Programs promoting optimal infant and young child nutrition could prevent a fifth of under five deaths in countries with high mortality. Effective strategies to improve infant and young child feeding practices are needed. This study was designed to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative recommended by the World Health Organization (WHO) to promote optimal infant and young child feeding practices. The study set out to primarily determine practicality and usefulness of BFCI as outlined in the Kenyan implementation guidelines, with regards to exclusive breastfeeding in the first six months after delivery, within a rural Kenya setting. The study was conducted in Koibatek, Baringo County between 2014 and 2016.

Key achievements

• Vitamin A supplementation coverage was improved from the home based counselling of breastfeeding mothers by community health volunteers
• Improved health seeking behaviour of community members leading to demand for services
• Decreased immunization defaulting
• Significant reduction of diarrhoea, acute respiratory infections and other common childhood illnesses
• Increased hospital deliveries
• Increased the number of mothers attending at least 4 recommended ante natal clinics
• Increased the number of children receiving all the recommended vaccines up to the age of 6 months
• Increase in the number of mothers using ANC iron and Folate supplementation recommended for pregnant women
• Increased exclusive breastfeeding rates
• Documentation by CHVs increased to almost 100% as well as attendance at continuous medical education
• Improved male involvement in child care practices for instance husbands/partners accompanying mothers to health facilities for immunization or health care seeking
• Attitude change where traditional birth attendants and herbalists converted to breastfeeding champions, birth companions  and advocates of hospital-based delivery
• Economic empowerment of community health workers implementing income generating activities in their community units
• Change in attitude of health care workers who became more friendlier to pregnant and breastfeeding women seeking ante natal, delivery and post-natal services
• Identification of over 100 breastfeeding champion mothers who model correct breastfeeding practices to new mothers

At the national level:

• Contributed to development of National BFCI implementation guidelines
• Contributed to development of BFCI training package
• Contributed to development of BFCI communication and advocacy materials
• Contributed to development of BFCI assessment and monitoring tools
• Contributed to development of BFCI external assessment protocols
• Contributed to the development of maternal infant and young child nutrition counselling cards

Main lessons:

• BFCI is a low cost intervention
• It drives a community’s accountability for their own health, that is, demand for services at health facilities
• Integration within the already established system, that is, the government’s community health strategy is a useful strategy
• Mentorship and support supervision is a powerful tool for success
• Involvement of nutrition sensitive sectors including agriculture, women’s empowerment, education, workplace support for mothers etc. is a plus for the success of the initiative.
• Data collection and documentation for community level activities is key to success
• Including a strong advocacy component ensures uptake and scale up
• Involvement of local and political leaders is vital to the success of BFCI
• Cash investment is an integral part of the initiative
• Initiating income generating activities for community units as opposed to a monthly stipend for community health volunteers is a viable and sustainable approach to incentivizing them and creating a momentum for the implementation

Funder:

The project was funded by USAID and Division of National Institutes for Health through the NAS PEER HEALTH program administered by the National Academies of Sciences.

Partners and collaborators:

Kenyatta University- Lead

Nutrition Information Working Group (NIWG) and MIYCN TWG (Maternal Infant & Young Child Nutrition Technical Working Group)

National Maternal, Infant and Young Child Nutrition Steering Committee

African Population & Health Research Center (APHRC)

Baringo County

Koibatek Sub County Health Management Team

National Nutrition Programme Cambodia

CHVs, CHEWs, CHCs & the entire Koibatek community