Evaluation of regional IFE workshop

A mother and her baby in a temporary shelter following Cyclone Nargis

Summary of evaluation report¹

An evaluation was undertaken by the Emergency Nutrition Network (ENN) to determine the impact of a regional workshop on infant and young child feeding in emergencies (IFE), held in March 2008 in Bali, Indonesia². The workshop was a joint initiative between the IFE Core Group, UNICEF and MOH Indonesia and funded by the Inter-Agency Standing Committee (IASC) Nutrition Cluster and IBFAN-GIFA³.

Key outputs of the workshop were country/territory action plans, a model joint statement on IFE, and a pledge for action⁴ agreed by all individuals attending.

The objectives of the evaluation were:

• To identify how the workshop has contributed to work on IFE in countries in the Asia region.
• To identify any further areas of concern/supports required by practitioners to facilitate optimal operations in the area of IFE.
• To provide a mechanism for participants feedback for future workshop development on IFE.

Responses were solicited in this evaluation in relation to progress on specific goals agreed in country action plans. Two major emergencies occurred in the region since the workshop took place, Cyclone Nargis in Myanmar and the Sichuan Earthquake in China. Feedback on the impact of the workshop on IFE response to these specific emergencies was also sought, and a detailed analysis undertaken of media reports on IFE released during both responses.

Contact details were identified from participant lists. Participants were contacted with a questionnaire by email, with follow-up phone interviews. The response rate was 30% with fourteen countries represented.

Key findings

Key progress reported by participants included:

Policy: The majority of countries have now either completed or are planning to complete national policies on IFE (or are incorporating IFE into the national nutrition policies on Infant and Young Child Feeding (IYCF)). Three countries have completed or planning to complete a policy on managing donations of breastmilk substitutes (BMS).

Training: Training of staff was completed in one country, in progress in seven and planned in another four countries. Feedback suggested rolling out training on IFE via:

• Incorporate into all routine health and nutrition programmes.
• Incorporate IYCF and breastfeeding into all appropriate disciplines of health staff training (from universities to pre-service training).
• All emergency preparedness plans and policies to incorporate an element of IYCF. Constraints to training included lack of appropriately skilled staff with sufficient expertise, and poorly accessible donor funds, especially in emergency preparedness.

Co-ordination: This was a key constraint identified in the Bali workshop and the majority of countries have nominated an IFE co-ordinator (or body). Regarding implementation of the cluster approach, four out of five countries had completed or are progressing with this action point; UNICEF and Ministry of Health for that country were identified as those bodies who should lead co-ordination activities.

Communication: Developing a media/ communication strategy occurred/is currently underway in most countries, although some participants indicated more technical support in this area would be worthwhile.

Emergency preparedness: Pre-emergency planning and training activities are essential but seen as challenging actions to achieve as funding is considered "not easily available" from donors.

Networking: Participants valued the resources shared at the workshop (the Operational Guidance on IFE and Resource CDs, in particular), the opportunity to network with peers, donors and experts in this domain. Representation of several representatives from each country facilitated the development of technical 'working groups' upon return to work. Thirteen from 21 respondents stayed in touch with participants from other countries.

Over 80% of responses indicated that a workshop was considered the best approach for people to start or continue working in the area of IFE. Some input into the organisation and development of the workshop by relevant personnel in key agencies (at field office level) may infer greater support (via a sense of greater ownership for progress) of action postworkshop.

Supports for action

Supports identified that would greatly facilitate action in IFE if available, included:

A strong lead agency

1. to provide follow-up support after the workshop
2. to facilitate co-ordination
3. to facilitate training
4. to recognise expertise available and use it when required.

Funding for activities such as:

1. Translation of IFE resources into other working languages
2. training of more health professionals in IYCF to increase technical expertise (especially as emergency preparedness)
3. printing and dissemination of messages /media strategy rollout
4. adequate budgeting to include supportive supervision and monitoring activities.

More involvement of international expertise

For example, human resources for implementation and monitoring of IFE activities, technical support (capacity building) in developing a Media Strategy (messages and promotion).

Networking

Consider a website for the group (highlighting annual achievements/progress on IFE, facilitating networking/discussion groups) or a follow-up forum to facilitate more exchange to learn from other countries.

Register of skilled/trained personnel

Availability of a register of appropriately skilled people at both country and regional level that could be called upon in an emergency by agencies.

Regional events

Two major emergencies occurred in the region since the workshop took place - Cyclone Nargis in Myanmar and the Sichuan Earthquake in China. Responses from countries which supported the Myanmar government and agencies included Afghanistan, Indonesia, Bangladesh, Sri Lanka and the Philippines. Responses from countries which supported the Chinese government and agencies included Indonesia, Nepal, Sri Lanka, Taiwan. UNICEF Afghanistan was also involved in assisting in India and Bangladesh flooding emergencies. Examples of impact of the workshop included:

• Regional orientation of high-level emergency teams on IFE prior to their departure to the affected country (Sri Lankan support to Myanmar cyclone).
• In Myanmar, the workshop impacted through "good co-ordination and networking system of the Nutrition Cluster". The model joint statement on IFE produced at the regional workshop was used as the basis for the interagency joint statement released.
• In Bangladesh, the workshop generated a network within the country and regionally /internationally which supported IFE activities.
• In China, the resources from the workshop supported activities after the earthquake.

A detailed analysis of media reports revealed that IFE messages were commonly communicated via the media. Some of the common and pertinent messages in media reports were: babies are vulnerable, that women breastfeed in emergencies but breastfeeding is a sign of weakness, and providing infant formula will save babies. Messages rarely reported in the media included that artificial feeding leads to diarrhoea and death in emergencies and that breastfeeding is a sign of resilience and protects infants in emergencies. This analysis suggests that current reporting patterns of the media may encourage the inappropriate donation and distribution of infant formula and powdered milk in emergencies, and so contribute to increased morbidity and mortality in infants and young children.

Recommendations

Recommendations made by participants to improve capacity to respond on IFE included:

Resources

• Support from decision makers (organisational management/funding bodies) for resource allocation (especially human resources and funding) to develop, rollout and monitor IFE progress.
• Further development of resources e.g. facilitating the development of 'field manuals' for training local health staff/ community health workers, particularly in local/other languages (time/funds were key constraints in developing these).
• More strategies on IFE in countries where bottle-feeding is currently the more common choice of feeding for mothers.
• Development of and consensus to commit to a 'Pledge' or statement of action should be considered in other countries/at future workshops.

Workshop

• The emphasis of the workshop on learning via case studies and field experiences ('practical' scenarios) should continue.
• Include practical skills/orientation in developing funding strategies (e.g. multiagency, etc.) as a workshop activity.
• Representation of several participants from each country (country 'teams' were identified to attend with mixed representation decided by country) enables progress on action and is supported as an approach.

Co-ordination

• Continued emphasis on supporting breast feeding as choice for all mothers, even in non-emergency situations.
• A focal person on IFE should be nominated by each country to provide support in co-ordinating national and regional collabortion/networking on IFE.
• Development and dissemination of a register of skilled personnel in IFE available for training/advice in and between countries.
• Increased networking via email forums/ internet (e.g. ENN website/online work ing groups).
• Increased dissemination of progress on IFE (results in increasing motivation and networking for local advice/strategies between peers).

Media and communication

• Aid organisations should provide the media and their supporters with good information on IFE including the protective role of breastfeeding, the dangers of artificial feeding and unsolicited donations of milk products and the need to support breastfeeding women, target the distribution of infant formula and support the carers of artificially fed babies.
• Aid agencies should avoid presenting them selves as saviours of infants but instead present mothers as partners in provision of aid to infants and young children.
• Media reports to present breastfeeding as a sign of strength not vulnerability and breast-feeding mothers as resilient and with the capacity to protect their infants if provided with support.
• Explicitly state that donation of infant formula is not needed.

¹Full evaluation report available at www.ennonline.net in Resources section, or email:marie@ennonline.net

²Regional IFE workshop in Bali. Field Exchange, Issue No 34, October 2008. p37. http://fex.ennonline.net/34/regional.aspx

³International Baby Food Action Network - Geneva Infant Feeding Association

⁴See Annexes 1,2 and 3of Bali workshop report. Making it Happen. Proceedings of a regional strategy workshop. March 2008. ENN, UNICEF, IASC. Nutrition Cluster, IBFAN-GIFA.