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. 2019 Jan;15 Suppl 1(Suppl 1):e12747.
doi: 10.1111/mcn.12747.

Baby-Friendly Community Initiative-From national guidelines to implementation: A multisectoral platform for improving infant and young child feeding practices and integrated health services

Justine A Kavle  1 , Brenda Ahoya  2 , Laura Kiige  3 , Rael Mwando  4 , Florence Olwenyi  5 , Sarah Straubinger  1 , Constance M Gathi  6
Affiliations

Baby-Friendly Community Initiative-From national guidelines to implementation: A multisectoral platform for improving infant and young child feeding practices and integrated health services

Justine A Kavle et al. Matern Child Nutr. 2019 Jan.

Abstract

The Baby-Friendly Community Initiative (BFCI) is an extension of the 10th step of the Ten Steps of Successful Breastfeeding and the Baby-Friendly Hospital Initiative (BFHI) and provides continued breastfeeding support to communities upon facility discharge after birth. BFCI creates a comprehensive support system at the community level through the establishment of mother-to-mother and community support groups to improve breastfeeding. The Government of Kenya has prioritized community-based programming in the country, including the development of the first national BFCI guidelines, which inform national and subnational level implementation. This paper describes the process of BFCI implementation within the Kenyan health system, as well as successes, challenges, and opportunities for integration of BFCI into health and other sectors. In Maternal and Child Survival Program (MCSP) and UNICEF areas, 685 community leaders were oriented to BFCI, 475 health providers trained, 249 support groups established, and 3,065 children 0-12 months of age reached (MCSP only). Though difficult to attribute to our programme, improvements in infant and young child feeding practices were observed from routine health data following the programme, with dramatic declines in prelacteal feeding (19% to 11%) in Kisumu County and (37.6% to 5.1%) in Migori County from 2016 to 2017. Improvements in initiation and exclusive breastfeeding in Migori were also noted-from 85.9% to 89.3% and 75.2% to 92.3%, respectively. Large gains in consumption of iron-rich complementary foods were also seen (69.6% to 90.0% in Migori, 78% to 90.9% in Kisumu) as well as introduction of complementary foods (42.0-83.3% in Migori). Coverage for BFCI activities varied across counties, from 20% to 60% throughout programme implementation and were largely sustained 3 months postimplementation in Migori, whereas coverage declined in Kisumu. BFCI is a promising platform to integrate into other sectors, such as early child development, agriculture, and water, sanitation, and hygiene.

Keywords: baby friendly; breastfeeding; infant and young child feeding; multisectoral; process documentation; programme implementation.

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Conflict of interest statement

The authors declare that they have no conflicts of interest. USAID provided review of the manuscript, and authors had intellectual freedom to include feedback, as needed.

Figures

Figure 1
Figure 1
Timeline of BFCI implementation
Figure 2
Figure 2
Baby‐Friendly Community Initiative (BFCI) conceptual framework
Figure 3
Figure 3
Progress in breastfeeding indicators and BFCI coverage, by month, Kisumu County, October 2016 to December 2017, source: MOH BFCI monitoring data. Monthly sample sizes varied and children reached for BFCI monitoring were dependent on case load of CHVs, number of households visited, and amount of time spent per household according to number of health issues/challenges discussed. For Kisumu, additional CUs (8) were added in 2017, as BFCI was rolled out (see text for detail).
Figure 4
Figure 4
Progress in breastfeeding indicators and BFCI coverage by month, Migori County, October 2016 to December 2017, source: MOH BFCI monitoring data
Figure 5
Figure 5
Progress in complementary feeding indicators by month, Kisumu County (October 2016–December 2017) source: MOH BFCI monitoring data
Figure 6
Figure 6
Progress in complementary feeding indicators by month, Migori County (October 2016–December 2017) source: MOH BFCI monitoring data
Figure 7
Figure 7
Coverage of BFCI, Kenya, January 2018, source: DHIS2
See this image and copyright information in PMC

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