Malawi Baby Friendly Hospital Initiative Stakeholders Meeting – August 2-3, 2018

The initiative aimed to promote breastfeeding practices in hospitals and communities. By 2010, the exclusive breastfeeding rate had increased to 71% following the designation of 26 hospitals as Baby-Friendly from 1993-2004. However, due to funding losses, the BFHI languished, and the exclusive breastfeeding rate decreased to 61% by 2015/16. In January 2016, the USAID-funded MCSP and the Malawi Ministry of Health (MOH) began revitalizing the BFHI. MCSP supported the MOH in implementing several activities, including revising the national BFHI training package to reflect updated World Health Organization (WHO)/MOH guidance on prevention of mother-to-child transmission of HIV. The organization also conducted refresher training for existing BFHI master trainers, trained clinical and support staff at 18 health facilities in 15 districts on the Ten Steps to Successful Breastfeeding, and oriented district health management teams from the 15 districts that underwent implementation activities. Additionally, MCSP trained over 1,400 community volunteers and village heads and 275 health surveillance assistants in breastfeeding counseling and promotion, as part of nutrition integration into immunization tracking efforts. The organization also oriented 350 area development committee members to BFHI and trained them as acting BFHI champions to educate their communities on avoiding breast milk substitutes and promoting early and exclusive breastfeeding to six months of age. Three health facilities were designated as Baby-Friendly through their demonstration of adherence to the Ten Steps. The MOH, MCSP, and other stakeholders hosted the Malawi Baby Friendly Hospital Initiative Stakeholders Meeting on August 2-3, 2017, to consolidate gains, discuss lessons learned, and develop key action items for institutionalizing BFHI in Malawi. The meeting had 205 participants, including representatives from UNICEF, WHO, USAID, and other organizations. Presentations covered historical background of BFHI in Malawi, global trends in breastfeeding, updated WHO/UNICEF BFHI guidance, and the BFHI revitalization process. To build consensus around how to strengthen BFHI in Malawi, plenary and working group sessions were held around three issues central to the meeting objectives: sustaining BFHI in Malawi, integrating BFHI into the continuum of care, and monitoring of BFHI in Malawi. Important progress was made in orienting key national-level stakeholders to the BFHI revitalization efforts, updated WHO BFHI guidance, and the WHO BFHI Congress recommendations. The MOH, MCSP, and other stakeholders agreed to move forward on several action items for institutionalizing BFHI in Malawi, including strengthening integration of BFHI indicators into the Health Management Information System, incorporating BFHI budget into district and health facility annual budgets and work plans, and integrating BFHI into routine systems, the continuum of care, and quality improvement mechanisms. The MOH pledged its commitment to sustainably integrating BFHI into Malawi's health system through implementation of these key actions, with the goal of improving breastfeeding practices and childhood mortality.