External assessments of the Centers of Excellence for Breastfeeding (COE) model, an innovation developed and implemented by Alive & Thrive with partners in Cambodia, Laos, Myanmar, and Viet Nam, show that the approach adds value to government-led efforts to scale up early essential newborn care and breastfeeding-friendly health services.
“It is clear from these assessments that health facilities can significantly improve breastfeeding outcomes through hands-on coaching and performance-based measurement,” said Jennifer Cashin, Regional Technical Specialist for Alive & Thrive Southeast Asia. “The COE model helps to ensure consistent implementation of breastfeeding counseling, prolonged skin-to-skin contact, early initiation of breastfeeding, and Code compliance.”
Learn more about the COE initiative in each country:
Two participatory assessments – conducted by an independent consultant in Viet Nam in 2020 and Cambodia, Laos, and Myanmar in 2021 – combined desk reviews of program monitoring data and national policies with structured partner and stakeholder interviews. Engagement with champions, provision of high-quality technical assistance, and a focus on integrating COE principles into national health monitoring systems were identified as enablers to successful implementation and sustainability. Hospital leadership and a multi-disciplinary, “all-team” were also found to be integral to health facilities meeting COE criteria.
The assessments also identified barriers including inadequate human resources and funding for breastfeeding and lack of support at the community level. Findings from these assessments are currently being used to inform future strategies for breastfeeding services and outcomes in the region.
Alive & Thrive conceived the COE approach to address health system and provider-driven behaviors that often impede breastfeeding, such as unnecessary medical interventions, separation of mothers and babies, unfriendly hospital environments including BMS promotion, and lack of practical counseling and support for breastfeeding.
“It is very important to have a systems approach and mainstream EENC/breastfeeding services into a national hospital accreditation system for sustainability,” said a UN representative and Alive & Thrive partner in Laos.
Since the initial launch of the program in Viet Nam in 2019, 32 hospitals in Viet Nam and Laos have been designated as COEs and 70 hospitals in Cambodia, Laos, Myanmar, and Viet Nam are consistently implementing early essential newborn care and breastfeeding services.
In Viet Nam, a recent policy update has expanded the initiative by allowing health facilities with pediatric departments to be evaluated against COE criteria on newborn care, kangaroo mother care, and breastfeeding for the first time. Initially, evaluation criteria were available only to hospitals providing obstetric services. This policy change will help to ensure the delivery of quality breastfeeding support to more infants, especially pre-term, low birthweight, and sick newborns.
Throughout the course of the project, hands-on, on-site coaching has proven to be a highly effective approach to changing provider behavior, especially when combined with routine monitoring and feedback. Health worker perspectives, which were analyzed in a peer-reviewed journal article, indicate a high degree of acceptance and support for the coaching approach. Another study of the approach in Viet Nam found enrollment in the initiative to be associated with improved breastfeeding practices during and after hospital stay.
“The hands-on coaching and supportive supervision help me to remember every single step that I need to change in my routine practice,” said Dr. Le Thi Thu Van, Head of Postpartum Ward, Phuong Chau International Hospital, Viet Nam.
Alive & Thrive is using the learning from the COE assessments to inform country approaches to health worker capacity-building that move away from top-down cascade training in favor of on-site, competency-based coaching that focuses on skills and practice.
CoE is a sustainable system strengthening approach effective for new born care services and any other services provided through health care facilities. Would be happy to receive any additional information on on what parameters these facilities were strengthened, who were engaged for coaching and in supportive supervision and how these facilities strengthened themselves.