Seeking to support efforts in West and Central Africa to accelerate implementation of the Ten Steps to Successful Breastfeeding, Alive & Thrive’s East Asia Pacific regional office shared lessons learned from the Centers of Excellence for Breastfeeding (COE) approach during a webinar in August. The COE initiative is funded by the Government of Ireland.

The webinar was moderated by Nemat Hajeebhoy of UNICEF Nigeria and featured the coordinators of the National Nutrition Programs in both Côte d’Ivoire – Dr. René Oka – and Mali – Dr. Aissatou Diarra.

The event also featured remarks by Susie Villeneuve, Senior Health Specialist at the UNICEF West and Central Africa Regional Office, and Hanna Bekele, Senior Nutrition Advisor of the WHO Africa Regional Office, who presented an overview of the global Baby Friendly Hospital Initiative (BFHI) guidance, which was updated in 2018.

View the webinar slide-deck here.

Sean Farrell, Deputy Head of Mission for the Embassy of Ireland in Hanoi, set the stage for the event.

“Over the past 15 years, we have seen huge and encouraging progress in reducing chronic and acute malnutrition in Southeast Asia,” Farrell said. “And from that experience many useful lessons have been learned. This workshop is a crucial opportunity to share experiences and contribute to the improvement of nutrition between the regions in Southeast Asia and our colleagues who work on the African continent.”

Despite the proven effectiveness of the Ten Steps to Successful Breastfeeding in improving breastfeeding rates, global coverage of the intervention remains low. The COE model utilizes national accreditation systems and leverages client-driven demand for quality care to incentivize implementation of the Ten Steps to Successful Breastfeeding. In this way, the COE approach responds to updated BFHI guidance to develop locally contextualized, performance-based models to advance nationwide implementation and achieve sustained adherence to evidence-based newborn care and breastfeeding interventions in maternity hospitals.

In Southeast Asia, the COE initiative was launched in 2019 in Viet Nam, and has since been replicated, with local variations, in Cambodia and Laos.

“We needed a model to change the health providers’ behavior,” said Duong Vu, Alive & Thrive Regional Technical Specialist in the East Asia and Pacific regional office. “While community interventions, mass communication, and interpersonal communication can improve breastfeeding to six months, that’s not enough.”

The COE initiative seeks to introduce and sustain key behaviors at hospitals, including integrating breastfeeding counseling in antenatal care visits; ensuring prolonged skin-to-skin contact (for at least 90 minutes) immediately after birth; ensuring mothers a birth companion of choice; reducing unnecessary caesarean sections and episiotomies; eliminating promotion of breastmilk substitutes; and introducing continuous on-site coaching.

The COE accreditation process, along with surveys of mothers about their experiences in COE hospitals and recognition of the COE designation in media and on social media, has created important incentives for hospitals to seek the “COE” label. To date, 86 hospitals in 16 provinces of Viet Nam have enrolled in the initiative. If all participating hospitals are designated, then one in five births will occur in COE hospitals. In Cambodia and Laos, the COE model is expanding with context-appropriate variations and in line with national quality improvement and hospital accreditation systems.

The COE initiative began to take form after Alive & Thrive conducted a pilot to introduce early essential newborn care (EENC) in several provinces in 2014, closely monitoring the data from the effort.

“We witnessed that EENC brought rapid improvements in early initiation of breastfeeding,” Duong Vu said. “The success of the two hospitals involved – in Da Nang and Quang Nam – turned them into champion hospitals. The hospitals became role models.

“We documented the pilot and integrated the learning into the policy and legal framework to ensure high-level political well. That has proven crucial to the success of the COE initiative.”

COE hospitals are accredited after an assessment by health officials and other stakeholders that measures performance against a set of agreed-upon criteria. Read more about the initiative here.

Health officials from Côte d’Ivoire and Mali, Dr. René Oka and Dr. Aissatou Diarra, respectively, shared experiences implementing BFHI in their respective countries. Mali began implementing the initiative in 2002; Côte d’Ivoire began in 1993.

In Côte d’Ivoire, the BFHI experience has reinforced the importance of obtaining the commitment of providers at the onset of the process and monitoring the effects of changes to the facility environment and provider behavior, Dr. Oka said. He said the country also needed to have a follow-up mechanism at both the district and national levels to ensure sustained effort.

In Mali, Dr. Diarra said implementing BFHI had highlighted the importance of reinforcing collaboration with community stakeholders and that achieving sustainability required implementing monitoring and quality assurance programs.

The presentation of the COE model sparked new ideas, the West and Central Africa health officials agreed.

“Regarding the Southeast Asia experience, I have noted a lot of things,” Dr. Oka of Côte d’Ivoire said. “Creating incentives in the process is something we can look at, and the client-centered monitoring is a good thing.”

He also said leveraging “healthy competition” between hospitals to implement the Ten Steps to Successful Breastfeeding could be effective as well as recognizing hospitals in the media and on social media. The COE-designated hospitals’ practice of involving a mother’s companion of choice was also noteworthy, he said.  

“We’ve learned a lot during this webinar,” Dr. Diarra added. “We plan to use these insights to improve our processes.”