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Baby Friendly Multicenter Needs Assessment Survey

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MCH/MoHP-MCFC-UNICEF BFHI Muti-Center Needs Assessment Survey, 2016 BABY FRIENDLY HOSPITAL INITIATIVE MUTICENTER NEEDS ASSESSMENT SURVEY (BFHI-MAS) Breastfeeding Promotion, Protection and Support UNICEF/WHO BABY FRIENDLY HOSPITAL INITIATIVE Revised Updated and Expanded for Integrated Care General Department of Motherhood & Childhood Care in Ministry of Health & Population Mother Child Friendly Care Association (MCFC) UNICEF, Egypt - Cairo Office ∭∭∭ COLLABORATING PARTNERS: Alexandria Health Directorate Benha Faculty of Medicine & Qaluibiya Health Directorate Sohag Faculty of Medicine & Sohag Health Directorate Egyptian Medical Women Association (EMWA) with Gharbia MCH/MoHP EGYPT, 2016 Page 1 MCH/MoHP-MCFC-UNICEF BFHI Muti-Center Needs Assessment Survey, 2016 PREFACE This research was initially proposed by MCFC to the Department of MCH/MoHP and UNICEF, Cairo office, as an exercise to identify, through mock assessments, the hospitals and health centers that were ready for final assessment for designation as Baby Friendly as MCFC had a team of International Board Certified Lactation consultants some of whom were also designated national assessors. However it was the wish of the officials in MCH/MoH to identify the needs of hospitals and MCH centers to become Baby Friendly health facilities, as a follow-up of the survey conducted in 2008 (MCH- MoH/ELCA/UNICEF, 2010). The survey was inspired by UNICEF/ECO’s support, motivation and facilitation throughout the work. MCFC started off initially with three governorates: Qaluibiya, Alexandria and Sohag then added Gharbia governorate (only 4 hospitals and affiliated MCH units). We then formed partnerships with the universities in each governorate. We partnered with Benha University Faculty of Medicine in Qaluibiya and Sohag University Faculty of Medicine, community department in Sohag governorate, while utilized our own IBCLCs and national BFHI assessors in Alexandria and Gharbia governorates. The Egyptian Medical Woman Association (EMWA) assisted in the survey of health facilities in Gahrbia and Qaluibiya by their experts in Baby Friendly assessments. The central department of MCH/MoH was very supportive in facilitating and participating in the work. They were involved from the very start in the review of the tools and in training and orientation meetings of the investigators. At Health directorate level, the Undersecretary of Health in the governorate and the local MCH director conducted orientations to the directors of the hospitals and district health officers to prepare them for the survey and for expecting the field surveyors and facilitating their work. These meetings also oriented the staff to the Ministerial Decree (36/2014) released for urging all hospitals to become Baby Friendly by implementing the Ten Steps and complying to the International Code of Marketing of Breastmilk substitutes. Later the MCH/MoH directors in each governorate facilitated the field visits and the wrap-up dissemination and planning workshops conducted at the end of the survey. Three wrap-up workshops were conducted in each governorate with the officials of the health directorate in the hospitals and MCH centers in each governorate for disseminating the results of the survey and planning improvement in each facility. Both the public and private sector were represented in the meetings. The officials actively participated in formulating policies, plans for education and training as well strengthening the community component by the MCH centers and developing indicators for monitoring and evaluation. The exercise motivated all the staff and is expected to pave the way for driving the implementation and designation process to scale at governorate and national level. We would like to express our gratitude to all the officials in the various departmental sectors in the Ministry of Health and the clinical and non-clinical staff and mothers who facilitated and supported this work, their contribution, commitment and dedication was the foundation for this work. This work is dedicated to their babies and to the joy and peace breastfeeding will bring to their lives and to the world. MCFC Board of Directors, 2016 Page 2 MCH/MoHP-MCFC-UNICEF BFHI Muti-Center Needs Assessment Survey, 2016 TABLE OF CONTENTS List of Tables 5 Step 10 83 List of Figures 9 Mother Friendly 91 Executive Summary 13 Compliance to Code 97 Introduction 20 Section II: MCH Survey 103 Status of Baby Friendly criteria Aim of the Study 22 Step 1 103 Methodology 23 Step 2 105 Section I: Hospital Survey 27 Step 3 107 Status of BFHI global 27 Antenatal education in 109 criteria in hospitals: Mother Friendly Step 1 34 Step 5 111 Step 2 39 Step 6 113 Step 4 45 Conclusions and 115 Recommendations Step 5 53 References 118 Step 6 63 List of Participants 120 Steps 7,8 & 9 71 Arabic Summary Page 3 MCH/MoHP-MCFC-UNICEF BFHI Muti-Center Needs Assessment Survey, 2016 LIST OF ABBREVIATIONS ALX: Alexandria governorate BFHI: Baby Friendly Hospital Initiative BMS: Breastmilk substitutes C: criteria CME: continued medical education Code: International Code of Marketing of Breastmilk Substitutes C-S: cesarean section delivery DH: District Hospital EBM: expressed Breastmilk EPI: Expanded program of Immunization FHSTS: first hour Skin-to-skin FP: Family Planning GH: General hospital GHB: Gharbia governorate IMCI: Integrated Management of Childhood Illness IMF: Infant milk formula KMC: Kangaroo Mother care MCH: Maternal and Child Health MF: Mother Friendly practices NCU: neonatal care units NVD: normal vaginal delivery Ped. H : Pediatric Hospital PHC: primary health care QAL: Qaluibiya governorate Sg: Sohag governorate STS: Skin to skin UNICEF: United Nation International Children’s Emergency Fund WHO: World Health Organization Page 4 MCH/MoHP-MCFC-UNICEF BFHI Muti-Center Needs Assessment Survey, 2016 LIST OF TABLES Table (1) List of hospitals assessed for needs in each governorate. 27 Table (2) List of hospitals in each governorate by exposure to training and date of training in Baby Friendly 20 hour course. 28 Table (3) Total number of deliveries by region over the past year in the targeted hospitals. 29 Table (4) Total number of staff working in the targeted hospitals by category in each 31 governorate. Table (5) Count of mothers and staff interviewed by category in each district of Sohag governorate. 32 Table (6) Count of mothers and staff interviewed by category and district in Qaluibiya governorate. 32 Table (7) Count of mothers and staff interviewed by category in the hospitals and districts in Alexandria governorate. 33 Table (8) Distribution of interviews conducted by category of population and geographic area. 33 Table (9) Distribution of the scores of Baby Friendly criteria for Step (1) according to the adapted BFHI global criteria in the hospitals providing maternity services in Sohag governorate. 34 Table (10) Distribution of the scores of Baby Friendly criteria for Step (1) according to the adapted BFHI global criteria in the hospitals providing maternity services in Qaluibiya governorate in Egypt. 35 Table (11) Distribution of the scores of Baby Friendly criteria for Step (1) according to the adapted BFHI global criteria in the hospitals providing maternity services in Alexandria governorate in Egypt. 35 Table (12) Comparison of the scores of Baby Friendly (BFHI) global criteria for Step (1) for the hospitals providing maternity and neonatal services in Alexandria, Gharbia, Qaluibiya and Sohag governorates in Egypt. 36 Table (13) Comparison of the scores of Baby Friendly (BFHI) global criteria for Step (1) for hospitals providing maternity and neonatal services in those exposed to training versus those not recently exposed to any training in Baby Friendly. 37 Table (14) Distribution of the scores of Baby Friendly criteria for Step (2) according to the adapted BFHI global criteria in the hospitals providing maternity services in Sohag governorate. 39 Table (15) Distribution of the scores of Baby Friendly criteria for Step (2) according to the adapted BFHI global criteria in the hospitals providing maternity services in Qaluibiya governorate in Egypt. 40 Table (16) Distribution of the scores of Baby Friendly criteria for Step (2) according to the adapted BFHI global criteria in the hospitals providing maternity services in Alexandria governorate in Egypt. 40 Table (17) Comparison of the scores of Baby Friendly (BFHI) global criteria for Step (2) for the hospitals providing maternity and neonatal services in Alexandria, Gharbia, Qaluibiya and Sohag governorates in Egypt. 41 Table (18) Comparison of the scores of Baby Friendly (BFHI) global criteria for Step (2) for hospitals providing maternity and neonatal services in those exposed to training versus those not recently exposed to any training in Baby Friendly. 42 Table (19) Distribution of the scores of Baby Friendly criteria for Step (4) according to the adapted BFHI global criteria in the hospitals providing maternity services in Sohag governorate. 46 Page 5 MCH/MoHP-MCFC-UNICEF BFHI Muti-Center Needs Assessment Survey, 2016 Table (20) Distribution of the scores of Baby Friendly criteria for Step (4) according to the adapted BFHI global criteria in the hospitals providing maternity services in Qaluibiya governorate in Egypt. 47 Table (21) Distribution of the scores of Baby Friendly criteria for Step (4) according to the adapted BFHI global criteria in the hospitals providing maternity services in Alexandria governorate in Egypt. 48 Table (22) Comparison of the scores of Baby Friendly (BFHI) global criteria
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