Background Youth friendly services, an evidence based approach to overcome the barriers experienced by youths in accessing care, is poorly implemented. The Medical Women's Association of Nigeria (MWAN) Rivers State chapter, was supported by Ford Foundation to mainstream youth-friendly health services (YFHS) into existing primary health care facilities in two hard-to-reach communities. This paper presents the interventions, findings, challenges and recommendations. Methods This study project was implemented in stages: design, baseline survey, interventions and evaluation, between 2014 and 2016. Interventions included facility modifications, health worker capacity building, school and community outreaches, peer group activities, and interpersonal communication. Pre-and-post-intervention surveys were carried out among in- and out-of-school youths to determine the effects of the interventions. Results The most commonly stated barriers to uptake of youth friendly health services included: unavailability of services (154; 33.1%), unavailability of health care workers (167; 38.9%), unaffordability of services (108; 45.8%) and difficulty in communicating with health workers (85; 36.0%). Post-intervention, utilization improved across all services while the perception of barriers to utilization of services reduced (p < 0.05). The interventions implemented increased the odds of youths utilizing YFHS 1.81 times (95% CI = 1.39-2.37). Conclusion Facility modifications, capacity building of health workers, school and community outreaches, peer group activities, and interpersonal communication improved utilization across all services while the perception of barriers to utilization of services reduced. Implementation of YFHS is impacted by external factors often beyond the control of project implementers. Innovative solutions outside of routine health care delivery systems are critical for success. Further evaluation to explore the effect of these interventions is needed. Strengthening of health systems remains a vital strategy for scale-up of YFHS.

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Background: As part of Nigeria’s effort to attain the targets of the 1990 Innocenti Declaration, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. The 2005 Innocenti Declaration reiterated the need for the Initiative by asking governments to “revitalize” it and maintain “the Global Criteria as the minimum requirement for all facilities”. The Nigerian government adopted the Initiative and in response to the national directive for tertiary health facilities to become Baby Friendly, the University of Port Harcourt Teaching Hospital (UPTH) established its BFHI Committee in 1992, with a multi-departmental and multi-disciplinary membership. Although the Baby Friendly Hospitals designated following this directive have largely not been reassessed, the BFHI Committee of the UPTH has remained active, implementing relevant activities at the facility and within and outside Rivers State. Aims: To share experiences with sustaining BFHI activities without adequate support in a tertiary health facility with a goal to stimulating commitment to the establishment and sustenance of similar committees in similar health facilities. Place and Duration of Study: University of Port Harcourt Teaching Hospital, Nigeria; 27 years. Methodology: From the inception of the Committee, an administrative structure comprising of the Steering Committee and its Chairman, the Coordinator and Secretary was set up. Information on the activities of the Committee was extracted from the reports of activities, Minutes of Meetings and other publications of the Committee. These were analysed for presentation.  Results: Established in 1992 to drive the hospital’s mandate to become Baby Friendly, the Committee has sustained the efforts to promote, protect and support breastfeeding through capacity development, provision of technical support to Departments and facilities, promotion of research and support of the implementation of the Ten Steps to Successful Breastfeeding, the International Code of Marketing of Breast milk Substitutes, HIV and Infant Feeding Counselling, Facility Based Management of Severe Acute Malnutrition and others. Some of the achievements of the Committee during the period 1992-2019 are: Sustained implementation of activities in support of the Ten Steps to Successful Breastfeeding (operating the Crèche, Mother’s Room, Nutrition Clinic and Breastfeeding Room in the Special Care Baby Unit, Nutrition education and the distribution of Information, Education and Communication materials on breastfeeding and the Code). Celebration of the World Breastfeeding Week and mobilization of stakeholders to celebrate the Week since 1997. Awareness creation on the Code for improved compliance within and outside Rivers State Integration of breastfeeding education into the curricula of health workers The Conduct of the 2015 World Breastfeeding Trends Initiative Assessment in Nigeria Challenges: include changes in leadership with some leaders not showing commitment to the mandate of the Committee; Lack of funds, lack of dedicated staff for breastfeeding promotion in the hospital and pressure from infant food industries. Conclusion: Successful and continued implementation of the Baby Friendly Hospital Initiative with its expansion to the BFH Community Initiative will contribute to improved breastfeeding practices and therefore the attainment of the global nutrition targets. While mitigating the challenges to effective implementation of the Committee’s activities, tertiary health facilities should reposition themselves to promote, protect and support the initiative for the realization of relevant global nutrition targets.

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