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Baby-friendly Hospital Initiative Training Materials (updated 2009)

Final version for country implementation

© UNICEF Ethiopia/2006/Getachew
Messelech Meteka has brought her 15- month-old daughter Shurube to the Manche Health Centre in Ethiopia’s Sidama Zone for a weekly nutritional screening and medical check-up.

The Baby-friendly Hospital Initiative (BFHI) was launched by UNICEF and WHO with the development of the guidelines for country and hospital level implementation, Global Criteria and assessment tools in 1992. The original 18-hour course was developed in support of the BFHI in 1993. This course assisted many health facilities to implement supportive practices and to move towards Baby-friendly designation.

Baby-friendly practices continue to be an important component of national and global infant feeding strategies. There is new information on the critical importance of breastfeeding and the practices to support it, particularly in emergencies and the HIV pandemic. There is increased recognition of the importance of competency-based education and the need for participants to understand what they can and cannot do as a result of this training. The BFHI materials have all been updated and revised based on a decade of accumulated knowledge and experience and the new developments.

The current BFHI package includes:

Section 1: Background and Implementation, which provides guidance on the revised processes and expansion options at the country, health facility, and community level, recognizing that the Initiative has expanded and must be mainstreamed to some extent for sustainability, and includes:

1.1 Country Level Implementation
1.2 Hospital Level Implementation
1.3 The Global Criteria for BFHI
1.4 Compliance with the International Code of Marketing of Breastmilk Substitutes
1.5 Baby-Friendly Expansion and Integration Options
1.6 Resources, References and Websites

Section 2: Strengthening and sustaining the Baby-friendly Hospital Initiative.
Section 2 is an 8 session course which aims to orient hospital decision and policy-makers on the BFHI and gain their commitment on achieving and sustaining BFH status. It contains PowerPoint slides including materials for use in areas with high HIV prevalence. Section 2 contains the following documents:
» 2.1 The national infant feeding situation
» 2.2 Benefits of breastfeeding
» 2.3 The Baby-friendly Hospital Initiative
» 2.4.a The scientific basis for the "Ten steps to successful breastfeeding"
» 2.4.b The scientific basis for the "Ten steps to successful breastfeeding" for settings with high HIV prevalence
» 2.5.a Becoming "baby-friendly"
» 2.5.b Becoming "baby-friendly" in settings with high HIV prevalence
» 2.6 Costs and savings
» 2.7 Appraising policies and practices
» 2.8 Developing action plans 

Section 3: Breastfeeding Promotion and Support in a Baby-friendly Hospital, which is a 20-hour course for maternity staff that can be used by facilities to strengthen the knowledge and skills of their staff towards successful implementation of the Ten Steps to Successful Breastfeeding. This section includes:

3.1 and 3.2 Guidelines for Course Facilitators including a Course Planning Checklist and Outlines of Course Sessions
3.3 Slides for the Course

This course is also suitable for integration into pre-service training so that students are prepared with the knowledge and skills to support breastfeeding when they begin work. However, this course is not designed to train specialists in breastfeeding or in lactation management, but rather to provide basic skills, including sufficient knowledge to recognize the need for referral to a trained and skilled lactation consultant or HIV/infant feeding counselor.

Section 4: Hospital Self-Appraisal and Monitoring, which provides tools that can be used by managers and staff initially to determine whether their facilities are ready to apply for external assessment and once their facilities are designated Baby-Friendly, to monitor continued adherence to the Ten Steps. This section includes:

4.1 Hospital Self-Appraisal Tool
4.2 Guidelines and Tool for Monitoring

Section 5: External Assessment and Reassessment can be obtained by contacting UNICEF and WHO Headquarters and country offices. It provides guidelines and tools for external assessors to use initially to assess whether hospitals meet the Global Criteria and thus fully comply with the Ten Steps, and then to reassess on a regular basis whether they continue to maintain the required standards.  Section 5 is restricted to members of National Breastfeeding or BFHI Steering Committees and/or certified National BFHI assessors. Section 5 includes PowerPoint slides to use when training new assessors and a computer tool that can be used to calculate and present the assessment results.  This section includes:

5.1 Guide for Assessors
5.2 Hospital External Assessment Tool
5.3 Guidelines and Tool for External Reassessment

The new set of materials is offered for consideration for country implementation. Section 1 (Background and Implementation) offers new approaches for country and hospital implementation, emphasizing sustainability and options for expansion and integration. In addition, significant changes have been made to the training materials. Section 2 (the course for decision-makers) has been updated to focus on the revised BFHI materials, includes new research results and offers guidance for implementing BFHI in settings of high HIV prevalence. Section 3 (the course for maternity staff) has updated technical information and additional clinical practice sessions and includes an emphasis on supportive practices during labour and birth, skin-to-skin contact, preparation for discharge, HIV considerations, and working towards Baby-Friendly status. Section 4 (the hospital self-appraisal and monitoring tools) includes the revised Global Criteria, a strengthened self-appraisal tool and a range of monitoring tools for consideration. Section 5 (the external assessment and reassessment tools) has revised data gathering tools, new modules focused on The Code, HIV, and “mother-friendly” labour and birth, PowerPoint slides for training assessors and a computer tool for calculating and presenting results.

While these materials are now ready for Country-level implementation, comments are most welcome. To contact UNICEF, send an e-mail to pdpimas@unicef.org (with subject: nutrition). Contact WHO at nutrition@who.int or visit the WHO Website.



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