RESUMEN
Health professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization (WHO)/United Nations Children's Fund (UNICEF) implementation guidance for the Baby-Friendly Hospital Initiative (BFHI). With stagnating rates of exclusive breastfeeding worldwide, skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. Few studies exist on how low-income countries are integrating BFHI into their standards of care. This qualitative case study describes Malawi's experience. We interviewed 48 key informants and conducted a desk review of the literature on BFHI programming, national plans, policies and other related documents. We explored the findings using the seven key domains and 16 competencies to implement the Ten Steps to successful breastfeeding from the WHO and UNICEF Competency Verification Toolkit. The study found that although the focus of the guidance is on preservice training, continuing education and in-service training remain important. To achieve universal coverage for health professional competency, Malawi uses preservice, in-service and refresher training. However, their main limitations to aligning with the new guidance are a lack of preservice BFHI- and breastfeeding-specific curricula, experienced lecturers and sufficient time to dedicate to practical skill development. Conducted during the coronavirus disease 2019 pandemic, this study confirmed disruptions to BFHI training and service delivery, while also documenting Malawi's resilient attempts to mitigate impacts on breastfeeding support through mentoring and coaching. Opportunities exist for strengthening and scaling up, including engaging preservice training institutions and standardizing mentoring, coaching and competency verification.
Asunto(s)
Lactancia Materna , Humanos , Malaui , Recién Nacido , Femenino , Promoción de la Salud/métodos , Organización Mundial de la Salud , Personal de Salud/educación , Hospitales , Competencia Profesional , Naciones Unidas , LactanteRESUMEN
The 2018 implementation guidance for the Baby-Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty-eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance-based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty-seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI.