Safe infant feeding remains a challenge: the Balkans experience

Summary of published paper¹

A recent article published in Disasters shows how the widespread failure of humanitarian agencies operating in the Balkan crisis to act in accordance with international policies and recommendations provides an example of the failure to translate infant feeding policies into practice. The article explores the underlying reasons behind this which included:

Inappropriate donations targeted at infants- Kosovo crisis1999

1. The weak institutionalisation of policies: During the Kosovo crisis, many agencies with infant feeding policies and good practice guidelines did not apply them. Good practice was more dependent on the presence of individuals with relevant knowledge, interest and experience in infant feeding than on the systematic communication within the respective organisations of a previously endorsed policy.
2. The massive quantities of unsolicited donations of infant feeding products: A NATO representative in Skopje estimated that during the initial weeks of the crisis, NATO in Macedonia received and transported 3,500 metric tonnes of donated aid of which an estimated 40% was baby food.
3. The absence of monitoring systems: Monitoring mechanisms were slow to become established during the Balkan crisis. The challenge of establishing effective monitoring for the complex flow of donated goods was huge. Given the sheer volume of donations, agencies were ill-prepared to establish monitoring systems that were effective.
4. Inadequate co-ordination mechanisms: The unprecedented number of NGOs, donors and bilateral agencies and the quantity of resources directed to the humanitarian response in the Balkans created enormous challenges for co-ordinating agencies.
5. The high cost of correcting mistakes: Late deliveries of UHT (ultra high temperature) milk contained in rations for refugees repatriating to Kosovo meant that the milk was stored in WFP warehouses in the last three months of 1999 and was recognised to be beyond its time limit and therefore unsafe. However, no agency was willing to incur the costs of destroying the milk (approximately $500,000). Also, re-labelling milk with appropriate health messages was considered too expensive by some agencies.

Efforts to uphold best practice during the crisis are also documented. The article identifies actions that could be undertaken in advance of, and during, future emergencies to enhance the application of infant feeding policies in emergencies. Proposed actions include the following:

• Agencies should take responsibility for ensuring that their own staff and partner agencies are aware of infant feeding policies and have the capacity to implement them.
• At the onset of the emergency an appropriate agency must be designated and resourced to coordinate infant feeding practice and implementation policy.
• Mechanisms for preventing the influx of unsolicited bilateral donations of inappropriate products need to be explored and established.
• Systematic and comprehensive monitoring systems which allow infant feeding products to be tracked through the distribution system need to be implemented in the relevant UN agencies.
• Viable solutions for dealing with inappropriate products need to be agreed upon, explicitly stated and endorsed by the humanitarian community. Financial resources should be made available to agencies that recognise the importance of implementing good practice and are willing to invest the time and effort to carry out activities such as the re-labelling of branded infant formula tins for the very small number of infants who actually require it.

For additional reading on Best practice and policies in Infant Feeding in Emergencies please refer to the Infant Feeding in Emergencies report and training modules, which are available to download from the ENN website at http://www.ennonline.net or alternatively contact fiona@ennonline.net for further information.

¹Borrel.A, Taylor.A, McGrath. M, Seal.A, Hormann.E, Phelps.L, and Mason.F (2001): From Policy to Practice: Challenges in Infant Feeding in Emergencies During the Balkan Crisis. Disaster, Volume 25, No 2, June 2001, pp 149- 163.