo care to provide care to low birth weight or pre-term infants.
4.Exclusive breastfeeding for 6 months is increasing even though slowly.
5.Community based support by mother support groups is fairly good except there is lack of optimal and correct information for mothers and community workers.
6.The World breastfeeding Week is celebrated nationally annually.
Among identified major gaps are:1.Too early introduction of other foods and water (26.2%) and too late introduction of complementary foods for 20% of infants.
2.Lack of a National Coordinator for infant and young child feeding in the Ministry of Health and a national coordinating committee supported by the Ministry of Health and fully responsible for IYCF.
3.The National Code of Marketing is not translated into English so that all can understand and lacks sanctions.
4.Information, education and communication efforts are only reaching 58% of the population.
5.High bottle feeding practices for infant 0-6 months (26%)
6.No efforts are made to implement BFHI in health facilities.
7.No awareness of infant feeding in emergencies.
8.On Maternity protection, not all provisions of the ILO 183 Convention are addressed and there was no protection of agricultural workers and those in the informal sector.
9.There is need to know more about what is happening to mothers who are HIV positive in terms of infant feeding.
Observed Opportunities•Cameroon has over 48 community radio stations that are not fully utilized by the government for infant and young child feeding education.
•Cameroon boasts of having a good national Federation of Cameroon Breastfeeding Promotion Associations, FECABPA; it hosts the International Men’s Initiative of the World Alliance for Breastfeeding Action, WABA; and is strongly affiliated to IBFAN and the Baby Milk action that are two advocacy houses for infant and young child feeding.
•Good relationships between Cameroon Link and the Government-for instance the government was fully supportive of the WBTi workshop and even supported with gathering of preliminary data.
•A very strong Cameroon Link-coordinating the federation of Cameroon Breastfeeding Promotion Associations, FECABPA and affiliated to many other national groups working on related work.
Among the key recommendations made to the national government and local partners are:
1.Appoint a national Coordinator for infant and young child feeding who is in a senior position and a national committee answerable to the Ministry of Health and the Federation.
2.The government should have a budget for implementing infant and young child feeding programme.
3.The government should translate the national Code into English so that all can benefit and it should revise the Code so that it includes sanctions.
4.The government, UNICEF and WHO to initiate urgent efforts to train health workers on BFHI and implement the BFHI in health facilities and communities.
5.The government needs to integrate guidelines on infant feeding in emergencies within the nutrition policy.
6.The Government with the support of UNICEF and the WHO to improve monitoring and evaluation of IYCF indicators within existing systems.
Major request made to IBFAN1.IBFAN to consider including French in all its future national training and IYCF documentation in order to achieve full participation of the French section of the country. It was explained that this was possible through IBFAN Africa sub-office in Burkina Faso.
DETAILED PROCESSWBTi is a web based tool that is adapted from the WABA’s GLOPAR 1993 tool and the WHO’s tool “Infant and Young Child Feeding: A tool for assessing national practices, policies, and programs” (2003/4). It is an action oriented tool that encourages involvement of all stakeholders from assessment, analysis to action planning and implementation.
The periodic use of the WBTi tool for monitoring of progress of the infant and young child activities is expected to identify best lessons of achievement and existing gaps and thereby generate action to improve on policies and programmes for maternal and child health. This in turn is expected to lead to improved infant feeding practices and maternal health and therefore speed up the achievement of MDG 4 and 5.
The WBTi objectives are to:
Provide critical information to governments, needed to bridge gaps in infant and young child feeding policy and practice
Provide evidence to IBFAN groups to advocate for greater effort and investment to promote early and exclusive breastfeeding in the respective countries and regions
Contribute to attaining MDG-4 and 5 and reducing under-five child mortality and improve women’s health
Document best practices and share them with other countries in regional forums.
Preparation of WBTi TrainingCameroon Link made excellent preparations for the workshop including development of information packs for all participants and collecting preliminary data on most of the 15 indicators, which enabled mock data processing-filling of forms, analysis and rating and scoring; as well as generating excellent discussions based on real life situations during the workshop.
Cameroon Link is the national Focal Point for the International Baby Food Action Network (IBFAN) in Cameroon. It is through Cameroon Link that the Ministry of Health of Cameroon now collaborates with IBFAN Africa closely. Cameroon Link has been instrumental in the formation of the national Federation of Cameroon Breastfeeding Promotion Associations, FECABPA, and the Men’s Initiative of the World Alliance for Breastfeeding Action, WABA.
It is IBFAN’s expectation that after this workshop the national team will be able to finalise their national assessment, conduct partial analysis and submit their national report to IBFAN AFRICA who together with IBFAN Asia will finalise the report cards for country advocacy work and further action. At the same time from the assessment reports the national group will design their advocacy strategy for improving country action for IYCF.
THE WORKSHOP PROCESS
SESSION ONE1. The head of the reproductive health unit and health partnerships focal point, Mr. Samuel Mibe (MOH), opened the workshop with acknowledgement to IBFAN for their support and the Cameroon government for their efforts towards improvement of Infant and Young Child Feeding, IYCF. He thanked Mrs. Joyce Chanetsa, current regional coordinator of IBFAN Africa for including Cameroon on the list of countries that have benefited from the training in the Africa region and welcomed the consultant. He also presented excusive breastfeeding trends from 1991 to 2006, indicating significant improvement from below 10% in 1991 at 3 months to 37% at 0-6 months.
2. Mr. James Achanyi-Fontem, the National Coordinator of IBFAN Group and Cameroon Link welcomed the consultant and participants, also acknowledging the support of IBFAN and WABA and the good collaboration they have with the Cameroon Ministry of Health and other partners. He also presented some of the preliminary data on infant and young child feeding adding to that from the Ministry of Health especially in the area of policies and programmes, calling for more vigilance from his colleagues so that they can sustain the ongoing efforts and exceed the level they have reached. He also reiterated that the WBTi was a good opportunity as a new initiative in boosting the Cameroon Link’s 20th Anniversary celebrations that were going to be held on the 23rd of November 2009. He called on vigilance and adviced that the WBTi results could be utilized in preparation of the national assessment workshop.
3. The consultant then briefed the trainers on the global strategy on IYCF as the basis for the protection, promotion and support of all IYCF activities. She highlighted the goal of the Global Strategy as:
•improve the feeding of infants and young children by
oprotecting, promoting and supporting optimal feeding practices
oempowering mothers/families/care-givers to make, and carry out, fully informed decisions about feeding, free from adverse commercial influences and misinformation; and
oensuring supportive conditions for exclusive and continued breastfeeding as well as timely, adequate, safe and appropriate complementary feeding for every child
•Increase the commitment of governments, civil society and international organisations to protecting, promoting and supporting optimal infant and young child feeding.
•provision of accurate, objective and consistent information about optimal child feeding practices
•skilled support to initiate/sustain the optimal feeding practices, preventing/overcoming difficulties
•protection from misinformation and inappropriate commercial influences
•creating enabling environment for mothers/families to adequately feed and care for their infants and young children
She emphasized the Innocenti Targets and the additional targets of the Global Strategy as basis for the WBTi implementation:
•Innocent Declaration targets All governments should:
1.appoint a national breastfeeding coordinator
2.ensure that every facility providing maternity services fully practices the Ten Steps to Successful Breastfeeding
3.take action to give effect to the principles and aim of all Articles of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant resolutions of the World Health Assembly
4.enact imaginative legislation protecting the breastfeeding rights of working women and establish means for its enforcement
•Additional operational targets
5.develop a comprehensive policy on infant and young child feeding
6.ensure that all key players protect, promote and support exclusive breastfeeding for the first 6 months of life
7.promote timely, adequate, safe and appropriately done complementary feeding
8.develop guidelines on appropriate feeding of infants and young children in exceptionally difficult circumstances, including HIV/AIDS
9.adopt national legislation and other suitable measures for implementing the International Code of Marketing of Breastmilk Substitutes and subsequent relevant
WHA Resolutions.
•GSIYCF o describes interventions for promotion, protection & support of IYCF
o concentrates on the role of critical partners (govt, Int org, civil society)
o builds on existing approaches
o comprehensive (all inclusiveness)
o calls for investment into IYCF
•The challengeo How do I use the strategy to ensure that appropriate IYCF is a reality in my country to achieve the United Nations Millennium Summit – MDG 4 and 5 (2000)
o Each country has been urged to develop, implement, monitor and evaluate a plan of action on IYCF. Many have plans but how well are they implementing and reporting on the achievement of the operational goals.
o This emphasis was made again in the Innocenti Declaration on IYCF (2005) that countries should put resources into IYCF as over 60% of under fives mortality is attributable to inadequate infant and young child feeding.
She stated that:
•The achievement of the OPERATIONAL GOALS needs to be monitored
•Action needs to be stimulated at all levels for implementation of the Global Strategy from the national assessments.
•IBFAN Asia has innovatively summarised the WHO monitoring tool into a more manageable tool-the WBTi
•The WBTi addresses all the 9 goals; is participatory, action oriented and is simple to use;
•It is the best in Tracking, Assessing and Monitoring (TAM) the implementation of Global Strategy for IYCF
5.Introduction to WBTI and the participants’ reading of the green book. A brief presentation of the WBTi was made followed by the participants reading the green book and answering questions that followed; which were mostly well understood.
This was followed by discussion of the Africa experience. The consultant briefed them on the regional workshop by IBFAN Africa and Asia for the 14 countries, the rationale for selection of countries and the work that followed at each country level. The consultant explained that to date 7 out of the 14 countries have their reports posted on the WBTi website, while other reports are still being reviewed by the IBFAN Regional office and IBFAN Asia.
5. How to conduct national assessmentsThis was a brief power point presentation on the steps that each country should follow in conducting assessments. This was followed by a brief discussion.
SESSION 2, 3, 4, 5In these sessions the participants worked in 3 groups on understanding the questionnaires and identifying the sources of data for each of the indicators.
This was followed by group presentations: Major sources of date for Cameroon were the DHS, Ministry of Health, WHO and UNICEF. Others were HIV/AIDS commission, Ministry of Labour and ILO; and health facilities referenced reports.
This was followed by another group work to read each indicator in detail: reading the question and the sub-set, suggesting possible sources of data and method of collecting the data. This was then followed by group presentations of findings and challenges. The participants understood the questionnaire and the only challenges indicated were in the language and lack of data in some of the areas.
Groups were organized as follows:
Group 1: Indicators-1, 2, 6, 7, and 8
Group 2: Indicators- 3, 4, 9, 10, and 11
Group 3: Indicators- 5, 12, 13, 14, and 15
SESSION 6, 7, 8This Sessions consisted of viewing the Africa report from Malawi on how the form was filled; filling the blank template using available national data, analyzing the data and rating and scoring; and discussing how to identify gaps, identify achievements, write recommendations for action on bridging the gaps.
This was then followed by presentation by groups and discussion.
At the end of this session all the indicators were scored and the a draft country score, determined (almost a true score because of the available information)
There was then a brief discussion on how the collected information and the score could be utilized for advocacy and since they had several journalists in the group there were many useful suggestions including: media houses, newsletters, meetings with policy makers, training of health workers and community resource people and IEC materials.
SESSION 9-Web actionThis was partially successful. Participants were shown how to register and how to obtain information from the WBTi website. Africa reports and scores were easily accessed but when it came to registration in order to get the tables, graphs, maps and pie charts, the registration failed. The participants were requested to each register so that they could access the reports later in their own time.
SESSION 10 PLAN OF ACTION AND BUDGETParticipants came up with their plan of action immediately after the web-action. This action plan is contained in the Coordinator’s report attached. Contained in the coordinator’s report are also national scores, achievements and recommendations for each of the indicators. These will however, be verified by the actual national assessments to be completed by 18th December.
