1 November 2012

In Kenya, MCHIP is implementing an integrated approach to health, incorporating family planning services, oral rehydration therapy (ORT), breastfeeding, and iron supplementation into a holistic program for maternal and child health and nutrition. This approach is fostering improved cooperation and programmatic effectiveness, and integration of health services is critical to ensuring that timely messaging reaches target populations in resource-constrained settings.

Family Planning
Integrating maternal, infant and young child nutrition and family planning (MIYCN-FP) can be mutually beneficial for mothers and their children, and has been shown to increase coverage, access and availability of both FP and MIYCN services. In Kenya, the Ministry of Public Health and Sanitation (Division of Nutrition and Division of Reproductive Health), with support from MCHIP, has conducted advocacy around integration of MIYCN-FP and developed a model for implementing an integrated MIYCN-FP package. Behavior Change Communication (BCC) materials with key messages were developed and pre-tested. Based on feedback, counseling materials were reviewed and field-tested in Bondo District, Nyanza Province, and training of health workers and community health workers was provided as well as ongoing supportive supervision to monitor and assess the process of integration.

A “One-Stop Shop” approach has been adopted in the target facility to enable clients accessing mother and child services during the child welfare clinic and antenatal, delivery and postnatal visits to receive critical integrated MIYCN-FP messages and services. At the community level, MIYCN-FP messages and community FP are included within routine community outreach activities, including community health worker home visits, community dialogue sessions, mother support groups, and health action days. The BCC materials, including counseling cards, brochures, and posters, are used to support integration efforts, and serve to complement existing community-level reproductive health and nutrition materials. This pilot will continue in the next coming year and will focus on evaluation and scale-up

MCHIP will conduct an evaluation of the integration process and will document the inputs and processes required for effective integration of MIYCN and FP. The Program will support the finalization, printing and distribution of the integration tools, development of the supportive supervision tools, and adaptation and reproduction of training materials, and share these results with partners. Based on the best practices identified and lessons learned from these pilot activities, MCHIP will work with the Division of Reproductive Health, the Division of Nutrition and the APHIAplus programs to design a plan for scaling up MIYCN and FP integration at the national level.

Infant and Young Child Feeding at Health Centers and in the Community
The MCHIP/Kenya team has also supported the Divisions of Nutrition and Child and Adolescent Health to pilot the integration of nutrition messages into ORT corners. This strategy allows mothers to access ORT, a simple, low-cost method for hydrating and protecting infants and young children from mortality due to diarrhea, as well as information on how to optimally feed their child. Combined information is provided to optimize the time that mothers spend waiting for maternal and child health services.

Diarrhea is the single greatest cause of death for children under five, mainly due to dehydration and related complications. Frequent diarrhea in children is associated with acute malnutrition due to poor feeding practices during and after illness; therefore, nutrition education is imperative to ensuring comprehensive care and support. Mothers now have access to education materials on feeding their child who is receiving ORT and zinc, and after diarrhea subsides.

To strengthen community-level support for infant and young child feeding, MCHIP supported the Division of Nutrition to develop the National Comprehensive MIYCN Operational Guidelines and the Baby Friendly Community Initiative (BFCI) package. The BFCI package is comprised of a monitoring tool and assessment protocols, and is based on the principles of the Baby Friendly Hospital Initiative “Ten Steps.” The BFCI package extends these principles to include health services at the dispensary, health center, and community levels in order to provide women with a comprehensive support system to improve breastfeeding rates. The BFCI also supports the MIYCN policies and guidelines for protection, promotion and support of breastfeeding in the community, and involves the implementation of the “Seven Point Plan” and compliance with the International Code of Marketing of Breast Milk Substitutes. Moreover, BFCI supports optimal feeding during the 6-23 month period, including complementary feeding and continued breastfeeding.

This package enables health workers—including those at the community level—to effectively counsel mothers on exclusive breastfeeding during the first six months, and to encourage mothers to practice optimal complementary feeding and to continue breastfeeding from six months through two years (and beyond). MCHIP has tested the roll-out of the BFCI package and will continue working with the Division of Nutrition to scale it up at a national level.

MIYCN in Social Media
The MCHIP/Kenya team utilized multiple platforms to ensure that key populations receive targeted messaging on nutrition. This year, MCHIP supported the Division of Nutrition to develop the “Let’s Talk Breastfeeding, Kenya” Facebook page with the goal of providing Facebook users with information regarding World Breastfeeding Week activities and educational resources surrounding benefits and best practices for breastfeeding.

The page also encouraged participatory learning and interactive dialogue: each day, a question was posted related to a theme and hints were posted throughout the day, including photo guides, informational pamphlets, links to videos, and other valuable resources. At the end of the day, the question was answered. Throughout the week, photos and other opinions were solicited, and news from World Breastfeeding Week activities in Kenya was shared with users.

"Let's Talk Breastfeeding, Kenya" was highly successful, achieving more than 400 “likes” and reaching more than 12,000 people. Topics included: how to breastfeed as a working mother; the role of the father in supporting breastfeeding; and common myths and misconceptions about breastfeeding. Messaging related to breastfeeding with HIV/AIDS was also provided. MCHIP will continue supporting the Facebook site as a platform for providing critical nutrition information and encouraging dialogue.

MIYCN into Law
Together with Kenya nutrition partners and the Division of Nutrition, MCHIP achieved a long-awaited goal—the provision of safe infant nutrition within a legal framework. On 20 September 2012, the Kenyan Parliament passed the “Breast-milk Substitutes (Regulation and Control) Bill, 2012,” a piece of national legislation that promotes, protects and supports mothers in Kenya to exclusively breastfeed during their infant’s first six months, and who provide the best local foods from six months through two years of age to help their child grow, develop and survive.

The Bill will regulate the marketing of breast milk substitutes to promote and protect breastfeeding. By moving forward with this critical area of legislation, the Kenya government has demonstrated its commitment to providing the maximum care for newborns, infants and young children through related health sector policy guidance. Moreover, the government is helping to ensure the right information is reaching mothers, parents and communities. MCHIP will continue supporting the drafting the regulations and implementation plans.

Way Forward
The MCHIP/Kenya team is leading the way in integrating nutrition into maternal and child health programs, and provides a useful model for local adaptation and scale-up in related settings. By making multiple services available in the same location on a single visit, MCHIP is maximizing opportunities for a greater impact of effective solutions for improved health.