islamic republic of afghanistan ministry of public health · 2019-02-18 · 2009 - 2013 17 st...
TRANSCRIPT
Islamic Republic of Afghanistan Ministry of Public Health
National Infant and Young Child Feeding Policy and
Strategy 2009 - 2013
17st September 2009 Final version approved by the Executive Board
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � � � � ! " # � $ % This Infant Young Child Feeding Policy and Strategy was prepared by the MoPH Public Nutrition Department, with technical assistance from USAID/BASICS and in close collaboration with the IYCF Working Group*. The Public Nutrition Department and IYCF Working Group would like to extend their thanks to the Deputy Minister for Health Care Services Provision, the General Director of Health Care Services Provision, and the Director Preventive Medicine and Primary Health Care, for their continued support throughout the policy and strategy development process. The Public Nutrition Department is grateful for the suggestions presented by participants in the National Consensus Workshop on IYCF held in Kabul in March 2009, in particular, the Public Nutrition officers, and representatives of the MoPH Health Promotion Department, Community-Based Health Care Department, Integrated Management of Childhood Illnesses Department, MAIL, MRRD, MoWA, MoC, UNICEF, FAO, WHO, WFP, NGO’s (IbnSina, CHA, STEP, Save the Children US, Save the Children UK, AADA, CAF, TDH, NAC, AMI, Health Net, IMC, SHDP), Malalai Maternity Hospital and JICA. Their recommendations have been incorporated in the present document. Finally, the PND and IYCF working group expresses their appreciation of the support provided by the MoPH Policy and Planning Department, the Consultative Group on Health and Nutrition, the Technical Advisory Group and the Executive Board. * The IYCF Working Group members who contributed to the Policy and Strategy formulation and
preparation of the National Consensus Workshop included: Dr. Zarmina Safi, Dr. Mohammad Qasem Shams, Dr. Humayoun Ludin, Dr. Ahmad Wali Aminee, Dr. Ahmad Khalid, and other technical officers from the Public Nutrition Department; Dr. Stanekzai, Emily Levitt (PhD), Dr. Farooq Mujadidi, Charlotte Dufour, Dr. Razia, Dr. Sharifi, Dr. Paul Ickx, Dr. William Newbrander, Tom Schaetzel and Mary Ann Anderson from BASICS; Akbar Sharestani, Mahbooba Abawi and Silvia Kaufmann (FAO); Anna-Leena Rasanen and Jamshid Zewari (WFP); Dr. Adela Mubasher and Dr. Annie Begum (WHO); Henry Mdebwe and Dr. Shah Mahmood (UNICEF); Dr. Nowroz and Dr. Tariq Ihsan (Save the Children US); Dr. Sayed Qubad and Ali Maclaine (Save the Children UK).
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[ 7 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` � � 4 � 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 9 [2.3. Goal and objective of the National IYCF Policy and Strategy................................... 122.2. Vision for the IYCF Policy and Strategy.................................................................... 12
2.4. Purpose of the Infant and Young Child Feeding Policy and Strategy ........................ 122.5. Policy components ...................................................................................................... 13V > a > = > b C Q M c L A L D L C D L G A G B d Q O C S D B O O E L A I > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > V > b e R M H S L W O d Q O C S D B O O E L A I D G S L e X G A D K S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > ? > f S O G B R G X X O Q R L C M B G Q X H M C C A E Q O S Y O R D G B D K O J G E O G B g C Q h O D L A I G B i Q O C S D g L M hj H d S D L D H D O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > k > J G A D L A H O E d Q O C S D B O O E L A I D G D l G c O C Q S C A E d O c G A E > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = ?V > a > a > @ A D Q G E H R D L G A G B S G M L E m S O X L n S G M L E B G G E S C D S L e X G A D K S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = kV > a > o > P Q G X G D L G A G B X L R Q G A H D Q L O A D n Q L R K B G G E S C A E C Y Y Q G Y Q L C D O S H Y Y M O X O A D C D L G A > > > > > > > > > > = kV > a > p > g C D O Q A C M K O C M D K C A E A H D Q L D L G A > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = aV > a > U > J K L M E Q O A L A O e R O Y D L G A C M M c E L B B L R H M D R L Q R H X S D C A R O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = aV > a > q > @ A B C A D C A E F G H A I J K L M E N O O E L A I L A b X O Q I O A R L O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = a
.6. Guiding Policy principles ........................................................................................... 162r 7 s $ 5 / $ " 6 1 � 5 ` 5 � # � $ 4 � " t u $ 4 # / � \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " 7 7 7 7 7 7 7 7 7 7 7 7 7 7 9 v3.1. Advocacy, regulations and guidelines ........................................................................ 18? > = > = > w L S S O X L A C D L G A x C E W G R C R c C A E Q O S G H Q R O X G d L M L y C D L G A B G Q D K O z C D L G A C M @ A B C A D C A EF G H A I J K L M E N O O E L A I P G M L R c C A E j D Q C D O I c { > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = U? > = > V > b A B G Q R O X O A D G B D K O J G E O G B g C Q h O D L A I G B i Q O C S D g L M h j H d S D L D H D O S > > > > > > > > > > > > > > > > > > > > > > = q? > = > ? > T Y Y M L R C D L G A G B D K O g C D O Q A L D c P Q G D O R D L G A T R D > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = q? > = > k > | C Q X G A L y L A I x S D Q O A I D K O A L A I C A E R G X Y M O D L A I @ A B C A D C A E F G H A I J K L M E N O O E L A I} H L E O M L A O S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > = q? > = > a > T Y Y M L R C D L G A G B @ A B C A D C A E F G H A I J K L M E N O O E L A I L A b X O Q I O A R L O S } H L E O M L A O S > > > > > > > = q3.2. Behaviour change through awareness raising, counselling and community support . 20? > V > = > | C Q X G A L y O E P H d M L R T l C Q O A O S S ~ C L S L A I > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > V Z? > V > V > J G H A S O M M L A I D K Q G H I K R G X X H A L D c S H Y Y G Q D I Q G H Y S C A E L A D O Q W O A D L G A S > > > > > > > > > > > > > > > > > > > > V =? > V > ? > @ A D O I Q C D L G A G B @ A B C A D C A E F G H A I J K L M E N O O E L A I L A A G A n K O C M D K R G X X H A L D c n M O W O ML A D O Q W O A D L G A S > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > V V3.3. Integration of Infant and Young Child Feeding promotion & counselling in the Basic Package of Health Services & Essential Package of Hospital Services ............................... 22? > ? > = > b e Y C A S L G A G B i C d c n N Q L O A E M c | G S Y L D C M @ A L D L C D L W O D G X G Q O K O C M D K B C R L M L D L O S > > > > > > > > > > > > V V? > ? > V > @ A D O I Q C D L G A G B @ A B C A D C A E F G H A I J K L M E N O O E L A I R G H A S O M M L A I L A C M M K O C M D K B C R L M L D L O SV V? > ? > ? > � Q C L A L A I G B K O C M D K S D C B B G A @ A B C A D C A E F G H A I J K L M E N O O E L A I > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > V ?� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
3
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.3. Estimated budget......................................................................................................... 244.2. Coordination mechanisms........................................................................................... 2448 7 � � � 4 $ � 5 4 � " / � ! � / � ; / $ 4 � � 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 [ 85.1. Regular monitoring and evaluation............................................................................. 25
5.3. Progress Reviews ........................................................................................................ 255.2. Operational research ................................................................................................... 25� � � � 9 � % ; � $ % 2 ^ / 4 � 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 [ <� � � � [ � 3 � " 4 � / � _ 5 / # � � 5 � � � / � 6 % 4 % 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 [ �� � � � r � � � 5 � u � / � 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 r [� � � � � � � % $ 4 # / $ ! � � % $ % � 1 $ ^ \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " % $ 5 / $ " 6 7 7 7 7 7 7 7 7 r <� � � � 8 � \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " � 1 5 � � % 1 � 5 � 1 " ^ / � 4 % $ / � 7 7 7 7 7 7 7 7 7 7 7 7 7 � [� � � � < � � � t 5 � � # # � ! ! \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " 4 � ! 4 � / $ � 5 % 7 7 7 7 7 7 � r
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� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �9 7 9 7 \ � $ 5 � ! ; � $ 4 � � � � ^ 6 ! � % � 1 " ^ / � 4 % $ / � � ! / � \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � !_ ! 4 � " ` � � 4 � 6 / � ! s $ 5 / $ " 6 �
\ # u 5 � � 4 � " \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " u 5 / � $ 4 � % 4 % % % � $ 4 / � $ � / � ^ 4 � $ ^ � / � $ ^/ � ! � ; $ 5 4 $ 4 � � s � $ � 5 s $ 5 / $ " 6 � 0 � � $ 4 � � 1 5 ! ; � 4 � " � ^ 4 � ! # � 5 $ / � 4 $ 6 7Afghanistan has the
3rd highest child mortality rate in the world (191 per thousand live births), with 327,000 children under 5 dying each year1. Malnutrition is a major underlying cause of child mortality and morbidity in Afghanistan, because poor nutritional status compromises a child’s ability to resist and recover from infections. Of the 327,000 children under age five who die each year in Afghanistan, at minimum 114,450 (35%) would have survived if they had been adequately nourished to support a strong immune system to fight infections. Malnutrition also affects children’s ability to learn in school and to become productive adults. Prevention of malnutrition and associated diseases would significantly reduce households’ health care costs. The economic costs of malnutrition to households and to the country undermine development efforts. � � ! 5 � ; $ 5 4 $ 4 � � 4 � 4 $ % � / 5 4 � ; % 1 � 5 # % 4 % ^ 4 " ^ � 6 u 5 � / � � $ 4 � � 1 " ^ / � 4 % $ / �
. According to the National Nutrition Survey (MoPH, 20042) and other surveys3, between 6 to 15% of children under 5 suffer from acute malnutrition (wasting), and over 50% from chronic malnutrition(stunting). Over 70% of children under 5 are iron and/or iodine deficient (MoPH, 2004). \ # u 5 � u 5 \ ] 2 _ u 5 / � $ 4 � % / 5 / # / � � 5 � / ; % � 1 ; � ! 5 � ; $ 5 4 $ 4 � � 4 � � 1 " ^ / � 4 % $ / �
. Around 40% of admissions in therapeutic feeding units (for the treatment of severe acute malnutrition) are under 6 months of age, pointing to breastfeeding problems as a primary cause. Furthermore, nutritional survey results show that acute malnutrition is highest in children 6-29 months of age. These data suggest that nutrition interventions should focus in this age group, and that improving feeding of children under 2 years of age would lead to significant reductions in malnutrition rates. Improvements in early childhood nutrition also contribute to improved health outcomes in later life. ` � $ � $ 4 / � 4 # u / � $ � 1 4 # u 5 � � 4 � " \ ] 2 _ 7
A review of child survival interventions in 42 countries revealed that promotion, support and protection of exclusive breastfeeding for the first six months of a child’s life prevents 13% of all deaths under 5 years in countries with a high child mortality rate4. The review also showed that continued breastfeeding up to two years with appropriate introduction of solid/semi-solid foods at six months (complementary feeding) contributes to a 6% reduction in child mortality. \ � $ 5 � / $ 4 � � / � 5 � ; 4 5 # � $ % � � \ ] 2 _ 7
In 2002, the Fifty-fifth World Health Assembly and the UNICEF Executive Board endorsed The Global Strategy for Infant and Young Child Feeding. According to clauses 36 and 37 of the Global Strategy, “The primary obligation of governments is to formulate, implement, monitor and evaluate a comprehensive national policy on infant and young child feeding” and “a detailed action plan should accompany the
1 UNICEF. (2006). Afghanistan Statistics. Accessed at: http://www.unicef.org/infobycountry/afghanistan_statistics.html 2 MOPH, UNICEF, CDC and Tufts University. (2004). National Nutrition Survey. Atlanta, GA: CDC. 3 MOPH Public Nutrition Policy and Strategy (2003) 4 WHO. (2003). Global Strategy for Infant and Young Child Feeding. Geneva: WHO. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
6
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �comprehensive policy”. For this reason, the Public Nutrition Department of MoPH has elaborated the present IYCF Policy and Strategy for 2009-2013. The present document is the result of an extensive consultation process facilitated by the Public Nutrition Department and USAID/BASICS, UNICEF, WHO, WFP, FAO), NGOs, MoPH Departments (HPD, CBHC & IMCI), MAIL, MRRD, MoWA and MoC. The recommendations from a National Consensus-building Workshop on IYCF, conducted in March, are incorporated here. 2 � # u � # � $ / 5 4 $ 6 � 4 $ ^ � $ ^ 5 � � ` � ` � � 4 � 4 % / � ! s $ 5 / $ " 4 % 7
The present document is designed to complement the MoPH Policies and Strategies on Child and Adolescent Health, Public Nutrition, Reproductive Health, as well as the Health and Nutrition Communication Strategy, by describing specific policy issues and strategic approaches related to Infant and Young Child Feeding, in accordance with the Global Strategy on IYCF. 9 7 [ 7 � 1 4 � 4 $ 4 � � % � 1 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` 5 / � $ 4 � %� / 5 � 6 4 � 4 $ 4 / $ 4 � � � 1 0 5 / % $ 1 ! 4 � "Early initiation of breastfeeding within the first hour of birth is recommended so that infants receive the ‘first milk’ (colostrum), which is rich in immunological factors and nutrients required by the neonate. Colostrum is available to the child only during the earliest days postpartum.� � � � ; % 4 � 0 5 / % $ 1 ! 4 � " � � � < # � � $ ^ % �Exclusive breastfeeding refers to a breast milk-only diet for the infant during the first six months of life. Other liquids (i.e. water, tea, juices, and ritual liquids) and solid/semi-solid foods are to be avoided. Exclusive breastfeeding has been shown to be associated with a reduced incidence of diarrhoea, respiratory infections and allergies. Promotion of exclusive breastfeeding is a key child survival strategy in resource-constrained countries5. 2 � � $ 4 � ; ! 0 5 / % $ 1 ! 4 � " � ; � $ 4 � [ 6 / 5 % �Continued breastfeeding at a sustained high level at least for the first year and continued breastfeeding until two years and beyond is beneficial for both infants’ nutrition and mothers’ lactational amenorrhea (cessation of menses during lactation), a natural method of birth spacing. � u u 5 � u 5 4 / $ � � # u � # � $ / 5 6 1 ! 4 � " � 4 � $ 5 � ! ; � $ 4 � � � 1 % � � 4 ! � % # 4 � % � � 4 ! 1 � � ! % �Children 6-24 months old are to continue breastfeeding adding “nutritionally adequate, safe and appropriate”
R G X Y M O X O A D C Q c B G G E S until age two years during their transition to the family
diet6. These first foods are termed ‘complementary’ because they are to be given as a complement (addition) to breast milk. After the age of six months breast milk provides some but not all of the nutrients a child needs for healthy growth and development and additional foods from the family food supply are required for the child. Complementary feeding is essential to provide needed nutrients, specifically iron, zinc, vitamin A, energy and protein for the growing infants that are in insufficient quantities in breast milk to meet the nutrient requirements for health and growth.
5 WHO collaborative study team on the role of breastfeeding on the prevention of infant mortality. (2000). Effect of breast feeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet, 355 (9202). 6 WHO. (2001). Guiding Principles for Complementary Feeding of the Breastfed Child. Geneva: WHO. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
7
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Complementary foods should not replace breastfeeding as a source of nourishment for the child. They are therefore
A G D �weaning’ foods, because children are encouraged to fully
continue breastfeeding during this period and should not be referred to as such. These foods are also different from ‘supplementary’ foods (given from outside sources to the household as a therapeutic treatment to a sick child for a short period of time). : 5 / % $ � 4 � � s ; 0 % $ 4 $ ; $ % � : � s � �
any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose. These include infant formula, other milk products, therapeutic milk, and bottle-fed complementary foods marketed for children up to 2 years of age and complementary foods, juices, teas marketed for infants under 6 months. 9 7 r 7 s 4 $ ; / $ 4 � � � � / � 6 % 4 %� � � � � � ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ° ± £ ² ¤ ¬ ² ¯ ³ ¬ ¡ ´ ¢ © « £ ¡ ¬ ³ ¤ £ ¡Formative research and field experience show that most caregivers do not follow appropriate IYCF, as demonstrated by the data presented in Table 1, below. Furthermore, the data presented in Table 1 must be interpreted with caution for the following reasons: the indicators used in different surveys are not systematically the same and thus not always comparable; data can be affected by “responder bias”, whereby interviewees say they do the recommended practice even if they do not; finally, there are considerable variations across regions, making it difficult to extrapolate provincial data to the rest of the country and to interpret national averages. The lack of appropriate data on IYCF is in itself a problem that needs to be addressed. µ ¶ · ¸ ¹ º »
¼ ½ ¹ ¾ ½ ¿ ¹ À Á Â Ã Ä ¾ ½ ¹ Å ¾ ¹ Ã Ä ¸ Æ Ã Á Ç È É Ê Ë Ì ¾ ¶ Í Æ ¿ Í ¹ Ã ¿ Ç Î Â Ï Ð ¶ Ç ¿ Ã Æ ¶ Ç. Ñ Ò Ó Ô Õ Ö × Ó Ó Ø Ù Ú Û Ü Ý Þ ß à Ó Þ Ó Ú Ö Ô Ò áâ Ó Ó Ø Ù Ú Ûã Ý ä Ò å Ó æ ç Ó Ô Ò è Ü Ý é Ó Ò Ô Û Ó Ñ Ò Ó Ô Õ Ö × Ó Ó Ø Ù Ú ÛÙ Ú Ù Ö Ù Ô Ö Ù Ý Ú ê Ñ âÔ Þ Ý Ú Ûë ì í Þ Ý î ï Ñ â Ô Öð á Ó Ô Ò ï Ñ â Ô Öñ á Ó Ô Ò Õ ò Û Ó Ý ×Ù Ú Ö Ò ÝÝ × Ü â ï × Ó ØÔ Ö Ö ó Ô ÖÔ Û Ó
AHS (2006) National 37% in 1st hour 70% --- --- 6-9 mos.
28%
HHS (2006) National N/A 40% 71% -- 6 mos. 27%
MICS (2003) National 92.7% in 1st day N/A 91% 54% 6-9 mo. 28%
UNICEF (2003) Herat 59.2% in 1st hour;
82.2% use colostrum
19.4% 93% 34% 6-9 mo. 71%
UNICEF/CDC (2002)
Badghis N/A 95% 96% 52% 6 mo 21%
UNICEF/MoPH (2003)
Parwan N/A 12.5% 64% 63% 6-9 mo. 40%
SC/US (2002) Jowzjan ~ 50% fed colostrum
0% “most mothers had introduced foods or liquids at 4 mo.”
There are indications that the data presented in Table 1 actually over-estimate adequate IYCF practices. Field experience and formative research show that common inadequate feeding practices include the following: � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
8
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � ¡ ¬ ¤ ¬ £ ¤ ¬ § ¡ § ¢ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © �Breastfeeding is rarely initiated in the first hour of birth
The use of ritual pre-lacteal foods (such as ghee, butter, tea, or even dirt) is common
Colostrum is often discarded, as it is considered to be dirty (because people believe it has stayed in the breast for 9 to 10 months.)
Many mothers do not know correct positioning and attachment of the infant to the breast, which limits optimal suckling and breast milk production.
õ ö ² ¨ ³ ¬ ÷ ¯ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © ¨ ¡ ¤ ¬ ø ù § ¡ ¤ « ³:
True exclusive breastfeeding is believed to be extremely rare, as caregivers often give tea, sugared water or soaked bread before the age of six months (data in Table 1 most likely report “predominant breastfeeding” rather than “exclusive breastfeeding)
Many mothers believe they have “insufficient milk”, which is often due to poor positioning and attachment. The perception of milk insufficiency often leads them to use formula milk, but most caregivers do not know how to prepare the milk to ensure it has the right consistency; bottle feeding is frequent and poor hygiene of the bottles and teats leads to infections
Many caregivers give pacifiers and teats to suckle; these are a source of infection and can affect the child’s attachment to the breast and suckling.
ª § ¡ ¤ ¬ ¡ ¨ ¯ ¥ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © �Most mothers continue to breastfeed for at least one year, and even beyond; however, they are very likely to wean the child early if they become pregnant while lactating.
It is common for mothers to stop or reduce breastfeeding when they or the child is ill; the cessation of suckling reduces their breast milk production and often leads them to wean the child early as they feel their milk is insufficient. ª § ù ú ¯ ù ¯ ¡ ¤ £ ± û ¢ § § ¥ ³ üComplementary foods are often introduced either too early or too late
The consistency and composition of complementary foods is inadequate: they often consist of watery soups that do not meet infants’ energy requirements; the foods lack protein and micronutrient-rich foods.
Complementary feeds are often given infrequently and in insufficient quantities.
Young children are often fed from the family dish, which is seldom adapted to their own requirements (too diluted, or too thick, etc.)
Caregivers do not know to increase the frequency and density of complementary foods as the child grows older.
ý £ ¤ ¯ ± ¡ £ ¡ ¨ ¤ ± ¬ ¤ ¬ § ¡ þ « ¯ £ ¤ « £ ¡ ¥ ÿ ¯ � ô ¯ ¬ ¡ ©Infant and young child feeding is affected by mother’s health, nutritional status and mental well-being. Maternal mortality rates are amongst the highest in the world (national estimate: 1600 per 100,000 live births) and the prevalence of underweight among non-pregnant Afghan women 15-49 years of age was 21%, which is a high prevalence of adult underweight based on the WHO classification7. Furthermore, nearly 50% of women are estimated to be iron deficient and nearly 80% are likely to suffer from iodine deficiency8. Food taboos limiting women’s intake of nutrient-rich foods during pregnancy and lactation are common. Mother’s
7 (WHO, 1995). 8 MOPH, UNICEF, CDC and Tufts University. (2004). National Nutrition Survey. Atlanta, GA: CDC. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
9
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �health is affected by early marriages and pregnancies, low birth spacing and a high workload. Their capacity to care for their child is affected by their limited education, lack of peer support, pressure from family members to comply with traditional practices, high workload, and limited resources (in particular diverse foods). Furthermore, many women suffer from poor mental health, with a high incidence of stress and depression linked to the insecure political situation and other social factors. This can affect mothers’ relationship with their child, and has been found to be a common cause of breastfeeding problems, mothers’ “milk insufficiency”, and consequently undernutrition, especially amongst infants under 6 months. ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ õ ù ¯ ± © ¯ ¡ ² ¬ ¯ ³ {In addition to challenges associated with chronic poverty and limited development, the Afghan population is exposed to recurrent emergencies, related to conflict and natural disasters (earthquakes, floods, droughts). Emergency responses and food distributions are therefore common. Several emergency providers become involved in donations and distributions of Breast Milk Substitutes (BMS), such as commercial milk formula, which undermine efforts by the MoPH to promote exclusive breastfeeding and adequate IYCF. � � � � � � ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³ ¬ ù ú ¯ ù ¯ ¡ ¤ ¯ ¥ ³ ¬ ¡ ² ¯ � � � � The Ministry of Public Health (in particular the Public Nutrition Department) and its partners have been very active since 2002 to promote improved IYCF in Afghanistan. Current initiatives are described in Table 2, below.
µ ¶ · ¸ ¹ � » È Ç ¿ Æ ¿ ¶ Æ ¿ ½ ¹ Ã ¶ � � ¾ ¹ Ã Ã ¿ Ç Ï È É Ê Ë ¿ Ç Î Â Ï Ð ¶ Ç ¿ Ã Æ ¶ Ç Ã ¿ Ç Í ¹ � � � � � Ý ß Ù å ò å Ö Ù é Ù Ö á � Ô Ù Ú ß Ô Ò Ö Ú Ó Ò Õ
IEC materials on IYCF MoPH/NGOs, UNICEF, FAO, WHO, WFP
IMCI Mother Card on IYCF MoPH/NGOs/WHO/BASICS
Afghan Family Nutrition Guide MAIL/MoPH/NGOs/FAO
Improved IYCF and Recipe Manual developed through formative research
MAIL/MoPH/FAO
Introduction of nutrition education, including IYCF, in agriculture projects, literacy classes and schools
MAIL/FAO/NGOs
� ç Ü â æ Û Ó Ú Ó Ò Ô à èPositive Deviance / Hearth SC-US/MoPH
Baby-Friendly Hospital Initiative MoPH/UNICEF/
Breastfeeding counselling: 3000 counsellors and 80 master trainers trained at national and provincial levels
MoPH/UNICEF/WHO/NGOs
Re-lactation support for mothers in TFUs ACF/MoPH
Growth monitoring and promotion (pilot) BASICS/MoPH/NGOs
40 Provincial Nutrition and Reproductive Health Officers trained on Maternal Nutrition
MoPH/Tech Serv
Breastfeeding promotion campaign:
Mass media campaign
Celebration of World Breastfeeding Week
MoPH/NGOs/MoReligious Affairs/MOWA/UNICEF/WHO/WFP
Afghanistan has adopted the � � � � � � � � � � � � � �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � MoPH / MoJ/UNICEF/IBFAN/International Code Documentation Centre
Ñ Ò Ó Ô Õ Ö × Ó Ó Ø Ù Ú Ûß Ò Ý Þ Ý Ö Ù Ý ÚSouth Asia Breastfeeding Forum 3, 2006 in Kabul MoPH/MoFA/WABA/IBFAN/WHO/UNICEF
Development of IMCI Complementary Feeding Card MoPH/WHO/UNICEF Ü Ý Þ ß à Ó Þ Ó Ú Ö Ô Òá â Ó Ó Ø Ù Ú Û
Integration of cooking demonstrations in health, agriculture & education projects (using manual)
MAIL/FAO/NGOs/MoPH
Supplementation as part of BPHS/EPHS MoPH/MI/UNICEF/NGOs
Iodised Salt; Fortified flour (iron, B-vitamins) MoPH/MoC/MoMines/Private Sector
� Ù å Ò Ý Ú ä Ö Ò Ù Ó Ú Ö ÕDiet diversification: horticulture, poultry, livestock… MAIL
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -10
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �
However, the effectiveness and impact of these interventions has been limited by:
Limited outreach at community and household levels
Limited scale and coverage
Lack of staff and resources for outreach (in particular female staff)
Limited knowledge and skills of relevant staff
Low community mobilization
Illiteracy
Limited resources and capacity for technical support and supervision at national and provincial levels
The present National IYCF Policy and Strategy are designed to address priority issues for improving IYCF and overcome the constraints that are limiting current interventions’ impact.
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -11
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � [ 7 9 7 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` � � 4 � 6 s $ / $ # � $ All Afghan infants and young children have the right to benefit from optimal breastfeeding and complementary feeding and caring practices to protect them from all forms of undernutrition and its adverse consequences. [ 7 [ 7 � 4 % 4 � � 1 � 5 $ ^ \ ] 2 _ ` � � 4 � 6 / � ! s $ 5 / $ " 6All Afghan children benefit from optimal infant and young child feeding and caring practices and all caregivers have the knowledge, skills and resources required for optimal infant and young child feeding and care. [ 7 r 7 � � / � / � ! � 0 � � $ 4 � � 1 $ ^ � / $ 4 � � / � \ ] 2 _ ` � � 4 � 6 / � ! s $ 5 / $ " 6The IYCF Policy and Strategy is designed to contribute to the objectives of the Afghanistan National Health and Nutrition Sector Strategy 2008-20139 of reducing child and maternal mortality and malnutrition. Its overall goal is the same as the overall goal of the Public Nutrition Policy and Strategy, namely:
. � 5 ! ; � / � � 1 � 5 # % � 1 ; � ! 5 � ; $ 5 4 $ 4 � �,
$ ^ 5 0 6 4 # u 5 � � 4 � " $ ^ " 5 � � $ ^ �! � � � u # � $ / � ! ^ / � $ ^ � 1 � 1 " ^ / � 4 � 1 / � $ % / � ! 6 � ; � " � ^ 4 � ! 5 � � $ ^ 5 � ; " ^ 4 # u 5 � � ! 4 � 1 / � $/ � ! 6 � ; � " � ^ 4 � ! 1 ! 4 � " u 5 / � $ 4 � % 7 The objective of the Infant and Young Child Feeding Policy, and its associated Strategy is: . � 4 � � 5 / % $ ^ u 5 � � $ / " � 1 � ^ 4 � ! � / 5 " 4 � 5 % / ! � u $ 4 � " / u u 5 � u 5 4 / $ 4 � 1 / � $ / � ! 6 � ; � "� ^ 4 � ! 1 ! 4 � " / � ! � / 5 4 � " u 5 / � $ 4 � %
(by 20%, by 2013). Strategic components and approaches to achieve this objective are described in section 3 of the present document. [ 7 � 7 ` ; 5 u � % � 1 $ ^ \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " ` � � 4 � 6 / � ! s $ 5 / $ " 6The purpose of the present Policy and Strategy is to describe the Government of Afghanistan’s position on IYCF, in accordance with the Global Strategy on IYCF. All key stakeholders directly or indirectly involved in IYCF, notably health sector professionals, NGOs, UN agencies, military, and private sector, are responsible, and will be held accountable, for respecting the present Policy. This document also clarifies the strategies that need to be adopted and interventions to be implemented to achieve the policy objectives. It will serve to support advocacy and resource mobilization, as well as coordination between the main implementing partners (MoPH Departments, BPHS partners, NGOs, UN, private sector, communities). Finally, it provides guidance on how to monitor the protection and promotion of optimal IYCF in Afghanistan.
9 Health and Nutrition Sector Strategy, 1387-1391(2007/8-2012/13), MoPH-Afghanistan. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
12
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �[ 7 8 7 ` � � 4 � 6 � � # u � � � $ % Nine policy components have been identified. The implementation of these policy components will be supported by the “guiding policy principles” described in section 2.6, the strategies and activities described in Section 3, and in relevant guidelines. � � � � � � õ £ ± û ¬ ¡ ¬ ¤ ¬ £ ¤ ¬ § ¡ § ¢ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ ©
Women of child-bearing age, in particular pregnant women, are to be educated on, and supported in, initiating breastfeeding within one hour of childbirth, and feeding colostrum to their newborn child. (This includes promotion of skin-to-skin contact within a half-hour of childbirth).
Newborn infants should not be given any food or drink other than breast milk unless X O E L R C M M cindicated. Pre-lacteal feeds of any kind should not be provided to the
newborn.
Mothers should be assisted in correct positioning of the child and how to maintain optimal lactation. � � � � � � õ ö ² ¨ ³ ¬ ÷ ¯ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © ¤ § ³ ¬ ö ù § ¡ ¤ « ³Women of child-bearing age, in particular pregnant women and lactating women, are to be educated on the importance and benefits of exclusive breastfeeding (for the first 6 months after birth), and supported in providing only breast milk to their baby for the first six months of life.
Mothers should be encouraged to breastfeed on demand.
Caregivers should be strongly discouraged from giving artificial teats or pacifiers to breastfeeding infants.
� � � � � � � ³ ¯ § ¢ ² § ù ù ¯ ± ² ¬ £ ¢ § ± ù ¨ £ £ ¡ ¥ ± ¯ ³ ú ¯ ² ¤ § ¢ ¤ « ¯ ª § ¥ ¯ § ¢ ý £ ± � ¯ ¤ ¬ ¡ © § ¢ ± ¯ £ ³ ¤ ý ¬ � ! ¨ ô ³ ¤ ¬ ¤ ¨ ¤ ¯ ³Suitable cows' milk based commercial formula should be recommended only if a mother is not able to breastfeed for medical reasons, or if the infant is orphaned and wet-nursing is not possible.
Caregivers using Breast Milk Substitutes should be educated on appropriate preparation of formula milk and measures required to reduce the risk of contamination. The feeding by cup should be promoted.
All Breast Milk Substitute Providers (whether private, non-profit, or public) should comply with all measures stipulated in the Code of Marketing of Breast Milk Substitutes that has been endorsed by the Government of Afghanistan. � � � � " � ª § ¡ ¤ ¬ ¡ ¨ ¯ ¥ ô ± ¯ £ ³ ¤ ¢ ¯ ¯ ¥ ¬ ¡ © ¤ § ¤ ÿ § û ¯ £ ± ³ £ ¡ ¥ ô ¯ û § ¡ ¥Women of child-bearing age, in particular pregnant and lactating women, are to be educated on the benefits of, and supported in, maintaining high levels of breastfeeding � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
13
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �in the first year of the child’s life and continuing breastfeeding until two years of age, even if they become pregnant or ill during lactation. � � � � � � ¡ ¤ ± § ¥ ¨ ² ¤ ¬ § ¡ § ¢ ³ § ¬ ¥ # ³ ¯ ù ¬ � ³ § ¬ ¥ ¢ § § ¥ ³ £ ¤ ³ ¬ ö ù § ¡ ¤ « ³All parents should be educated before the child reaches the age of six months about when and how to introduce appropriate complementary foods.
Complementary feeding should be: $ D L X O M c %introduced at the appropriate age (generally six months), when the
need for energy and nutrients exceeds what can be provided through exclusive and frequent breastfeeding; $ C E O & H C D O %
providing sufficient energy, protein and micronutrients (vitamins & minerals) to meet the growing child’s nutritional needs; $ S C B O %
hygienically stored and prepared, and fed to the child with clean hands using clean utensils and not bottles or teats; $ Y Q G Y O Q M c B O E %
given according to the child’s signals of hunger or fullness, and that meal frequency and feeding method are suitable for the child’s age. These methods include actively encouraging the child to consume sufficient food using fingers, spoon or self-feeding, even during illness.
Complementary foods should be increasing in consistency, diversity and frequency of feeding as children grow up.
Caregivers should be educated and supported in ensuring optimal hygiene during complementary food preparation and consumption (including hand-washing of the caregiver and child)
Promoted complementary foods should be locally available, affordable to low-income households, nutritionally balanced, and culturally acceptable. � � � � ø � ° ± § ù § ¤ ¬ § ¡ § ¢ ù ¬ ² ± § ¡ ¨ ¤ ± ¬ ¯ ¡ ¤ � ± ¬ ² « ¢ § § ¥ ³ £ ¡ ¥ £ ú ú ± § ú ± ¬ £ ¤ ¯³ ¨ ú ú ¯ ù ¯ ¡ ¤ £ ¤ ¬ § ¡Caregivers should be encouraged and supported to feed the child micronutrient-rich foods, in particular those rich in: $ Iron & zinc: Animal flesh (i.e. sheep, beef, goat), legumes (beans, chick pea,
lentil), certain green vegetables (i.e. spinach, ladyfinger/okra), and dried fruits and nuts. $ Vitamin A: meat, eggs, and various coloured fruits and vegetables (to be given with some oil or fat, as vitamin A is fat-soluble).
Children above 6 months should receive appropriate micronutrient supplements as per the national protocols.
All family members should be encouraged to use iodized salt.
All family members should be encouraged to use fortified flour where available.
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -14
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � ' � ý £ ¤ ¯ ± ¡ £ « ¯ £ ¤ « £ ¡ ¥ ¡ ¨ ¤ ± ¬ ¤ ¬ § ¡Women of child-bearing age, in particular pregnant and lactating mothers, should be educated on their nutritional requirements (including increased requirements during pregnancy and lactation) and supported in meeting these nutritional requirements.
All pregnant and lactating women should be provided with micronutrient supplements as per national protocols.
Family and community members should be encouraged to support pregnant and lactating mothers in ensuring they meet their nutritional requirements, rest sufficiently, and have the time required to feed their infant and young children optimally.
� � � � ( � ª « ¬ ¥ ± ¯ ¡ ¬ ¡ ¯ ö ² ¯ ú ¤ ¬ § ¡ £ û ¥ ¬ ¢ ¢ ¬ ² ¨ ¤ ² ¬ ± ² ¨ ù ³ ¤ £ ¡ ² ¯ ³3 � � : 4 5 $ ^ � 4 " ^ $ � 3 : � � 0 / 0 4 % �caregivers of LBW babies should be encouraged
to apply the same IYCF practices as for other children; Kangaroo Mother Care (Aghosh-e Garm-e Madar) should be promoted._ ! 4 � " % 4 � � � ^ 4 � ! 5 � �
sick children should continue breastfeeding and be fed appropriate complementary foods if above six months; the frequency of feeds, and amounts and density of feeds should be adjusted to the sick child’s increased nutritional requirements and limited appetite (e.g. smaller feeds more frequently).� � % u 4 $ / � 4 � ! 4 � 1 / � $ % � � ^ 4 � ! 5 � / � ! # � $ ^ 5 % �
should a lactating mother and/or her child be ill, health facilities should be able to accommodate both mother and child, and health staff should support the mother to continue breastfeeding and provide adequate complementary feeding. s � 5 � 6 # / � � � ; 5 4 % ^ ! � ^ 4 � ! 5 �
: children suffering from severe acute malnutrition should be referred to the appropriate treatment facility and receive treatment as per national protocols. Mothers who have breastfeeding difficulties should receive breastfeeding counselling and, when necessary, mothers (or if mother deceased an appropriate other e.g. grandmother) should be supported to re-lactate. This is particularly important for infants under 6 months of age. \ � 1 / � $ % � 1 � \ � � u � % 4 $ 4 � # � $ ^ 5 %
: HIV-positive mothers should be counseled on the risks and benefits associated with breastfeeding and formula-feeding in the case of HIV-AIDS, so as to make an informed choice on the feeding method they choose.
� � � � ) � ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ õ ù ¯ ± © ¯ ¡ ² ¬ ¯ ³In all emergency situations, relief interventions and emergency service providers must comply with the policy components and principles described in the IYCF Policy.
Further the above parties should adhere to the Code of Marketing of Breast Milk Substitutes as a minimum requirement and the internationally endorsed Operational Guidance for Infant and Young Child Feeding in Emergencies. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
15
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Mothers should be provided with the additional support, counselling, and resources, required to protect and promote optimal IYCF in emergency situations.
Donated (free) or subsidised supplies of Breast Milk Substitutes, bottles and teats, are prohibited in order to ensure that breastfeeding is not undermined. [ 7 < 7 � ; 4 ! 4 � " ` � � 4 � 6 u 5 4 � � 4 u � %
The design of the IYCF policy and strategy has been inspired by the 7 Working Principles of the MoPH for 2005-2009, and guiding principles described in the ANDS Health and Nutrition Sector Strategy. The following principles are of particular importance for Infant and Young Child Feeding. Their application to IYCF is described below. ° ± § ù § ¤ ¬ ¡ © « ¯ £ ¤ « û ¬ ¢ ¯ ³ ¤ û ¯ ³ £ ¡ ¥ ¥ ¬ ³ ² § ¨ ± £ © ¬ ¡ © ú ± £ ² ¤ ¬ ² ¯ ³ ú ± § ÷ ¯ ¡ ¤ § ô ¯ « £ ± ù ¢ ¨ IYCF counselling and promotion of optimal IYCF are at the heart of the IYCF Policy and Strategy. Promotion of IYCF cannot be limited to awareness raising. It requires transfer of practical skills (e.g. through breastfeeding counselling and participatory cooking sessions adapted to mothers’ circumstances), peer support, and assistance to caregivers in mobilizing the resources required to apply IYCF (time, food, etc.).ª § ù ù ¨ ¡ ¬ ¤ û ú £ ± ¤ ¬ ² ¬ ú £ ¤ ¬ § ¡ £ ¡ ¥ ² § ù ù ¨ ¡ ¬ ¤ û � ô £ ³ ¯ ¥ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³Optimal ICYF should also be promoted and appropriate counselling provided at the community level. Community ownership, support of community leaders and active participation of caregivers and their families are essential for effectiveness and sustainability. õ ¡ ³ ¨ ± ¬ ¡ © ¯ * ¨ ¬ ¤ £ ô ¯ £ ² ² ¯ ³ ³ ¤ § þ £ ¡ ¥ ú ± § ÷ ¬ ³ ¬ § ¡ § ¢ þ * ¨ £ ¬ ¤ û þ ô £ ³ ¬ ² þ ¯ ³ ³ ¯ ¡ ¤ ¬ £ « ¯ £ ¤ « ³ ¯ ± ÷ ¬ ² ¯ ³Equitable access to IYCF counselling requires that optimal IYCF practices should be promoted at all levels of the health system. All health workers have a responsibility for promoting optimal IYCF and should be trained to fulfil these responsibilities. ! ¨ ³ ¤ £ ¬ ¡ £ ô ¬ ¬ ¤ û �IYCF education and counselling should promote the use of local resources to ensure efficiency, affordability, sustainability and replicability. Should supplementary rations be distributed as part of emergency food aid or supplementary feeding programmes, ration providers should also inform beneficiaries of the nutritional value of local foods and establish linkages to agriculture and food security projects (see below). ¡ ¤ ¯ ± � ³ ¯ ² ¤ § ± £ ² § £ ô § ± £ ¤ ¬ § ¡ üOptimal IYCF should be promoted by a broad range of stakeholders beyond the health sector. The Ministry of Public Health will work in partnership with other ministries, in particular the ministries of: Agriculture Irrigation and Livestock (MAIL), Women’s Affairs (MoWA), Rehabilitation and Rural Development (MRRD), Education (MoE), Religious Affairs (MoRA), Labour and Social Affairs (MoLSA), Justice (MOJ), Trade and Commerce (MoTC), and Ministry of Interior (MoI) to promote IYCF and the application of the Code of Marketing of BMS. At the community level, optimal IYCF can be promoted through a broad range of development interventions, including literacy courses, agriculture projects, community development interventions, etc. Linkages to food security interventions are of particular importance.! ² £ ¬ ¡ © � ¨ ú § ¢ ¯ ÷ ¬ ¥ ¯ ¡ ² ¯ � ô £ ³ ¯ ¥ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
16
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Interventions that have proven to be effective for promoting optimal IYCF should be implemented nationwide.
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -17
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � The IYCF Policy and Strategy is designed to contribute to the objectives of the Afghan National Health and Nutrition Sector Strategy and the overall goal of the Public Nutrition Policy and Strategy by focusing on the following objective: . � 4 � � 5 / % $ ^ u 5 � � $ / " � 1 � ^ 4 � ! � / 5 " 4 � 5 % / ! � u $ 4 � " / u u 5 � u 5 4 / $ 4 � 1 / � $ / � ! 6 � ; � "� ^ 4 � ! 1 ! 4 � " / � ! � / 5 4 � " u 5 / � $ 4 � %
(by 20% by 2013)7
This objective will be achieved through the following three strategy components:
1.T Y Y M L R C D L G A G B @ F J N P G M L R c C A E j D Q C D O I c S H Y Y G Q D O E d c C E W G R C R c x D O R K A L R C M I H L E C A R OC A E M C l O A B G Q R O X O A D
.
2.J C Q O I L W O Q S h A G l G Y D L X C M @ F J N Y Q C R D L R O S C A E C Q O S H Y Y G Q D O E L A Y Q G W L E L A I G Y D L X C M R C Q OC A E X G d L M L y L A I D K O Q O S G H Q R O S Q O & H L Q O E B G Q @ F J N x D K Q G H I K @ b J m i J J C A E R G X X H A L D cS H Y Y G Q D L A D O Q W O A D L G A S >
3.@ F J N Y Q G X G D L G A C A E R G H A S O M M L A I L S O B B O R D L W O M c L X Y M O X O A D O E C S Y C Q D G B D K O i P | j C A Eb P | j L A C M M K O C M D K B C R L M L D L O S
.
Capacity-building of various categories of personnel involved in implementation will be an integrated component of each strategic priority/output. Advocacy and resource mobilization will be essential to enable the implementation of the activities required to achieve these outputs. An advocacy and resource mobilization plan will therefore be developed. The activities to be implemented to achieve these outputs/strategic priorities are described below. r 7 9 7 � ! � � � / � 6 � 5 " ; � / $ 4 � � % / � ! " ; 4 ! � 4 � % The implementation of the IYCF Policy and Strategy entails that sufficient resources and political support are mobilized, that supportive legislation and regulations are enforced, and that adequate guidelines are developed and applied. � � � � � � + ¬ ³ ³ ¯ ù ¬ ¡ £ ¤ ¬ § ¡ þ £ ¥ ÷ § ² £ ² û £ ¡ ¥ ± ¯ ³ § ¨ ± ² ¯ ù § ô ¬ ¬ , £ ¤ ¬ § ¡ ¢ § ± ¤ « ¯ - £ ¤ ¬ § ¡ £ ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ° § ¬ ² û £ ¡ ¥ ! ¤ ± £ ¤ ¯ © û üThe implementation of the National IYCF Disseminate the National IYCF Policy and Strategy will require several supportive steps to be implemented. They include:
Dissemination of the strategy amongst all key stakeholders (MoPH, MAIL, MoJ, MoMI, MoEd, MoRA, MoWA, NGO’s, private sector). This can be done by preparing a policy brief (e.g. leaflet) to be distributed to key decision-makers, relevant Government officials and civil servants, NGOs, UN agencies, Provincial Reconstruction Teams (PRT), and private sector stakeholders. Participation in relevant meetings and forums to disseminate information on the IYCF policies will also be important.
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -18
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Regular updating of the IYCF action plan and preparation of a resource mobilization plan, in collaboration with technical partners, donors and relevant MoPH departments to mobilize funds (including proposal preparation).
Reviewing MoPH nutrition-related policies, strategies and guidelines and make sure IYCF policy priorities and strategies are adequately reflected in these documents � � � � � � õ ¡ ¢ § ± ² ¯ ù ¯ ¡ ¤ § ¢ ¤ « ¯ ª § ¥ ¯ § ¢ ý £ ± � ¯ ¤ ¬ ¡ © § ¢ ± ¯ £ ³ ¤ ý ¬ � ! ¨ ô ³ ¤ ¬ ¤ ¨ ¤ ¯ ³
The Government of Afghanistan has adopted the Code of Marketing of Breast Milk Substitutes, which is now officially approved by the Ministry of Justice, endorsed by the Cabinet, signed by the President and published in the Official Gazette. It is now essential to put in place enforcement mechanisms to ensure the Code is respected. This requires the establishment of a National Committee responsible for defining enforcement mechanisms and monitoring the application of the Code and disseminating information on the Code and related regulations to all key stakeholders (Provincial Departments of Health, Provincial Reconstruction Teams, private sector, all health facilities, MoWA, NGOs, etc.). Code monitors shall be trained (with technical assistance from IBFAN). � � � � � � ´ ú ú ¬ ² £ ¤ ¬ § ¡ § ¢ ¤ « ¯ ý £ ¤ ¯ ± ¡ ¬ ¤ û ° ± § ¤ ¯ ² ¤ ¬ § ¡ ´ ² ¤The Maternity Protection Act has been passed by the Ministry of Labour and Social Affairs. It stipulates that working mothers are entitled to a paid 13 week maternity leave and are allowed 2 hours / day for (paid) breastfeeding breaks while they are lactating. Enforcement and monitoring mechanisms must now be defined to ensure that employers respect mothers’ rights. This also entails disseminating information to women on their rights so they can encourage their employers to apply them. Guidelines could be developed for relevant Government departments and employers, as well as guidance for mothers, to support the application of the Maternity Protection Act. � � � � " � . £ ± ù § ¡ ¬ , ¬ ¡ © þ ³ ¤ ± ¯ ¡ © ¤ « ¯ ¡ ¬ ¡ © £ ¡ ¥ ² § ù ú ¯ ¤ ¬ ¡ © ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥® ¯ ¯ ¥ ¬ ¡ © / ¨ ¬ ¥ ¯ ¬ ¡ ¯ ³The MoPH and its partners have already produced a number of training materials, namely on breastfeeding counselling, BFHI, and complementary feeding (including improved recipes and participatory cooking sessions). However, a comprehensive and harmonized set of guidelines, providing guidance on how IYCF can be promoted in different circumstances (e.g. in health facilities, at community-level, in emergencies, etc.) is lacking. These guidelines should therefore be developed and used to inform the development of training packages adapted to the needs of various audiences (e.g. different categories of health staff; personnel working in other sectors such as education and agriculture). Training activities and related material development are specified under outputs 2 and 3. � � � � � � ´ ú ú ¬ ² £ ¤ ¬ § ¡ § ¢ ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ õ ù ¯ ± © ¯ ¡ ² ¬ ¯ ³/ ¨ ¬ ¥ ¯ ¬ ¡ ¯ ³The present IYCF policy clearly stipulates the obligation of emergency service providers to respect the IYCF policy statements in all situations, and in particular to avoid free distributions of infant formula or other Breast Milk Substitutes and respect the Code. Afghan guidelines on IFE should be developed, based on the internationally endorsed Operational Guidance on IFE. These guidelines should preferably be part of the general IYCF guidelines mentioned under 3.1.4. Until finalisation of the national guidelines emergency service providers should adhere to the Operational Guidance on IFE. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
19
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �The IYCF policy and IFE guidelines should be disseminated to all relevant stakeholders, in particular the Disaster Management Committee, the PRTs, NGOs and Provincial Development Councils, and the MoPH should monitor that the policy and guidelines are applied in emergency situations. r 7 [ 7 : ^ / � 4 � ; 5 � ^ / � " $ ^ 5 � ; " ^ / � / 5 � % % 5 / 4 % 4 � " � � � ; � % � � 4 � " / � ! � � # # ; � 4 $ 6% ; u u � 5 $Improving IYCF practices essentially involves promoting behaviour change, whereby families adopt improved breastfeeding and complementary feeding practices. Behaviour change requires caregivers to have the necessary:
knowledge
motivation
skills
resources
supportive environment
The following strategic approaches will be implemented to promote and support behaviour change. (Note: activities conducted under output 3 will also contribute to behaviour change). These strategic approaches are complementary and all necessary: none alone can lead to sustainable behaviour change. For example, awareness raising must be accompanied by personalised counselling and peer support at community level and in health facilities. � � � � � � . £ ± ù § ¡ ¬ , ¯ ¥ ° ¨ ô ¬ ² ´ ÿ £ ± ¯ ¡ ¯ ³ ³ 0 £ ¬ ³ ¬ ¡ ©Currently the Ministry of Public Health Public Nutrition Department and Healthy Behaviour Department are organizing a large National Breastfeeding Communication Campaign. It will be launched during the National Breastfeeding Week in August (1st - 7th) 2009. This campaign will use various media (posters, leaflets, TV & radio spots, integration of message in TV series, etc.) and is being implemented in partnership with NGOs and other ministries, such as MAIL, MoWA, MoRA, MRRD, and MoE. Furthermore, the Ministry of Public Health has been implementing World Breastfeeding Week since 2003 with a broad range of partners. It will continue to do so annually. The present IYCF Policy and Strategy plans to expand the National Breastfeeding Communication Campaign to cover complementary feeding and IYCF as a whole. Messages on complementary feeding should notably focus on the amount of foods to be given, the composition and frequency of feeds. Appropriate caring practices, and health and hygiene practices related to feeding, should also be promoted. In addition to the campaign, regular awareness raising activities will be conducted on IYCF in partnership with media, other ministries, religious leaders and community leaders. (see Logical Framework in Annex 2 for detailed activities). Ideally, KAP surveys (Knowledge Attitude Practice surveys) should be conducted in areas selected to cover regional and cultural diversity. This would also provide useful baseline information and help refine the messages. Reference should also be done to existing formative research carried out by MoPH, UNICEF, Save the Children and FAO. Monitoring KAP surveys should also be conducted in selected areas to assess the impact of awareness-raising activities. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
20
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Public awareness activities will increase caregivers’ knowledge and also help mobilize community leaders to build their support for community-level interventions described below. � � � � � � ª § ¨ ¡ ³ ¯ ¬ ¡ © ¤ « ± § ¨ © « ² § ù ù ¨ ¡ ¬ ¤ û ³ ¨ ú ú § ± ¤ © ± § ¨ ú ³ £ ¡ ¥ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³It is essential that education and counselling activities be conducted at the community-level to support behaviour change. In addition to knowledge and skills regarding adequate breastfeeding, complementary feeding and care, mothers require peer support, time, and access to the resources required for optimal child feeding (in particular diverse foods). It is therefore essential to also involve other family members in IYCF promotion, in particular men. Counselling and generating this support can be best done through the establishment of community support groups associated with a wide range of community development interventions. Various models and approaches can be used, such as the establishment of “Baby-Friendly Communities”, or “Mother Support Groups. The groups can be established through existing circles such as literacy classes, family health action groups, women’s shuras, etc. As far as possible, IYCF counselling should be conducted through existing groups and platforms. Flexibility is required to build on local opportunities, to adapt to different cultural settings and better respond to local caregivers’ needs. Community support groups can be facilitated by a woman volunteer from the community, with experience of working with women and women’s groups, such as literacy teachers, E C K L C S
, CHW’s, heads of women’s S K H Q C S
, etc10. They would be trained on breastfeeding counselling, preparation of improved local recipes and participatory cooking sessions. Resources for participatory cooking sessions would be mobilized by community members themselves, for example with each woman bringing some food and utensils to the session. (See detailed activities in the logical framework in Annex 2). z G D O { D K L S l G Q h E G O S A G D A O O E D G d O L X Y M O X O A D O E D K Q G H I K D K O K O C M D K S O R D G Q C A E d c K O C M D Kl G Q h O Q S G A M c > T I Q L R H M D H Q O � | G X O b R G A G X L R S 1 B B L R O Q S 2 x D O C R K O Q S C A E l G X O A 2 S S K H Q C S R C Al G Q h L A Y C Q D A O Q S K L Y l L D K g G P | D G L X Y M O X O A D D K O S O C R D L W L D L O S > z H D Q L D L G A R G H A S O M M L A I L S M L h O M cD G d O X G Q O O B B O R D L W O l K O A C S S G R L C D O E l L D K G D K O Q E O W O M G Y X O A D C R D L W L D L O S D K C D L A R Q O C S O l G X O A 2 SI O A O Q C M h A G l M O E I O x Q O S G H Q R O S C A E R G A B L E O A R O > 3 S O O C M S G ? > V > ? 4 The support groups can be linked to and/or initiated from hospitals and health facilities participating in the Baby-Friendly Hospital Initiative. An essential component of the community support activities should be support to households in diversifying their household food production and / or income, so as to enable them to access the ingredients required for optimal feeding. This can be done by implementing activities such as vegetable gardens and orchards, poultry rearing, goat keeping, bee-keeping (honey for income), and food processing. Such projects should be implemented side-by-side with IYCF counselling. For example, demonstration gardens should be established in hospitals (in particular where TFUs exist) and other health centres. If direct implementation is difficult, linkages and partnerships should be sought with other partners implementing food security projects.
10 It is important to avoid introducing salaries or incentives of facilitators as this could undermine the sustainability and replicability of the intervention. Rather, mechanisms can be explored whereby volunteers receive in kind contributions from the women they are assisting. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
21
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� � � � � � ¡ ¤ ¯ © ± £ ¤ ¬ § ¡ § ¢ ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ¬ ¡ ¡ § ¡ � « ¯ £ ¤ «² § ù ù ¨ ¡ ¬ ¤ û � ¯ ÷ ¯ ¬ ¡ ¤ ¯ ± ÷ ¯ ¡ ¤ ¬ § ¡ ³As far as possible, IYCF promotion should be integrated in “non-health” community-level interventions, in particular agriculture and education programmes. For example, participatory cooking sessions can be held as part of agricultural extension activities and food processing work with women producer organizations. IYCF message can be integrated in school and literacy trainings, and where possible, participatory cooking sessions can be held as practical work during literacy classes. (See activities in Annex 2). r 7 r 7 \ � $ " 5 / $ 4 � � � 1 \ � 1 / � $ / � ! ] � ; � " 2 ^ 4 � ! _ ! 4 � " u 5 � # � $ 4 � � 5 � � ; � % � � 4 � "4 � $ ^ : / % 4 � ` / � � / " � 1 � / � $ ^ s 5 � 4 � % 5 � % % � $ 4 / � ` / � � / " � 1 � � % u 4 $ / �s 5 � 4 � %Promotion of appropriate IYCF is already an integral part of the public nutrition component of the Basic Package of Health Services and Essential Package of Hospital Services. However, BPHS partners, health facility managers and health staff require further support to enhance the quality, appropriateness, and coverage. The following activities are suggested to strengthen IYCF activities, in particular coverage, as part of the BPHS and EPHS. � � � � � � õ ö ú £ ¡ ³ ¬ § ¡ § ¢ £ ô û � ® ± ¬ ¯ ¡ ¥ û . § ³ ú ¬ ¤ £ ¡ ¬ ¤ ¬ £ ¤ ¬ ÷ ¯ ¤ § ù § ± ¯ « ¯ £ ¤ «¢ £ ² ¬ ¬ ¤ ¬ ¯ ³The Baby-Friendly Hospital Initiative is currently being implemented in five hospitals (in Kabul and Eastern region), which have yet to be fully certified as Baby-Friendly. Priorities for applying the BFHI in Afghanistan include:
Supporting health facilities in completing the entire BFHI process, in particular applying the 10th step to successful breastfeeding, i.e. establishment of breastfeeding support groups. This will notably be achieved through activities described under output 2 (see section 3.2.2).
Expanding the coverage of BFHI certified facilities to more hospitals, and to health facilities providing MCH services.
Detailed activities for expanding the coverage of BFHI are described in the logical framework in Annex 2. � � � � � � ¡ ¤ ¯ © ± £ ¤ ¬ § ¡ § ¢ ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ © ² § ¨ ¡ ³ ¯ ¬ ¡ © ¬ ¡ £ « ¯ £ ¤ « ¢ £ ² ¬ ¬ ¤ ¬ ¯ ³Messages about adequate IYCF are currently disseminated as part of health and nutrition education sessions in most health facilities and through CHWs. However, these messages will not likely generate behaviour change if not accompanied by counselling. It is therefore important to integrate IYCF counselling (including breastfeeding demonstration and participatory cooking sessions) as part of health education activities in health facilities, in particular Comprehensive Health Centres and Basic Health Centres. This can be done by establishing IYCF corners in health facilities, or conducting IYCF counselling as part of “child health corners”. It is also absolutely essential that breastfeeding counselling and re-lactation assistance are part of the management of acute malnutrition, whether it is provided in Therapeutic Feeding Units or Community-based Management of Acute Malnutrition. Mothers of severely malnourished � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
22
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �children should also participate in cooking sessions on improved complementary feeding practices. Furthermore, there should be at least one referral centre at each province for referral of complicated and difficult lactation and IYCF cases. It may not be realistic, at this stage, to expect mobile teams and community-health workers to conduct actual counselling (except if part of community support activities described in section 3.3.2), but they should at least provide information to caregivers on adequate IYCF practices. All BPHS partners and hospitals are encouraged to implement these activities, and BPHS donors encouraged to provide the funds required for their implementation. Technical support can be provided by the Public Nutrition Department and its technical partners. These activities will be supported by those described in section 3.3.3. � � � � � � 6 ± £ ¬ ¡ ¬ ¡ © § ¢ « ¯ £ ¤ « ³ ¤ £ ¢ ¢ § ¡ ¡ ¢ £ ¡ ¤ £ ¡ ¥ ¦ § ¨ ¡ © ª « ¬ ¥ ® ¯ ¯ ¥ ¬ ¡ ©Training of all health staff on appropriate IYCF practices and good IYCF counselling skills is absolutely essential for the integration of IYCF in health services. This should be done by integrating IYCF into the curricula of all medical and paramedic education institutions including community midwifery school and postgraduate programs (esp. residency training programs in paediatrics, obstetrics and gynaecology). Furthermore, IYCF should be part of in-service trainings for different staff categories, including doctors, nurses, midwives, community midwives, and CHWs. This can notably be done as part of the IMCI trainings. At least two MCH staff in each facility should be trained on IYCF counselling, and all CHWs and outreach staff should be trained to conduct education on IYCF. (See detailed activities in Annex 2)
� 7 9 7 \ � % $ 4 $ ; $ 4 � � / � 1 5 / # � � 5 � / � ! # / 4 � u / 5 $ � 5 % The implementation of the IYCF Policy and Strategy will be supervised and monitored by the Ministry of Public Health Public Nutrition Department, at central level, and at provincial level, through Public Nutrition Officers. The Public Nutrition Department receives technical and financial support from technical agencies, in particular WHO, UNICEF, FAO, WFP, USAID/BASICS, IBFAN, BPNI, WABA, Micronutrient Initiative, and other punctual sponsors (e.g. IAEA). These partners can notably assist the PND in mobilizing human and financial resources required to implement the IYCF Policy and Strategy. Implementation of the IYCF Policy and Strategy, in particular at community-level and health-facility level will be done through partnerships with the BPHS partners, and other NGO’s working with communities. Collaboration with the private sector, and emergency service providers (including the military) will be essential, notably to ensure the Code of Marketing of BMS is respected. � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
23
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �� 7 [ 7 2 � � 5 ! 4 � / $ 4 � � # � ^ / � 4 % # %Effective coordination mechanisms are essential to support the effective implementation of the IYCF Policy and Strategy. Coordination should be managed through existing coordination bodies and mechanisms, strengthening them if and as required. An IYCF Working Group is already established at the central level, under the leadership of the MoPH Public Nutrition Department. It includes representatives of the main stakeholders listed above. It should be strengthened and its Terms of Reference revised so as to include overseeing the implementation of IYCF Policy & Strategy, monitoring the application of the policy priorities and activities, and taking strategic decisions concerning its implementation. Furthermore, a Committee for monitoring the application of the Code of Marketing of Breast Milk Substitutes is in the process of being established, under the leadership of the Public Nutrition Department. Effective coordination mechanisms should be established at the provincial level to oversee district and community level activities, namely for the public awareness activities, the establishment of IYCF community support activities, and trainings. This can include the preparation, implementation and supervision of IYCF provincial work plans, where possible. Provincial committees can also be responsible for monitoring the application of IYCF policies, in particular the Code of Marketing of BMS. � 7 r 7 � % $ 4 # / $ ! 0 ; ! " $The total estimated budget for the implementation of this four-year strategy is over 7 v � � � � � � � �
. The table below provides a summary budget by the main components and a detailed budget is provided in annex 4. z G D O { D K L S d H E I O D E G O S A G D L A R M H E O Q O I H M C Q P H d M L R z H D Q L D L G A w O Y C Q D X O A D S D C B B C A E S H Y Y G Q DR G S D S > J H Q Q O A D M c x G A M c G A O X O E L R C M E G R D G Q L S Q O S Y G A S L d M O B H M M n D L X O B G Q S H Y O Q W L S L A I @ F J N L S S H O S xC D D K O R O A D Q C M M O W O M > T A G D K O Q D l G D O R K A L R C M S D C B B C Q O Q O & H L Q O E D G C E O & H C D O M c S H Y Y G Q D D K O @ F J NS D Q C D O I c L X Y M O X O A D C D L G A x D G I O D K O Q l L D K C S S G R L C D O E S H Y Y G Q D R G S D S 3 R G X Y H D O Q x D Q C A S Y G Q D x O D R > 4 >
Ê Á 8 Ì Á Ç ¹ Ç Æ 9 Ä � Ï ¹ Æ ¾ ¹ : Ä ¿ ¾ ¹ �; < = > ? @ A @ B C D E B F G ? H I @ > J C D F G @ K B ? @ J B C L M N N M � �1.1 National IYCF Policy & Strategy $46 000
1.2 The Code of Marketing of BMS $425 500
1.3 Maternity protection $35 000
1.4 IYCF Guidelines $38 000
1.5 Infant and Young Child Feeding in Emergencies O < P B Q H R @ > G E A Q H J F B > J S T U V$6 147 000
2.1 Public Awareness Raising $1 634 000
2.2 Establishment of community support groups and interventions $2 382 000
2.3 Integration of IYCF in non-health community-level interventions W X Y Z Y [ [ [\ < S T U V @ J P = ] ^ _ ` = ] ^ L º a º a a � �3.1 Expansion of BFHI $562 000
3.2 Integration of IYCF counselling in all health facilities $652 500
3.3 Training of health staff in IYCF $503 200Ê ¼ b c d e µ e µ ¼ µ Î d L f N � g � � �� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -24
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -25
Effective monitoring and evaluation must also be established to assess progress towards the strategy objectives. Monitoring and evaluation should be supported by regular monitoring, progress reviews, and eventually, operational research. Indicators for monitoring the objectives, components and strategic approaches are proposed in Annex 2. (Note: these indicators may be slightly modified when survey and M&E tools are designed). 8 7 9 7 � " ; � / 5 # � � 4 $ � 5 4 � " / � ! � / � ; / $ 4 � �Adequate M&E tools (including self-assessment tools) should be developed to support effective monitoring of the IYCF Policy and Strategy. Indicators should, as far as possible, be integrated in the HMIS, national monitoring checklists, and third party evaluations. Furthermore, relevant staff (in particular PNO’s) should be trained on the use of the M&E tools and measures to take corrective action. Regular monitoring of field activities by MoPH staff (in particular Provincial Nutrition Officers) will be essential. Monitoring can also be done by integrating IYCF indicators in surveys, such as the MICS survey, and other studies. It will be necessary to assess whether there are any specific operational research needs and develop an operational research plan accordingly. 8 7 [ 7 t u 5 / $ 4 � � / � 5 % / 5 � ^Formative research has already been carried out on breastfeeding practices in 2002 and 2003 (notably with UNICEF and Save the Children support), and on complementary feeding practices and recipes (by FAO and MAIL in 2006). However, new operational research needs may arise during the IYCF Policy and Strategy implementation. If there are research needs, an operational research plan should be developed and resources mobilized to implement it. 8 7 r 7 ` 5 � " 5 % % � � 4 � %The information generated by the M&E system should be used to regularly assess progress on the implementation of the IYCF Policy and Strategy and make necessary adjustments in the implementation plan. Furthermore, progress should be reported to the relevant authorities and stakeholders, for issues of accountability, but also to maintain / generate motivation to pursue implementation. A national review workshop should be conducted annually (including the preparation of the following annual work plan). Progress on the implementation of the IYCF Policy and Strategy should also be reviewed at the regional level through regional workshops. Progress can be reviewed at least once a year at the provincial level using the Provincial Health Coordination Committee (PHCC) or other forums. Finally, information on this progress should be shared through the Consultative Group on Health and Nutrition (CGHN), as well as other through media, such as “Sehat” and “Salamaty” journals.
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1.
Dis
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Par
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and f
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to d
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ate
info
rmat
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on t
he
IYC
F p
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. 2
.R
egula
r updat
ing o
f IY
CF
act
ion p
lan a
nd p
repar
atio
n o
f a
reso
urc
e m
obil
izat
ion p
lan t
o s
uppo
rt t
he
imp
lem
enta
tio
n o
f th
e IY
CF
Po
licy
& S
trat
egy
3.
Rev
iew
Mo
PH
rel
ated
sub
-poli
cies
, st
rate
gie
s an
d g
uid
elin
es a
nd
mak
e su
re I
YC
F h
as b
een
ref
lect
ed i
n t
hes
e d
ocu
men
ts
Ç� ½� ¶º ½¶ÊÉ ·ÃÌ ½¿À ¹È¶ÊÆ Ã½·Ä¿ÉÀ̧Ì- Ï» Ä¿À ¿ Ï¿ ½Ä
4.
Est
abli
sh a
Nat
ional
Co
mm
itte
e fo
r th
e E
nfo
rcem
ent
of
the
Code
5.
Est
abli
sh e
nfo
rcem
ent
mec
han
ism
s fo
r th
e C
od
e of
Mar
ket
ing o
f B
MS
6
.D
isse
min
ate
info
rmat
ion
on t
he
Co
de
(in
clud
ing
tra
nsl
atio
ns)
and
rel
ated
leg
isla
tio
n t
o a
ll k
ey s
takeh
old
ers
(Pro
vin
cial
Dep
artm
ents
of
Hea
lth,
PR
Ts,
pri
vat
e se
ctor,
all
h
ealt
h f
acil
itie
s, M
OW
A, N
GO
s, e
tc.)
th
roug
h p
ost
ers,
lea
flet
s, a
nd
work
shop
s 7
.T
rain
ing
of
Cod
e m
on
ito
rs (
IBF
AN
)
É ·¿ ½Ã¹À ¿ ,Ñö¿ ½¾¿À ¶¹
8.
Est
abli
sh e
nfo
rcem
ent
mec
han
ism
s an
d d
evel
op
gu
idel
ines
fo
r th
e im
ple
men
tati
on
of
the
Mat
ern
ity P
rote
ctio
n A
ct
9.
Info
rm w
ork
ing
wo
men
of
thei
r ri
gh
ts u
nd
er t
he
Mat
ern
ity P
rote
ctio
n A
ct (
e.g
. th
rough
lea
flet
s an
d r
adio
; ca
n b
e p
art
of
IYC
F P
ubli
c A
war
enes
s C
amp
aign)
Â)�*µ ÏÀº ½À̧ ¹½Ä
10.
Rev
iew
ex
isti
ng
in
tern
atio
nal
gu
idel
ines
and
nat
ion
al t
rain
ing
pac
kag
es a
nd d
evel
op
a c
om
pre
hen
siv
e an
d c
oh
eren
t se
t o
f h
arm
on
ized
guid
elin
es c
over
ing I
YC
F p
oli
cy a
nd
pri
ori
ties
and
str
ateg
ic i
nte
rven
tio
ns,
nam
ely
: IY
CF
pro
mo
tio
n i
n d
iffe
ren
t h
ealt
h f
acil
itie
s (i
ncl
ud
ing B
FH
I gu
idel
ines
); I
YC
F p
rom
oti
on
at
com
mu
nit
y l
evel
; In
fan
t an
d
Youn
g C
hil
d F
eed
ing
in E
mer
gen
cies
; Im
ple
men
tati
on
of
the
Cod
e, e
tc.
11.
Dis
sem
inat
e g
uid
elin
es t
o t
he
rele
van
t st
akeh
old
ers,
an
d c
on
du
ct t
rain
ing
s on
th
eir
imp
lem
enta
tio
n (
c.f.
als
o t
rain
ing
act
ivit
ies
und
er o
utp
uts
2 a
nd 3
)  ¹Ê ·¹¿ ·¹º) ¶ ϹÈ��À̧º* ½½ºÀ ¹ÈÀ ¹/ нÃȽ¹¾À ½Ä
12.
As
par
t of
the
Afg
han
IY
CF
gu
idel
ines
, d
evel
op
a s
ecti
on
on I
YC
F i
n E
mer
gen
cies
bas
ed o
n t
he
inte
rnat
ion
ally
en
do
rsed
Op
erat
ion
al G
uid
ance
for
IFE
1
3.
Dis
sem
inat
e th
e IF
E G
uid
elin
es t
o a
ll r
elev
ant
stak
eho
lder
s (i
ncl
ud
ing t
he
Dis
aste
r M
anag
emen
t C
om
mit
tee,
th
e P
RT
, N
GO
s a
nd
Pro
vin
cial
Dev
elopm
ent
Co
un
cils
) an
d
ensu
re t
hey
are
im
ple
men
ted
in
em
erg
ency
sit
uat
ion
s.
� ¶ÐѶ¹½¹¿ ·¹º Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ¹ºÀ ¾·¿ ¶ÃÄ
Æ ·Ä½À̧ ¹½Ç ·ÃȽ¿É ½·¹Ä¶Ê Á½ÃÀÊÀ ¾·¿À ¶¹ËÀ ÄÌ ÄÍ ·ÄÄ ÏÐÑ¿À ¶¹
� © �®Ú ¦̈«Û ¬¡�ÜÝ ¤¤Ü¡ «³ ¨�¡ ¢²�ÜÞ ® ±�® ¤«² ¯Þ ¤¥® ¤ § ¤±ßààá29
� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �¡ �® � ¯°¡ ¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬
��������0� ����� #�� 1 ��&���� '� ���������� �� ��� ��� !����� �� � �
���#�� � ������ '� �������'�" � � 2� ���% ��� �!��� ��3!� ��� � ���� ��� �3!�� �����
�% ��!�% �4�5 6�� �����''!�� � � !������ �� ��#���� ��
70%
of
Afg
han
ad
ult
an
d a
dole
scen
t pop
ula
tio
n
is a
war
e of
key
IY
CF
pra
ctic
es
90%
sh
ura
mem
ber
s aw
are
of
good
IY
CF
Nu
mb
er o
f IY
CF
co
mm
un
ity
sup
port
gro
ups
esta
bli
shed
an
d o
per
atio
nal
Num
ber
of
wom
en r
ecei
vin
g s
atis
fact
ory
b
reas
tfee
din
g c
oun
sell
ing
õö ô÷778íòö 9: ì;ì:
Nu
mb
er o
f m
oth
ers
hav
ing
par
tici
pat
ed i
n a
t le
ast
5 p
arti
cipat
ory
co
ok
ing
ses
sio
ns
TB
D
TB
D
0
0
TB
D
70%
9
0%
1
500
2000
0
2000
0
Nat
ion
al N
utr
itio
n
Surv
ey (
&/
or
KA
P
surv
eys)
H
MIS
M
on
itori
ng
vis
its
Impac
t as
sess
men
t an
d s
urv
eys
Sec
uri
ty
Po
liti
cal
and
com
mu
nit
y
suppo
rt
Res
ourc
es
mo
bil
ised
Strategic Approaches
+ Ï»̧À ¾Î <·Ã½¹½ÄÄË ·À ÄÀ ¹È
1.
Imp
lem
ent
the
Nat
ion
al B
reas
tfee
din
g C
om
mu
nic
atio
n C
amp
aig
n (
to b
e la
un
ched
duri
ng
Worl
d B
reas
tfee
din
g W
eek
1-7
Aug
ust
2009
) 2
.C
eleb
rate
Worl
d B
reas
tfee
din
g W
eek a
nnual
ly
3.
Exp
and
th
e N
atio
nal
Bre
astf
eed
ing
Co
mm
un
icat
ion
Cam
pai
gn
to
co
ver
co
mp
lem
enta
ry f
eed
ing a
nd
IY
CF
as
a w
ho
le, an
d c
ondu
ct r
egu
lar
IYC
F a
war
enes
s ac
tiv
itie
s:
Iden
tifi
cati
on a
nd m
ob
iliz
atio
n o
f k
ey p
artn
ers
for
pub
lic
awar
enes
s ac
tiv
itie
s, n
amel
y M
oP
H,
MA
IL, M
oW
A,
Mo
RA
, M
oE
, M
RR
D a
nd p
ub
lic
med
ia.
Conduct
sam
ple
bas
elin
e K
AP
surv
eys,
wher
e po
ssib
le (
refe
rrin
g t
o f
orm
ativ
e re
sear
ch c
onduct
ed i
n 2
002 a
nd 2
003)
Iden
tifi
cati
on a
nd d
efin
itio
n o
f h
arm
on
ized
mes
sag
es t
o b
e u
sed
by a
ll s
tak
eho
lder
s, u
nder
MoP
H P
ND
lea
d.
Dev
elo
pm
ent
of
adeq
uat
e m
ater
ials
, in
clu
din
g p
ost
ers,
lea
flet
s, r
adio
and
TV
spo
ts
Tra
inin
g o
f re
lev
ant
stak
eho
lder
s on
th
e IE
C m
essa
ges
(in
clu
din
g k
ey h
ealt
h s
taff
-cf
lin
k t
o o
utp
ut
4-,
rel
igio
us
lead
ers,
co
mm
un
ity l
ead
ers,
jou
rnal
ists
, et
c.)
Imp
lem
enta
tio
n o
f P
ub
lic
Aw
aren
ess
Act
ivit
ies
thro
ugh
th
e v
ario
us
med
ia i
den
tifi
ed
Po
st-a
war
enes
s ra
isin
g m
on
ito
rin
g s
urv
ey (
KA
P)
/ Ä¿ ·»̧À Ä� н¹¿ ¶Ê ¾¶ÐРϹÀ ¿ ,Ä ÏÑѶÿ Èö ÏÑÄ·¹ºÀ ¹¿ ½Ã Á½¹¿À ¶¹Ä1
.Id
enti
fica
tio
n o
f o
ppo
rtun
itie
s fo
r es
tab
lish
ing
IY
CF
co
mm
un
ity s
uppo
rt g
roup
s, o
n t
he
bas
is o
f ex
isti
ng n
etw
ork
s an
d p
roje
cts
(e.g
. h
ealt
h s
hu
ras,
wo
men
’s s
hu
ras,
Gro
wth
M
on
itori
ng
and
Pro
mo
tio
n, et
c.)
and
/or
inte
gra
ting
IY
CF
co
un
sell
ing
in e
xis
tin
g c
om
mu
nit
y d
evel
op
men
t ac
tiv
itie
s.
2.
Mo
bil
izat
ion
of
eld
ers
and
com
mu
nit
y l
ead
ers
to e
stab
lish
su
ppo
rt f
or
the
com
mu
nit
y s
up
port
gro
up
s an
d/o
r co
mm
un
ity-b
ased
IY
CF
cou
nse
llin
g
3.
Iden
tify
fac
ilit
ato
rs w
ho c
an p
rov
ide
cou
nse
llin
g a
t co
mm
un
ity l
evel
, th
rou
gh
co
mm
un
ity s
uppo
rt g
roup
s an
d/o
r o
ther
dev
elop
men
t in
terv
enti
on
s (e
.g.
CH
W,
dah
ia, li
tera
cy
teac
her
, hea
d o
f w
om
en’s
shura
, et
c.)
and d
eter
min
e th
eir
trai
nin
g n
eed
s 4
.D
evel
op
men
t of
trai
nin
g m
ater
ials
and
job
aid
s fo
r co
mm
un
ity-l
evel
IY
CF
co
un
sell
ors
and
su
ppo
rt g
roup
fac
ilit
ato
rs
5.
Tra
inin
g o
f IY
CF
coun
sell
ors
and
/or
sup
port
gro
up f
acil
itat
ors
on
ad
equ
ate
IYC
F c
oun
sell
ing
and
psy
cho
-so
cial
su
ppo
rt s
kil
ls
6.
Pro
vid
e IY
CF
co
un
sell
ors
and
/or
sup
port
gro
up
fac
ilit
ato
rs w
ith t
he
reso
urc
es r
equ
ired
to
cond
uct
ad
equ
ate
cou
nse
llin
g (
e.g. B
F c
ou
nse
llin
g k
it;
cook
ing
set
;)
7.
Pro
vid
e re
gu
lar
assi
stan
ce a
nd
su
per
vis
ion
to
IY
CF
supp
ort
gro
up
s an
d I
YC
F c
oun
sell
ors
op
erat
ing
at
com
mu
nit
y l
evel
.
8.
Mo
nit
or
the
imp
lem
enta
tio
n o
f co
un
sell
ing s
essi
on
s an
d p
arti
cip
ato
ry c
ookin
g s
essi
on
s 9
.E
stab
lish
lin
kag
es a
nd
par
tner
ship
s w
ith f
ood
sec
uri
ty p
roje
cts
aim
ing
to
div
ersi
fy h
ou
seh
old
food
pro
du
ctio
n a
nd
in
com
e g
ener
atio
n (
if l
oca
lly i
n p
lace
) or
mobil
ize
reso
urc
es a
nd e
xper
tise
to i
mple
men
tati
on f
ood s
ecuri
ty i
nte
rven
tions
if t
hey
are
not
in p
lace
.
 ¹¿ ½È÷¿À ¶¹¶ÊÂ)�*À ¹¹¶¹ =� ½·¸ ¿� ¾¶ÐРϹÀ ¿ , =¸ ½ Á½À̧ ¹¿ ½Ã Á½¹¿À ¶¹Ä1
.E
stab
lish
po
ol
of
IYC
F t
rain
ers
in M
AIL
and
tra
in e
xte
nsi
on w
ork
ers
(in
par
ticu
lar
wo
men
) on
IY
CF
co
un
sell
ing
2
.In
teg
rati
on
of
IYC
F m
essa
ges
and
par
tici
pat
ory
coo
kin
g s
essi
on
s in
agri
cult
ura
l p
roje
cts
3.
Incl
ude
IYC
F i
n t
he
curr
icu
la o
f li
tera
cy t
rain
ing a
nd t
rain
lit
erac
y t
each
ers
on I
YC
F.
� ¶ÐѶ¹½¹¿ ·¹º Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ¹ºÀ ¾·¿ ¶ÃÄ
Æ ·Ä½À̧ ¹½Ç ·ÃȽ¿É ½·¹Ä¶ÊËÀ
ÄÌ ÄÍ
� © �®Ú ¦̈«Û ¬¡�ÜÝ ¤¤Ü¡ «³ ¨�¡ ¢²�ÜÞ ® ±�® ¤«² ¯Þ ¤¥® ¤ § ¤±ßààá30
� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �¡ �® � ¯°¡ ¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬
Á½ÃÀÊÀ ¾·¿À ¶¹·ÄÄ ÏÐÑ¿À ¶¹
��������>úûüý ?ø÷7÷öò ÷íõíó ô÷8íëì:: ò í@ò ëìùù ìôöò ;ì: 9ò 7?: ì7ìíö ìó õë?õøö
÷ù öA ìBCðD õíóECðD ò íõ::A ìõ: öAù õôò: òöò ìë
Nu
mb
er o
f fa
cili
ties
cer
tifi
ed a
s B
aby-f
rien
dly
50%
of
the
EP
HS
fac
ilit
ies
and h
ealt
h c
entr
es
(CH
C&
BH
C)
pro
vid
e IY
CF
co
un
sell
ing
as
par
t o
f th
e M
CH
ser
vic
es.
(=7
00
)
50%
of
do
ctors
, nurs
es, co
mm
un
ity m
idw
ives
and
C
HW
s d
emo
nst
rate
co
rrec
t co
un
sell
ing
sk
ills
on
IY
CF
Av
erag
e n
um
ber
of
wo
men
rec
eiv
ing
bre
astf
eed
ing c
oun
sell
ing
per
mo
nth
per
co
un
sell
or
in h
ealt
h s
erv
ices
Nu
mb
er o
f h
ealt
h f
acil
itie
s co
ndu
ctin
g
par
tici
pat
ory
co
ok
ing
dem
on
stra
tio
ns
5 i
n p
roce
ss
TB
D
4,0
00
(%
T
BD
)
Chec
k w
ith
coun
sell
or
Chec
k w
ith
FA
O
>3
0
>50%
5
0%
>3
/mo
nth
/ co
un
sell
or
>1
00
Mo
PH
rep
ort
s T
rain
ing
rep
ort
s H
MIS
Sec
uri
ty
Po
liti
cal
support
R
esourc
es
mo
bil
ised
Strategic Approaches
/ FÑ·¹ÄÀ ¶¹¶ÊÆ ·» , =* ÃÀ ½¹º̧ ,G ¶ÄÑÀ ¿ ·Â̧ ¹À ¿À ·¿À Á½¿ ¶Ð¶Ã½� ¶ÄÑÀ ¿ ·¸ Ä·¹º Ľ¸ ½¾¿ ½º� ½·¸ ¿�Ê ·¾À̧À ¿À ½ÄÑö ÁÀºÀ ¹ÈÉ�G Ľà ÁÀ ¾½Ä1
.R
evie
w l
esso
n l
earn
ed f
rom
th
e cu
rren
t B
FH
I 2
.T
rain
pool
of
BF
ass
esso
rs/a
dvoca
tes
at t
he
cen
tral
and
reg
ion
al l
evel
. 3
.D
evel
op t
oo
ls, co
ndu
ct a
sses
smen
t/re
-ass
essm
ent
to c
erti
fyin
g h
ealt
h f
acil
itie
s as
Bab
y-f
rien
dly
4
.T
rain
hea
lth f
acil
ity s
taff
on m
easu
res
requ
ired
to
co
mp
ly w
ith
BF
HI
crit
eria
and
im
ple
men
t th
ese
mea
sure
s 5
.S
up
erv
ise
and m
on
ito
r fa
cili
ties
and
pro
vid
e ce
rtif
icat
es f
or
faci
liti
es c
om
ply
ing
wit
h B
FH
I cr
iter
ia
 ¹¿ ½È÷¿À ¶¹¶ÊÂ)�* ¾¶ ϹĽ¸̧À ¹ÈÀ ¹·¸̧� ½·¸ ¿�Ê ·¾À̧À ¿À ½Ä
6.
Dev
elo
p g
uid
elin
es a
nd e
stab
lish
IY
CF
corn
ers
in h
ealt
h f
acil
itie
s, i
ncl
ud
ing b
reas
tfee
din
g c
oun
sell
ing
an
d p
arti
cip
atory
co
ok
ing
ses
sio
ns
(N.B
. ca
n b
e p
art
of
chil
d h
ealt
h
corn
er)
7.
En
sure
IY
CF
co
un
sell
ing
is
par
t of
hea
lth
edu
cati
on a
ctiv
itie
s, i
ncl
ud
ing b
reas
tfee
din
g d
emo
nst
rati
on
and
par
tici
pat
ory
co
ok
ing
ses
sions
8.
En
sure
bre
astf
eed
ing
co
un
sell
ing
an
d r
e-la
ctat
ion a
ssis
tan
ce a
re p
art
of
the
man
agem
ent
of
acu
te m
aln
utr
itio
n (
in T
FU
and
CM
AM
) 9
.Id
enti
fy a
t le
ast
on
e re
ferr
al c
entr
e in
eac
h p
rov
ince
fo
r re
ferr
al o
f co
mp
lica
ted a
nd d
iffi
cult
lac
tati
on
an
d I
YC
F c
ases
. Ç Ã·À ¹À ¹È¶Ê� ½·¸ ¿� Ä¿ ·ÊÊ ¶¹Â)�*
10.
Inte
gra
te I
YC
F i
nto
th
e cu
rric
ula
of
all
med
ical
an
d p
aram
edic
edu
cati
on
in
stit
uti
on
s in
clu
din
g c
om
mu
nit
y m
idw
ifer
y s
choo
l an
d p
ost
gra
du
ate
pro
gra
ms
(esp
. re
siden
cy t
rain
ing
pro
gra
ms
in p
aed
iatr
ics,
obst
etri
cs a
nd
gyn
aeco
log
y).
1
1.
Dev
elo
p t
rain
ing p
ack
ages
and
job
aid
s on
IY
CF
for
dif
fere
nt
hea
lth
sta
ff c
ateg
ori
es,
incl
ud
ing
: d
oct
ors
, nurs
es,
mid
wiv
es, co
mm
un
ity m
idw
ives
, an
d C
HW
s 1
2.
Inte
gra
te I
YC
F t
rain
ing m
odule
s as
par
t of
in-s
erv
ice
trai
nin
gs,
in
par
ticu
lar
for
MC
H s
taff
, C
HW
s &
mid
wiv
es (
e.g
. as
par
t of
C-I
MC
I tr
ain
ing)
1
3.
Dis
trib
ute
pri
nte
d m
ater
ial
and
job
aid
s to
all
fac
ilit
ies,
in
clu
din
g f
or
CH
Ws
and
co
mm
un
ity m
idw
ives
as
par
t o
f C
-IM
CI
1
4.
Tra
in a
nd
est
abli
sh p
ool
of
trai
ner
s at
th
e n
atio
nal
lev
el a
nd
in
“ea
ch r
egio
n”
on
MB
FI
and I
YC
F,
in p
arti
cula
r by t
rain
ing P
rov
inci
al N
utr
itio
n O
ffic
ers
on I
YC
F
15.
Tra
in a
t le
ast
2 M
CH
sta
ff o
f ea
ch h
ealt
h f
acil
ity.
16.
Tra
in o
ut-
reac
h s
taff
to
en
able
th
em t
o i
nte
gra
te I
YC
F i
n o
ut-
reac
h s
ervic
es.
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� ¶ÐѶ¹½¹¿ ÄM Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂN
O PQ RST UT VW XYVZ[S \]T R̂W XZ[T_ VST V̂W
K `K( ·¿À ¶¹·Â̧)�*+ ¶À̧ ¾ ,Í- ¿ ÷¿ ½È ,
Dis
sem
inat
e th
e N
atio
nal
IY
CF
Po
licy
an
d S
trat
egy a
mo
ng
st a
ll k
ey
stak
eho
lder
s
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Reg
ula
r upd
atin
g o
f IY
CF
act
ion
pla
n
and p
rep
arat
ion o
f a
reso
urc
e m
ob
iliz
atio
n p
lan
X
X
X
X
X
Rev
iew
Mo
PH
rel
ated
sub
-poli
cies
, st
rate
gie
s an
d g
uid
elin
es
X
X
X
X
X
K `HÇ� ½� ¶º ½¶ÊÉ ·ÃÌ ½¿À ¹È¶ÊÆÉ-
Est
abli
sh a
nd
reg
ula
r m
eeti
ng
s of
Nat
ion
al C
om
mit
tee
for
the
En
forc
emen
t o
f th
e C
od
e
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Est
abli
sh e
nfo
rcem
ent
mec
han
ism
s
X
Dis
sem
inat
e in
form
atio
n o
n t
he
Co
de
and r
elat
ed l
egis
lati
on
X
X
Tra
inin
g o
f C
od
e m
on
ito
rs
X
X
Mo
nit
or
Co
de
imp
lem
enta
tio
n
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
K `LÉ ·¿ ½Ã¹À ¿ ,Ñö¿ ½¾¿À ¶¹
Est
abli
sh e
nfo
rcem
ent
mec
han
ism
s an
d d
evel
op
guid
elin
es
XX
Info
rm w
ork
ing
wo
men
of
thei
r ri
gh
ts
und
er t
he
Mat
ern
ity P
rote
ctio
n A
ct
X
X
X
X
X
X
X
X
X
X
X
X
X
X
K `aÂ)�*µ ÏÀº ½À̧ ¹½Ä
Dev
elo
p I
YC
F g
uid
elin
es
X
X
X
X
Dis
sem
inat
e g
uid
elin
es a
nd
co
ndu
ct
trai
nin
gs
on t
hei
r im
ple
men
tati
on
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
K `b ¹Ê ·¹¿ ·¹º) ¶ ϹÈ��À̧º* ½½ºÀ ¹ÈÀ ¹/ нÃȽ¹¾À ½Ä
Dev
elo
p I
FE
Gu
idel
ines
& i
nte
gra
te i
n
IYC
F g
uid
elin
es
X
X
X
X
Dis
sem
inat
e th
e IF
E G
uid
elin
es &
m
on
ito
r ap
pli
cati
on
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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� ¶ÐѶ¹½¹¿ ÄM Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂN
c Pd Ve \fT R[YUe \̂ZVR̂ghi j
H `K+ Ï»̧À ¾Î <·Ã½¹½ÄÄË ·À ÄÀ ¹È
Imp
lem
ent
the
Nat
ion
al B
reas
tfee
din
g
Co
mm
un
icat
ion
Cam
pai
gn
X
X
Cel
ebra
te W
orl
d B
reas
tfee
din
g W
eek
X
X
X
X
X
Exp
and
to
IY
CF
as
a w
ho
le,
and c
ond
uct
re
gu
lar
IYC
F a
war
enes
s ra
isin
g:
Mo
bil
izat
ion
of
key
par
tner
s
X
X
X
X
X
Bas
elin
e K
AP
surv
eys
X
X
X
X
X
Iden
tifi
cati
on o
f m
essa
ges
X
X
X
X
X
Dev
elo
pm
ent
of
mat
eria
ls
X
X
X
X
Tra
inin
gs
on
the
IEC
mes
sag
es
X
X
X
X
Imp
lem
ent
Pu
bli
c A
war
enes
s
X
X
X
X
X
X
X
X
X
X
X
X
X
Impac
t m
on
ito
rin
g s
urv
ey (
KA
P)
X
X
X
H `H/ Ä¿ ·»̧À Ä� н¹¿ ¶Ê ¾¶ÐРϹÀ ¿ ,Ä ÏÑѶÿ Èö ÏÑÄ·¹ºÀ ¹¿ ½Ã Á½¹¿À ¶¹Ä
Iden
tifi
cati
on o
f o
ppo
rtun
itie
sX
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Mo
bil
izat
ion
of
com
mu
nit
y l
ead
ers
Id
enti
fy f
acil
itat
ors
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Dev
elo
p t
rain
ing m
ater
ials
& j
ob a
ids
X
X
X
X
Tra
inin
g o
f IY
CF
coun
sell
ors
and
fa
cili
tato
rs &
pro
vid
e re
sou
rces
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Reg
ula
r as
sist
ance
an
d m
on
ito
rin
g
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Est
abli
sh l
ink
ages
wit
h f
ood
sec
uri
ty
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
k õø@ìö í87l ìø÷ù ë8??÷øö @ø÷8?ëm
2
0
1
00
300
800
1500
H `L ¹¿ ½È÷¿À ¶¹¶ÊÂ)�*À ¹¹¶¹ =� ½·¸ ¿�¾¶ÐРϹÀ ¿ , =¸ ½ Á½À̧ ¹¿ ½Ã Á½¹¿À ¶¹Ä
Est
abli
sh p
oo
l o
f IY
CF
tra
iner
s in
MA
IL
and t
rain
ex
tensi
on w
ork
ers
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Inte
gra
tion
of
IYC
F m
essa
ges
and
p
arti
cip
atory
co
ok
ing
ses
sions
in
agri
cult
ura
l p
roje
cts
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Incl
ud
e IY
CF
in
lit
erac
y c
urr
icu
la
X
X
X
X
X
Tra
in l
iter
acy
tea
cher
s o
n I
YC
F
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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� �� � ¡ ¢£ ¤¥¦§�¡ ¢̈© ª© «¬ �¡ �® � ¯°¡ ¡ �® ±²̈© ³ ¦§�¡ ¢´ ¤��®¬ HIIJHIKIHIKKHIKHHIKL
� ¶ÐѶ¹½¹¿ ÄM Ä¿ ÷¿ ½ÈÀ ¾·ÑÑö·¾� ½Ä ÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂN
n ghi jT ^dQopq rQop
L `K/ FÑ·¹ÄÀ ¶¹¶ÊÆ*GÂ
Rev
iew
les
son
lea
rned
fro
m c
urr
ent
BF
HI
X
X
Dev
elo
p t
oo
ls t
o a
sses
s B
FH
I st
atu
s
X
X
X
X
X
Tra
in p
ool
of
BF
ass
esso
rs/a
dvoca
tes
at
the
cen
tral
an
d r
egio
nal
lev
el
X
X
X
X
X
X
X
X
Co
nd
uct
ass
essm
ents
/re-
asse
ssm
ents
on
B
FH
I st
atu
s of
hea
lth
fac
ilit
ies
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Tra
in h
ealt
h f
acil
ity s
taff
on B
FH
I
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Mo
nit
or
faci
liti
es a
nd
pro
vid
e ce
rtif
icat
es
X
X
X
X
X
X
X
X
X
X
X
X
X
X
k õø@ìö ë?ìø9ìõø
5
10
15
20
30
L `H ¹¿ ½È÷¿À ¶¹¶ÊÂ)�* ¾¶ ϹĽ¸̧À ¹ÈÀ ¹·¸̧� ½·¸ ¿�Ê ·¾À̧À ¿À ½Ä
Dev
elo
p g
uid
elin
es o
n I
YC
F c
orn
ers
X
X
X
Est
abli
sh I
YC
F c
orn
ers
in h
ealt
h f
acil
itie
s
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
En
sure
IY
CF
co
un
sell
ing
is
par
t of
hea
lth
ed
uca
tion
act
ivit
ies
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Ensu
re b
reas
tfee
din
g c
ounse
llin
g a
nd
rela
ctat
ion a
ssis
tance
are
par
t of
the
man
agem
ent
of
acu
te m
aln
utr
itio
n
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Iden
tify
at
leas
t o
ne
IYC
F r
efer
ral
cen
tre
/ pro
vin
ce
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
k õø@ìö ës 9ìõøêA ìõ: öAù õôò: òöò ìëîòöAúûüý
ô÷8íëì:: ò í@�
4
0
1
00
200
400
700
Ç Ã·À ¹À ¹È¶Ê� ½·¸ ¿� Ä¿ ·ÊÊ ¶¹Â)�*
Inte
gra
te I
YC
F i
nto
th
e cu
rric
ula
of
med
ical
an
d p
aram
edic
ed
uca
tio
n
inst
itu
tio
ns
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Dev
elo
p t
rain
ing p
ack
ages
and
job
aid
s on
IY
CF
fo
r d
iffe
ren
t h
ealt
h s
taff
cat
ego
ries
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Inte
gra
te I
YC
F t
rain
ing m
odule
s as
par
t of
in-s
ervic
e tr
ainin
gs
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Tra
in a
nd
est
abli
sh p
oo
l o
f tr
ain
ers
at t
he
nat
ional
lev
el a
nd i
n “
each
reg
ion
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Dis
trib
ute
pri
nte
d m
ater
ial
and
job
aid
s to
al
l fa
cili
ties
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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HIIJHIKIHIKKHIKHHIKL
� ¶¶ÃºÀ ¹·¿À ¶¹ tÉÍ/ ·¹º ýĽ·Ã¾� ÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂNÂÂÂÂÂÂÂN
� ¶¶ÃºÀ ¹·¿À ¶¹Ð½¾� ·¹À ÄÐÄ
IYC
F W
ork
ing G
rou
p
mee
tin
gs
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Est
abli
sh e
ffec
tiv
e co
ord
inat
ion
mec
han
ism
s at
pro
vin
cial
lev
el
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
É ¶¹À ¿ ¶ÃÀ ¹È·¹º ½ Á·¸ Ï·¿À ¶¹
Dev
elo
p a
nd
ad
op
t IY
CF
mo
nit
ori
ng t
oo
ls
for
use
at
dif
fere
nt
level
s X
X
X
X
X
Bu
ild
cap
acit
y o
f th
e st
aff
to u
se
mo
nit
ori
ng t
ools
and
tak
e co
rrec
tiv
e ac
tio
n
X
X
X
X
X
Inco
rpora
te I
YC
F s
elec
ted i
ndic
ators
in
nat
ion
al m
on
ito
rin
g s
yst
ems
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Inco
rpo
rate
IY
CF
mai
n i
nd
icat
ors
in
n
atio
nal
surv
eys
(in p
arti
cula
r M
ICS
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Incl
ud
e IY
CF
in
IM
CI
and C
BH
C
super
vis
ory
chec
kli
sts/
too
lsX
X
X
Co
ndu
ct r
egu
lar
mo
nit
ori
ng
vis
its
on
IYC
F
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
u ѽ÷¿À ¶¹·¸ ýĽ·Ã¾�
Iden
tify
res
earc
h n
eeds;
if
nee
ds,
dev
elop
o
per
atio
nal
res
earc
h p
lan
X
X
X
X
Mo
bil
ize
reso
urc
es
X
X
X
Imp
lem
ent
the
pla
n
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� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � The cost for each component of the IYCF strategy is provided below, broken down by activity and type of resources. *N.B. The “Potential Sources of support” (column 6) are not donors but technical assistance providers (through which donor funding can be channelled in addition to direct support to MoPH) Ü Ý Þ ß Ý Ú Ó Ú Ö Õ v Õ Ö Ò Ô Ö Ó Û Ù åÔ ß ß Ò Ý Ô å ó Ó Õ w Ó Õ Ý ä Ò å Ó Õ Ú Ó Ó Ø Ó Ø æ á Ó Ô Ò ð è x ä Þ y Ó ÒÝ × ä Ú Ù Ö Õ z Ú Ù Ö å Ý Õ Ö Õ ò Þ Ý ä Ú Ö Ú Ó Ó Ø Ó Øæ Ö Ý Ö Ô à è { Ý Ö Ó Ú Ö Ù Ô àã Ý ä Ò å Ó Ý ×Õ ä ß ß Ý Ò Ö |} ~ � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �ð î ð x Ô Ö Ù Ý Ú Ô à � ç Ü â { Ý à Ù å á� ã Ö Ò Ô Ö Ó Û á
Translation (Dari & Pashtoo) 2 $1 500 $3 000 BASICS
Printing (English, Pashtoo and Dari)
3 $1 000 $3 000 BASICS
Disseminate the National IYCF Policy and Strategy amongst all key stakeholders
PND staff &support costs MoPH
PND staff &support costs MoPH Regular updating of IYCF action plan and preparation of a resource mobilization plan
Technical assistance (4 months over 4 years)
4 $10 000 $40 000 � � � � � } ~ } � � í ë ë ë
ð î ñ � ó Ó Ü Ý Ø Ó Ý ×� Ô Ò � Ó Ö Ù Ú Û Ý × Ñ � ã
PND staff &support costs MoPH
Technical assistance (4 months over 4 years)
4 $10 000 $40 000 IBFAN, UNICEF?
Support to Committee est & regular meetings (2/year, 4 years)
8 $1 000 $8 000 UNICEF + IBFAN
Establishment and regular meetings of National Committee for the Enforcement of the Code
National meeting (2009) 1 $7 000 $7 000 UNICEF+IBFAN
PND staff &support costs MoPH Establish enforcement mechanisms � � � � � � � � � � � � � � � � �
IBFAN?
Translation (in English & Pashto)
� � � � � � � � � UNICEF
Printing costs (in dari & pashto)
� � � � � � � � �
Disseminate information on the Code and related legislation
PND staff &support costs MOPH
Training of Code monitors Annual trainings in 5 regions, each year
15 $4 000 $60 000 UNICEF
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -36
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Bi-annual field visits by provincial staff to each district (incremental coverage)
1 380 $200 $276 000 UNICEF + IBFAN
Annual visit by central level staff to each province (incremental coverage)
69 $500 $34 500
PND staff &support costs MoPH
Monitor Code implementation
BPHS/EPHS staff time BPHS donors � � � � � } ~ �
� � ñ � � ë ë
ð î � � Ô Ö Ó Ò Ú Ù Ö á ß Ò Ý Ö Ó å Ö Ù Ý Ú
PND staff & support costs MoPH Establish enforcement mechanisms & develop guidelines
Technical assistance 1 $10 000 $5 000
PND staff & support costs
Dissemination of info through media
1 $10 000 $10 000
Inform working women of their rights under the Maternity Protection Act
Sensitization workshops for employers (1/region/year, 4 years; 1 day)
20 $1 000 $20 000 � � � � � } ~ � � � � ë ë ë
ð î � � ç Ü â � ä Ù Ø Ó à Ù Ú Ó Õ
Develop IYCF guidelines International consultant 2 months
2 $10 000 $20 000
Translation (Dari and Pashto) 2 $1 500 $3 000 Disseminate guidelines and conduct trainings on their implementation
Publication costs (in Eng, Dari and Pashto) � � � � �� � � � � � � � ¡ ¢ � � � � £ ¤ ¥ ¦� � � � § ¨
3 $5 000 $15 000 BASICS, WHO, UNICEF? � � � � � } ~ ©
� � ª ë ë ë
ð î � � Ú × Ô Ú Ö Ô Ú Ø ç Ý ä Ú ÛÜ ó Ù à Ø â Ó Ó Ø Ù Ú Û Ù Úê Þ Ó Ò Û Ó Ú å Ù Ó Õ
Develop IFE Guidelines & integrate in IYCF guidelines
� � � � � � � � � � � � � � � � � � ¡ � � � � � � � � ¨ « � � � � � � � � �
Disseminate the IFE Guidelines & monitor application
« � � � � � � � � � � � � � � « � � � � � � � � � � ¬ � ò ð ® ¯ ° ° ¯ ± ±
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -37
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Ü Ý Þ ß Ý Ú Ó Ú Ö Õ v Õ Ö Ò Ô Ö Ó Û Ù åÔ ß ß Ò Ý Ô å ó Ó Õ w Ó Õ Ý ä Ò å Ó Õ Ú Ó Ó Ø Ó Ø æ á Ó Ô Ò ð è x ä Þ y Ó ÒÝ × ä Ú Ù Ö Õ z Ú Ù Ö å Ý Õ Ö Õ ò Þ Ý ä Ú Ö Ú Ó Ó Ø Ó Øæ Ö Ý Ö Ô à è { Ý Ö Ó Ú Ö Ù Ô àã Ý ä Ò å Ó Ý ×Õ ä ß ß Ý Ò Ö | � ~ ² � ³ � ´ � � � � � ³ � � � � � � � µ � ¶ñ î ð { ä y à Ù å ò · Ô Ò Ó Ú Ó Õ Õw Ô Ù Õ Ù Ú Û
PND staff time & support costs
MOPH
Material development
Dissemination through media
Transport costs
Implement the National Breastfeeding Communication Campaign (1 year: 2009-2010)
campaign staff costs?
$150 000 UNICEF & WHO
PND staff time & support costs
MOPH Celebrate World Breastfeeding Week
Materials and campaign implementation (lumpsum, 4 years)
4 $100 000 $400 000 UNICEF & WHO
PND staff time & support costs
MoPH
Technical assistance (1 international or national consultant, as per need, e.g. 6 months total)
6 $10 000 $60 000
Baseline KAP survey 1 $100 000 $100 000
Development of materials 1 $100 000 $100 000
Trainings on messages (1 training / region, 4 years)
20 $4 000 $80 000
Field work (staff & transport) in each province, 4 years
136 $4 000 $544 000
Dissemination through media 1 $100 000 $100 000
Expand to IYCF as a whole, and conduct regular IYCF awareness raising (2010-2013):
Impact monitoring survey 1 $100 000 $100 000
UNICEF, WHO, FAO, WFP
� � � � � � ~ } � ð í � � ë ë ë
�
PND staff & support costs MoPH ñ î ñ ê Õ Ö Ô y à Ù Õ ó Þ Ó Ú Ö Ý ×å Ý Þ Þ ä Ú Ù Ö á Õ ä ß ß Ý Ò ÖÛ Ò Ý ä ß Õ Ô Ú Ø Ù Ú Ö Ó Ò é Ó Ú Ö Ù Ý Ú Õ
Technical assistance (6 months total)
6 $10 000 $60 000
Design / review of training materials & job aids (Technical assistance) -team for 2 months
2 $3 000 $6 000
Translation (Dari & Pashto) 2 $1 000 $2 000
Develop training materials & job aids
Printing (Dari & Pashto) 2 $6 000 $12 000
BASICS, FAO, UNICEF, FAO, WHO, WFP (MDG-Fund)
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -38
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Training of IYCF counsellors and facilitators & provide resources
Regional trainings (2/year in each region, 4 years)
40 $4 000 $160 000
Regular assistance and monitoring
Field visists (1/district/2months)
7 140 $300 $2 142 000 ¸ � � � � � � � ¹ � � � � � � � § � � ¹ � � � �� � � � � � �
TOTAL 2.2. � ñ � ª ñ ë ë ë
ñ î � � Ú Ö Ó Û Ò Ô Ö Ù Ý Ú Ý × � ç Ü â Ù ÚÚ Ý Ú ì ó Ó Ô à Ö ó å Ý Þ Þ ä Ú Ù Ö á ìà Ó é Ó à Ù Ú Ö Ó Ò é Ó Ú Ö Ù Ý Ú Õ
PND / MAIL / MoE staff and support costs
MoPH/MAIL/MoE
Technical assistance (6 months over 4 years)
6 $10 000 $60 000
Establish pool of IYCF trainers in MAIL and train extension workers
Master trainings (3) and regional trainings (1/region/year for 3 years)
18 $4 000 $72 000
FAO, with support from UNICEF, WHO, and BASICS
Provincial trainings for field staff (1/province + refresher)
68 $4 000 $272 000 Integration of IYCF messages and participatory cooking sessions in agricultural projects
Monitoring visits (at least 1/district/year; incremental)
690 $300 $207 000
FAO, with UNICEF, WHO, and BASICS
Include IYCF in literacy curricula
Preparation of literacy materials / job aids / training materials
1 $200 000 $200 000
Train literacy teachers on IYCF
Provincial trainings for literacy teachers (1/District + refresher course)
660 $2 000 $1 320 000
FAO, Habitat, UNICEF � � � � � � ~ �
º � } � } » » » � ¬ � ò ñ
� í ð � ¼ ë ë ë Ü Ý Þ ß Ý Ú Ó Ú Ö Õ v Õ Ö Ò Ô Ö Ó Û Ù åÔ ß ß Ò Ý Ô å ó Ó Õ w Ó Õ Ý ä Ò å Ó Õ Ú Ó Ó Ø Ó Ø æ á Ó Ô Ò ð è x ä Þ y Ó ÒÝ × ä Ú Ù Ö Õ z Ú Ù Ö å Ý Õ Ö Õ ò Þ Ý ä Ú Ö Ú Ó Ó Ø Ó Øæ Ö Ý Ö Ô à è { Ý Ö Ó Ú Ö Ù Ô àã Ý ä Ò å Ó Ý ×Õ ä ß ß Ý Ò Ö | \ < S T U V @ J P = ] ^ _ ` = ] ^½ ¾ º e ¿ Ì ¶ Ç Ã ¿ Á Ç Á Â 9 Ë À È
Technical assistance (4 mo)
4 $10 000 $40 000 UNICEF, WHO?
PND staff and support costs
MOPH
Review lesson learned from current BFHI
External assessment of BFHI (incremental)
80 $1 000 $80 000 UNICEF, WHO
Develop tools to assess PND staff time MOPH � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -39
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �Technical assistance (2 months)
2 $10 000 $20 000 UNICEF, WHO
BFHI status
Print materials 1 $30 000 $30 000
PND staff time & support costs
MOPH Train pool of BF assessors/advocates at the central and regional level Trainings for assessors at
regional level (1 training/region/year, 4 yrs)
20 $4 000 $80 000 UNICEF, WHO
PND staff time MOPH
Provincial trainings (2/province)
68 $4 000 $272 000 UNICEF, WHO
Train health facility staff on BFHI
EPHS/BPHS staff time BPHS
PND staff time & support costs
MOPH
EPHS/BPHS staff time BPHS
Monitor facilities, conduct assessments / reassessments, and provide certificates
Monitoring visits (1/province/year; incremental)
80 $500 $40 000 UNICEF, WHO Á > I H ? \ < ;
L M Â � � � �
½ ¾ � È Ç Æ ¹ Ï ¾ ¶ Æ ¿ Á Ç Á Â È É Ê ËÍ Á Ä Ç Ã ¹ ¸ ¸ ¿ Ç Ï ¿ Ç ¶ ¸ ¸ Ð ¹ ¶ ¸ Æ ÐÂ ¶ Í ¿ ¸ ¿ Æ ¿ ¹ ÃÃ Ä Å Ä Æ Ç È É Ê Ë Ì Ä Æ Ë Í Ä Î Ç ÍÏ Ð Ñ Ò Ó Ç Ô Í Ä Ô Î Õ È Ö Ô × Ç ØÏ Ð Ñ Ò É Ê Ë Ì Ä Æ Ë Í Ä Î Ù Ö Ú Ç Å Ä Û Ü Ä Ä Ö Ú Ç Å Ä
Technical support to BPHS/EPHS partners by PND staff
MoPH
EPHS/BPHS staff time BPHS
Establish IYCF corners in health facilities & identify at least one IYCF referral center / province (training covered in 3.3)
2 visits in each facility for establishment (assessment and support)
3 420 $100 $342 000
PND staff time and support costs
MoPH
EPHS/BPHS staff time BPHS
Bi-annual field visits by provincial staff to each district (incremental coverage)
1 380 $200 $276 000
Ensure IYCF counselling is part of health education activities and management of acute malnutrition (training covered in 3.3)
Annual visit by central level staff to each province (incremental coverage)
69 $500 $34 500 Á > I H ? \ < O
L Â M � M � � � � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -
40
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �½ ¾ ½ µ ¾ ¶ ¿ Ç ¿ Ç Ï Á  Р¹ ¶ ¸ Æ ÐÃ Æ ¶   Á Ç È É Ê ËPND staff and support costs
Technical assistance 6 $10 000 $60 000
Material development 4 $20 000 $80 000
Integrate IYCF into the curricula of medical and paramedic education institutions
Training of trainers (for faculty professors; 4/year)
16 $4 000 $64 000
MoPH; UN MDG-Fund, Univ of Massachussetts
PND staff and support costs
MoPH
Technical assistance 4 $10 000 $40 000
Develop training packages and job aids on IYCF for different health staff categories
Material development 4 $20 000 $80 000
UNICEF, WHO, FAO, WFP
PND staff and support costs
MOPH
Regular MoPH training MoPH?
Integrate IYCF training modules as part of in-service trainings
Additional training to complement regular in-service training (1/province)
34 $4 000 $136 000 UNICEF, WHO, BASICS
PND staff and support costs
MOPH Train and establish pool of trainers at the national level and in “each region Training costs (1 training
year 1 + 3 refresher courses)
4 $4 000 $16 000 UNICEF, WHO, FAO
PND staff and support costs
MOPH Distribute printed material and job aids to all facilities transport costs 34 $800 $27 200 UNICEF,
WHO Á > I H ? \ < \
L M � ½ � � �
µ ¼ µ Î d ½
L º a º a a � � Ê ¼ b c d e µ e µ ¼ µ Î d
L f N � g � � �
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -41
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �
´ ¢ © « £ ¡ ù £ ¤ ¯ ± ¬ £ ³ Ý £ ÷ £ ¬ £ ô ¯ ¬ ¡ + £ ± ¬ £ ¡ ¥ # § ± ° £ ³ « ¤ § Þ ü Breastfeeding Counselling Training Package translated in Dari Baby-Friendly Hospital Initiative training package translated in Dari/Pashto Code of Marketing of Breast Milk Substitutes (2009) Translated in Dari/Pashto/English � K O T B I K C A N C X L M c z H D Q L D L G A } H L E O
(MAIL, MoPH, FAO, 2007) | O C M D K c N G G E x | C Y Y c i C d c x ß L W O M c N C X L M c { @ X Y Q G W O E ~ O R L Y O S C A E N O O E L A I P Q C R D L R O S B G QT B I K C A g G D K O Q S C A E J K L M E Q O A
(MAIL, MoPH, FAO, UNICEF, 2008), and relevant training materials (FAO) WHO/UNICEF Global Strategy on Infant and Young Child Feeding, translated in Dari and Pashto. ¡ ¤ ¯ ± ¡ £ ¤ ¬ § ¡ £ ± ¯ ¢ ¯ ± ¯ ¡ ² ¯ ³ üWHO/UNICEF Global strategy on Infant and Young Child Feeding (2002): http://www.who.int/nutrition/topics/global_strategy/en/ Code of Marketing of Breast Milk Substitutes (1981) http://www.who.int/nutrition/publications/code_english.pdf Operational Guidance on Infant and Young Child Feeding in Emergencies (IFE Core Group): http://www.ennonline.net/pool/files/ife/ops-guidance-2-1-english-010307.pdf
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -42
� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �
� � � � � & � � � ' � � � ( ) � � ( � � � � � � � � � � � ( * � � � � � � � � * � � � � � � � + , , -43
� / 5 � 6 4 � 4 $ 4 / $ 4 � � � 1 0 5 / % $ 1 ! 4 � " � Proportion of children born in the last 24 months
who were put to the breast within one hour of birth
Children born in the last 24 months who were put to the breast within one hour of birth Children born in the last 24 months
T E E L D L G A C M L A E L R C D G Q S X C c L A R M H E O {Children born in the last 24 months who were put to the breast within 24 hours of birth
Children born in the last 24 months
Children born in the last 24 months who received colostrum (not discarded) Children born in the last 24 months
� � � � ; % 4 � 0 5 / % $ 1 ! 4 � " ; � ! 5 % 4 � # � � $ ^ % �Proportion of infants 0-5 months of age
who are fed exclusively on breast milk
Infants 0-5 months who received only breast milk during the previous day Infants 0-5 months of age - § ¤ ¯ ü
Using the previous day recall period will overestimate the proportion of infants who are exclusively breastfed. Some infants who are given other liquids irregularly may not have received them the day before the survey. T A C E E L D L G A C M L A E L R C D G Q X C c L A R M H E O {` 5 ! � # 4 � / � $ 0 5 / % $ 1 ! 4 � " ; � ! 5 % 4 � # � � $ ^ % �
Proportion of infants 0-5 months of agewho have breast milk as their main source of nourishment. This indicator recognizes that the infant receives certain liquids (water, tea, watery liquids, ritual fluids).
Infants 0-5 months of age who received breast milk as a main source of nourishment Infants 0-5 months of age \ � $ 5 � ! ; � $ 4 � � � 1 % � � 4 ! � % # 4 � % � � 4 ! � 5 % � 1 $ 1 � � ! % � 2 � # u � # � $ / 5 6 1 ! 4 � " � �
Proportion of infants 6-8 months of age who receive solid, semi-solid or soft foods
Infants 6-8 months of age who ate solid, semi-solid or soft foods in the previous day Infants 6-8 months of age
2 � � $ 4 � ; ! 0 5 / % $ 1 ! 4 � " / $ � � 6 / 5 � Proportion of children 12-15 months of age
who are fed breast milk
Children 12-15 months of age who were fed breast milk in the previous day Children 12-15 months of age
2 � � $ 4 � ; ! 0 5 / % $ 1 ! 4 � " / $ $ � � 6 / 5 % � Proportion of children 20-23 months of age
who are fed breast milk
Children 20-23 months of age who were fed breast milk in the previous day Children 20-23 months of age