Infant and Young Infant and Young Child Feeding in Child Feeding in - PowerPoint PPT Presentation

Infant and Young Infant and Young Child Feeding in Child Feeding in Dadaab: Dadaab: Improving practices Improving practices in a protracted crisis in a protracted crisis Mary Lung’ ’aho, CARE aho, CARE Mary Lung on behalf of on behalf of Interagency Dadaab IYCF Team Interagency Dadaab IYCF Team UNHCR, CARE & Partners UNHCR, CARE & Partners October 14, 2009 October 14, 2009

IYCF Support in Dadaab: an Interagency Effort IYCF Support in Dadaab: an Interagency Effort Dadaab IYCF Team Members Objectives Dadaab IYCF Team Members Objectives � UNHCR* UNHCR* � Integrate support for Integrate support for � � appropriate IYCF into appropriate IYCF into � CARE* CARE* � multi ‐ ‐ sectoral sectoral multi � GTZ* GTZ* � programming programming � NCCK NCCK � � Strengthen capacity of Strengthen capacity of � � IRC* IRC* � staff/workers and staff/workers and � ACF ACF � partners to support partners to support � MSF MSF ‐ ‐ Swiss* Swiss* IYCF in emergency IYCF in emergency � contexts contexts * = current * = current

Protracted Emergency Protracted Emergency Dadaab Refugee Camps in Kenya Dadaab Refugee Camps in Kenya

Dadaab Camps Dadaab Camps

Strengthening the System Strengthening the System What are the key elements? What are the key elements? � Orientation for all staff � � Rapid assessment of new arrivals � Capacity ‐ building for staff & volunteers � IYCF support in on ‐ going programming � Behavior change communications � Monitoring

UNHCR Nutritionist Dadaab IYCF Team CARE IYCF Supervisor UNHCR—CARE—GTZ—NCCK GTZ Nutrition Coordinator AAH—Save UK NCCK IYCF Coordinating Team: Ifo Hospital Dagahaley Hospital Hagadera Hospital IYCF Officer. • Maternity staff • Pediatric staff IYCF Health Post Team • Under five consultant • HIS staff • SC staff • PMTCT • etc. Health Health Health Post Post IYCF Community Workers Post Health Post Staff • ANC consultant • Under five consultant • HIS staff • EPI staff • SFP and OTP staff Community Workers • CHWs- Community Health Workers • TBAs- Traditional Birth Attendants • CDWs- Community Dev Workers • RHMs- Repro. Health Motivators • CPWs- Children Protection Workers Community Volunteers-IYCF Counselors Mother-to-Mother Support Groups Secondary Targets • Men’s support groups • School clubs • Youth groups • etc.

Orientation for all staff Orientation for all staff � IFE: Why it Matters IFE: Why it Matters � � Key policy guidance: Key policy guidance: � IFE Core Group: IFE Core Group: Ops Guidance Ops Guidance � Challenges in Challenges in � implementation implementation � Role and Role and � responsibilities of all responsibilities of all sectors sectors � CME for medical staff CME for medical staff �

Ensure staff have Ensure staff have basic knowledge basic knowledge

Rapid Assessment for New Arrivals Rapid Assessment for New Arrivals � Identify acute Identify acute � feeding and care feeding and care problems needing problems needing immediate immediate attention attention � Provide critical Provide critical � information information � Link to support Link to support � systems systems

Orientation & Capacity ‐ ‐ Building Materials Building Materials Orientation & Capacity � Orientation: interagency Orientation: interagency � Ops Guidance & IFE Ops Guidance & IFE Core Group Mod 1 Core Group Mod 1 � WHO/UNICEF BF WHO/UNICEF BF � Counselling course (40 hr) Counselling course (40 hr) � IYCF Community IYCF Community ‐ ‐ Focused Focused � and C ‐ ‐ F Plus (incorporates F Plus (incorporates and C ENA content) Approaches ENA content) Approaches � Mother Mother ‐ ‐ to to ‐ ‐ Mother Mother � Support Group: Facilitator Support Group: Facilitator Training Training � Integration of IYCF Support Integration of IYCF Support � into CTC/CMAM into CTC/CMAM

Capacity ‐ ‐ Building Building Capacity IYCF Community ‐ ‐ Focused Approach Focused Approach IYCF Community Integration of IYCF Support into CTC/CMAM Integration of IYCF Support into CTC/CMAM

Capacity ‐ ‐ Building: Breastfeeding Counselling Building: Breastfeeding Counselling Capacity WHO/UNICEF 40 ‐ ‐ hour course hour course WHO/UNICEF 40

Community ‐ ‐ Focused Training Focused Training Community

Strengthening Assessment Strengthening Assessment & Counselling Skills & Counselling Skills

Staff & Workers: Hands ‐ ‐ on Practice on Practice Staff & Workers: Hands

Peer Support: MtMSG Peer Support: MtMSG

Camp Blocks showing Mother Support Group Locations Camp Blocks showing Mother Support Group Locations

BCC Activities BCC Activities Transporting a video between health posts Transporting a video between health posts

IEC Materials IEC Materials

IYCF Support Activities IYCF Support Activities � IYCF Counsellors: staff, CHW incentive workers and mother volunteers (234 CHWs, 214 trained ‐ to ‐ date as IYCF Counsellors; 32 Trainers) � Identified Contact Points (facility and community) to visit and counsel pregnant and lactating women � IYCF counselling cards and other job aids for community workers � Mother support groups spread throughout the blocks: currently 658 functioning groups (610 with trained facilitators) � Activities to engage community ‐‐ including men; involve religious leaders � Instructional videos and action ‐ oriented educational talks in health posts � Feedback to community

Tracking our Progress Tracking our Progress Has it made a difference? Has it made a difference? � Monitoring of programme activities � Age ‐ disaggregation in UNHCR HIS � Annual nutrition survey Measures child nutritional status Provides coverage data Tracks IYCF practices at population level using globally ‐ agreed indicators � Step ‐ by ‐ Step GUIDE to Collecting and Analyzing IYCF Data, with Tools

Annual nutrition surveys Annual nutrition surveys

Exclusive BF Dadaab 2005 ‐ 2009 70.00% Influx of New IYCF 60.00% Refugees Program Start 50.00% 40.00% 30.00% 20.00% 10.00% Projected EBF Rate from Baseline 0.00% 2005 2006 2007 2008 2009 Percent EBF Dag Hag Ifo

African Countries: EBF 0 ‐ ‐ <6 Months <6 Months African Countries: EBF 0 UNICEF State of the World’ ’s Children 2009 s Children 2009 UNICEF State of the World & & EBF 0 ‐ ‐ <6 Months in Dadaab: 2005 & 2009 <6 Months in Dadaab: 2005 & 2009 EBF 0 Exclusive Breastfeeding 0 <6 months 100 90 80 70 60 50 40 30 20 10 0 l i ) i i i a r r t d e 5 n a e a a a u a o n a a e d a a C o l a a n 9 a a a e a a a i l e i a i i i i i i i d i r c e y R a w a a r n l a g e e n d d u i 0 o i r o u n n g r R h 0 d o b n b g w b t n n p r a c a n A a r o h 0 b e r o i e e n o i n q a a e e 0 l n n o g i l D M a t s f b i e u o g e s r C i o m i h e a m a C a e g o z i a b v 2 l N m n w n b r 2 a a s i ( m u s r i I A b z i a B g a j ' L K i C e s n h G V g G e w A o A b a a L e u E b N G t b t M Z B c G a U a d a m S D h S m i L B e R a ‐ N a E t r l w o T m a d a p e a r i a a b z S B t u a a d Z e C d e u o o o i C a a n M S p C S i M D D e u R G n a c i r f A l a r t n e C 24 24

Global Acute Malnutrition Dadaab 2005 ‐ 2009 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 2005 2006 2007 2008 2009 Percent GAM Dag Hag Ifo

Ongoing Challenges Ongoing Challenges � Continued population influx: 134,000 to 289,307 … � Limited diet options Quality: limited food commodity diversity Quantity: continued pressure from influx Concerns for maternal nutrition & care � Post ‐ training mentoring of workers & volunteers � Ongoing staff turnover � Others … This year: transition to UNHCR coordination

The Dadaab experience suggests The Dadaab experience suggests that IYCF practices can be protected, that IYCF practices can be protected, and even improved, in some and even improved, in some emergency contexts. emergency contexts. Thank You! Thank You!