Ensuring Appropriate and optimal Infant and Young Child Feeding (IYCF) Practices during emergencies in the Philippines
Table of Contents
Acknowledgement 4
Executive Summary 5
Introduction 6
Purpose 7
Intended Users 7
Background 8
Global recommendations and guidelines 10
IYCF/IYCF-E in the Philippines: policies, guidelines, progress and directions 13
The Philippines IYCF legal and policy environment: 15
IYCF practices (2013/2008)* 20
Case Study: The Yolanda experience from November 2013 to October, 2014 21
Background: 21
The Strategic Response Plan (SRP) 21
IYCF-E Strategies implemented 23
The response 24
IYCF-E: principles and approaches 28
The key PILLARS of IYCF-E 28
What the Philippines needs: 29
1. Enforcing the IYCF/IYCF-E legal framework 29
2. IYCF-E Coordination 30
3. Communication and Media 30
4. Assessment & monitoring: practices and needs: cluster and field 31
5. Implement key interventions to support IYCF-E 31
6. Ensuring adequate capacities 33
7. Preventing and handling BMS donations 33
IYCF-E Objectives and Actions-for the Philippines 35
Preparedness 36
Response 45
Rehabilitation 52
Acronyms and abbreviations 61
References: 63
Annex 1: IYCF-E experiences from other countries 64
Annex 2: Philippines Case study: IYCF-E response in previous emergencies 66
Annex 3: List of IYCF-E Tools used during Yolanda’s response 69
Annex 4: List of IYCF-E IEC materials disseminated during Yolanda’s response 70
List of tables:
Table 1 National Objectives for Health 2011-2016 16
Table 2 Philippines IYCF Strategic Plan of Action 2011-2106 17
Table 3 National IYCF practices 18
Table 5 IYCF practices based on SMART Survey (Feb 2014) 21
Table 4 Intervention Coverage 64
Table of figures:
Figure 1 Mobilizing support, NGO leading (photo courtesy KMI, Inc.) 22
Figure 2 ACF MBFT in Tacloban City (Photo Courtesy ACF) 23
Figure 3 Aruugaan Mobile tents (Photo Courtesy Arugaan) 24
Figure 4 Recipe trial activities in Region 6 (Photo Courtesy Region 6) 25
Figure 5 The key pillars of IYCF-E 27
Figure 6 IYCF Legal framework in the Philippines 28
Acknowledgement
Executive Summary
Introduction
In emergencies, the risks of illness, mortality and acute malnutrition among children are amplified. The protection, promotion and support of infant and young child feeding practices in emergencies is a crucial, life-saving to prevent illness, mortality and malnutrition, and yet the potential of IYCF interventions often falls short due to less than adequate resources and implementation. This strategy aims to provide a comprehensive menu of actions and tools for emergency preparedness, response and recovery in relation to infant and young child feeding that if implemented will help address common barriers and gaps and ensure the protection, promotion and support of IYCF practices even during emergencies.
The goal of this paper therefore is to consolidate global and national guidance and good practices on infant and young child feeding in emergencies (IYCF-E) into a strategy document that will guide international, national and sub national decisions makers, program managers and field officers during the preparedness, response and early rehabilitation phases in the Philippines context. This document complements the recently developed National Operational Guidance on IYCF E (2014). The latter provides guidance emergency responders on what are the essential actions and steps within the community and the evacuation centers, to be able to ensure support to IYCF practices. The IYCF-E strategy paper, instead provides government and partners a broad menu of actions and strategies, mid and long term, that if implemented would strengthen the preparedness and response mechanisms for IYCF during emergencies.
The document structure provides the reader with a short introducing on the importance of IYCF-E in the Asia-Pacific region, in particular for the Philippines. Global evidence and recommendations are presented. Core components of the document are the following:
a) IYCF program in the Philippines, looking at policy, plans and strategic directions.
b) Key pillars of IYCF-E and their relevance to the Philippines.
c) Recommendations on objectives, actions and indicators
The recommendations are structured around
1. Preparedness
2. Response
3. Rehabilitation
For each, key objectives, activities and indicators are suggested, both for national and sub-national governments, UNICEF and Nutrition Cluster partners.
Several consultations, with government and partners, building consensus and agreeing on what needs to be done, will help in the finalization of the document. A second phase of the work would be to start put the different recommended actions into time bound action plans that would guide the implementation. .
Purpose
The paper consolidates global and national guidance and good practices on IYCF-E into a strategy document that will guide international, national and sub national decisions makers, program managers and field officers during the preparedness, response and early rehabilitation phases of an emergency in the Philippines.
Intended Users
1. Department of Health
2. National Nutrition Council
3. UNICEF Country office
4. Nutrition Cluster agencies and partners
5. Department of Health, attached agencies (Food and Drugs Administration) , agencies working on emergency preparedness and response like the Department of Social Welfare and Development-(DSWD), the Department of Agriculture (DA), the Department of Education (Dep-Ed) and the Department of Trade and Industry (DTI)
6. Sub-national: Regional offices of national agencies, local government units
7. International agencies (based in the Philippines and abroad)
a. UN partners
b. INGOS
c. National /Local NGOs
d. Other civil society organizations
Background
Countries in Asia and the Pacific are four times more likely to be affected by natural catastrophe than those in Africa and 25 times more vulnerable than Europeans or North Americans. Asia experiences 70% of the world’s natural disasters, which are generally sudden onset, such as the Indian Ocean tsunami in 2004, the earthquakes in Sichuan, China in 2008, Typhoon Ketsana and Typhoon Haiyan in the Philippines in 2009 and 2013 respectively, and the earthquakes in Japan and New Zealand in 2011. Coastal areas and small island states with limited adaptive capacity such as Kiribati, Samoa, and Tonga, are particularly susceptible to the effects of climate change and natural disaster.[1]
From 1980 to 2010, the Philippines was hit by 363 disasters, affecting more than 11.6 million persons, an average of 3.7 million people a year, and killing 39 956. The most common disasters were floods (94), storms (197), volcano eruptions (14), earthquakes (12) and epidemics (10). [2]
Exclusive breastfeeding for the first six months and continued breastfeeding would prevent 13% of under-five deaths, primarily from infections resulting in diarrhoea, pneumonia and neonatal sepsis. 3 Initiation of breastfeeding in the first hour would prevent an additional 22% of newborn deaths. 4 Also appropriate and optimal complementary feeding its one of the top three interventions that could prevent around 6% of under five deaths. Not being breastfed increases the risk of mortality by six times in infants < 2 months old and even between 9 and 11 months, the risk is increased by 40% [3] Risk of neonatal death is four times greater if milk-based fluids or solids are provided to breastfed infants less than four weeks[4] At the same time, beyond the early
childhood period, breastfeeding can improve children’s quality of life through preventing leukemia, asthma, ear infections, allergies, and diabetes, and it could support the achievement of optimal mental development (IQ). [5],[6]
There is a strong link between sub-optimal infant and young child feeding practices and acute malnutrition. Deterioration in the infant and young child feeding practices puts young children at increased risk of acute malnutrition and therefore a linked and integrated response is needed and encouraged.[7] During emergencies, breastfeeding is a shield that protects infants by providing food security, comfort, warmth and protection. Therefore, protection, promotion and support of optimal breastfeeding practices absolutely need to be continued in times of emergencies. However, response related with infant and young child feeding in general and breastfeeding in particular during emergencies is often less than adequate.
Evidence shows that in emergencies those risks increase hence the need to ensure protection, promotion and support of optimal and appropriate infant and young child feeding practices.
Global recommendations and guidelines
During emergency situations, whether manmade or natural disasters, disease and death rates among under-five children are generally higher than for any other age group. The younger the child, the higher the risk. Mortality may be particularly high due to the combined impact of a greatly increased prevalence of communicable diseases, diarrhoea and soaring rates of under-nutrition.
The fundamental means of preventing malnutrition (over and under-nutrition) and mortality among infants and young children is to ensure their optimal and appropriate infant and young child feeding (IYCF) practices, access to health services and proper child care practices. IYCF is essential in promoting resilience to the potential negative impact of shortfalls in the days following a disaster.
In 2002, the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) Global Strategy for Infant and Young Child Feeding, 7 recommends optimal infant and young child feeding as:
- Initiation of breastfeeding within one hour of birth
- Exclusive breastfeeding[8] for the first six months of life
- Continued breastfeeding for two years and beyond
- Introduction of adequate and appropriate complementary foods[9] from 6 months onwards.
The World Health Organization, in 2004 issued guiding principles for feeding infants and young children during emergencies.[10] Ten (10) principles The principles reaffirms the importance of protecting, promoting and supporting breastfeeding during calamities, limiting and strictly controlling the use of breastmilk substitutes and the role of complementary feeding. The same highlights the importance of assessing the nutrition status of children and continuously monitoring their feeding practices as a mean of preventing malnutrition.
In 2007, the IFE Core Group, of which UNICEF and WHO are members, issued operational guidelines on IYCF in emergencies.[11] The guidelines reaffirm the importance of supporting breastfeeding in difficult situations, ensuring that donations of breast milk substitutes are not collected and to meet the needs of the small proportion of infants who have no other option for breastfeeding after all alternatives such as wet nursing etc have been exhausted.procuring only the minimal amount of infant formula necessary through the emergency coordinating mechanism.
The Infant and Young Child Feeding in Emergencies: Operational Guidance for emergency relief staff and programme managers.[12] Proposes the following steps are:
(1) Endorse or develop policies
(2) Train staff
(3) Coordinate operations
(4) Assess and monitor
(5) Protect, promote and support optimal infant and young child feeding with integrated multi-sectoral interventions, including integration with services for acute malnutrition
(6) Minimize the risks of artificial feeding
In 2009, the IFE Core Group, released a technical paper, that focused on Evaluating the Specific Requirements for Realising a Dedicated Complementary Feeding in Emergencies Training Resource (Module 3); a Preliminary Scoping Review of Current Resources (Phase I), underlying the importance that also during emergency there is a need to ensure that all complementary feeding practices are not disrupted and are indeed appropriate in accordance to the age of the child.
An addendum to the IFE guidance was issued in 2010[13] clarifies that the type and source of BMS to purchase should be considered:
• Generic (unbranded) infant formula is recommended as first choice, followed by locally purchased infant formula.
• Infant formula should be manufactured and packaged in accordance with the Codex Alimentarius standards and have a shelf-life of at least 6 months on receipt of supply.
• The type of infant formula should be appropriate for the infant, including their age.
• Specially formulated milks, so called ‘follow-up’ or ‘follow-on’ milks, are not necessary.
• In the early stage of an emergency, ready to use infant formula (RUIF) has the advantage that it does not require reconstitution with water.
In 2010 the World Health Assembly, endorsed resolution WHA 63.23 where expressed concerns that “in emergencies, many of which occur in countries not on track to attain Millennium Development Goal 4 and which include situations created by the effects of climate change, infants and young children are particularly vulnerable to malnutrition, illness and death;”
and urges member states to:
“(8) to ensure that national and international preparedness plans and emergency responses
follow the evidence-based Operational Guidance for Emergency Relief Staff and Programme
Managers on infant and young child feeding in emergencies, which includes the protection,
promotion and support for optimal breastfeeding, and the need to minimize the risks of artificial
feeding, by ensuring that any required breast-milk substitutes are purchased, distributed and used according to strict criteria;”
The Sphere standards (2011), includes a specific set of recommendations on IYCF-E[14] and call on all humanitarian workers and agencies to “Uphold the provisions of the Operational Guidance on infant feeding in emergencies (IFE) and the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions (collectively known as the Code)”
In September 2014 Save the Children, released a comprehensive IYCF-E tool kit that proposes[15] the most up-to-date policy guidance, practical tools, references, documented experiences that to support agencies, programme managers, governments and others in their IYCF related efforts during emergency response and preparedness.
IYCF/IYCF-E in the Philippines: policies, guidelines, progress and directions
Protecting the nutritional status of vulnerable groups affected by emergencies is crucial and a humanitarian right. The main nutritional problems of concern in emergencies are acute malnutrition (wasting) especially in young children, micronutrient deficiencies and in some situations chronic malnutrition. Individuals who suffer from acute malnutrition are much more likely to become sick and to die. At the same time, sick individuals are more likely to become malnourished
The Department of Health with the National Nutrition Council , drafted a “Minimum Public Health Service Packages in Emergencies and Disasters”[16] and encourages the Nutrition Cluster to work closely with the Food Cluster, to ensure that the “nutritional requirements of the general population and vulnerable groups shall be met primarily through nutrition assessment, infant and young child feeding, food assistance, management of acute malnutrition, and micronutrient supplementation in accordance with accepted national and international standards.”