The revitalization and scale‐up of the Baby‐Friendly Hospital Initiative in Malawi

Abstract

The Baby‐Friendly Hospital Initiative (BFHI) has shown to strengthen health providers' skills in the provision of breastfeeding counselling and support, which have led to improvements in breastfeeding outcomes. In Malawi, where BFHI was introduced in 1993 but later languished due to losses in funding, the Maternal and Child Survival Program supported the Malawi Ministry of Health (MOH) in the revitalization and scale‐up of BFHI in 54 health facilities across all 28 districts of the country. This paper describes the revitalization and scale‐up process within the context of an integrated health project; successes, challenges, and lessons learned with BFHI implementation; and the future of BFHI in Malawi. More than 80,000 mothers received counselling on exclusive breastfeeding following childbirth prior to discharge from the health facility. Early initiation of breastfeeding was tracked quarterly from baseline through endline via routine MOH health facility data. Increases in early initiation of breastfeeding were seen in two of the three regions of Malawi: by 2% in the Central region and 6% in the Southern region. Greater integration of BFHI into Malawi's health system is recommended, including improved preservice and in‐service trainings for health providers to include expanded BFHI content, increased country financial investments in BFHI, and integration of BFHI into national clinical guidelines, protocols, and nutrition and health policies.

Barriers and Facilitators to the Implementation of Large-Scale Nutrition Interventions in Africa: A Scoping Review

“…Additionally, language barriers between implementors and program users were cited in two studies as a barrier to implementation (Carroll et al 2019;Kavle et al 2019a). Certain words and phrases can be lost in translation, hindering users' understanding of the nutrition programming, which significantly reduces intervention accessibility (Kavle et al 2019b). However, linguistic sensitivity was also cited as an enabler, where Carroll et al (2019) stressed the importance of developing communication materials in various local languages in order to maximize program implementation.…”

Facility readiness and counseling during antenatal care and the relationship with early breastfeeding in Haiti and Malawi

“…Similar to Haiti, babies born to mothers of lower wealth or lower educational attainment were more often breastfed in the first hour compared with highest socio-economic characteristics. The Malawi government was an early adopter of the BFHI in 1993 [34]. Through the 2007-12 Malawi National Nutrition Policy and Strategic Plan and subsequent 2018-2022 National Multi-Sector Nutrition Policy, the government outlined its multisectoral response to address malnutrition, including promotion of optimal breastfeeding at the facility, community, and household levels [35,36].…”

“…Through the 2007-12 Malawi National Nutrition Policy and Strategic Plan and subsequent 2018-2022 National Multi-Sector Nutrition Policy, the government outlined its multisectoral response to address malnutrition, including promotion of optimal breastfeeding at the facility, community, and household levels [35,36]. By 2008 almost 5 % of facilities were ever certified, but a 2015 evaluation of facilities revealed there were no longer any BFHI certified facilities in the country [34,37]. Although funding constraints hampered the implementation of the BFHI in the mid-2000's, recently the government has refocused on strengthening the BFHI including certification of facilities [34].…”

“…By 2008 almost 5 % of facilities were ever certified, but a 2015 evaluation of facilities revealed there were no longer any BFHI certified facilities in the country [34,37]. Although funding constraints hampered the implementation of the BFHI in the mid-2000's, recently the government has refocused on strengthening the BFHI including certification of facilities [34].…”

Integrating nutrition services into health care systems platforms: Where are we and where do we go from here

“…Another mixed‐methods implementation research study in the Democratic Republic of Congo was designed to understand how to best integrate nutrition‐specific actions into iCCM (Kavle, Pacqué, et al, ). This was done by identifying cultural beliefs, family/community influences, and perceptions of infant and young child feeding and child illness.…”