Kenyan Strategy on Infant and Young Child Feeding

Kenyan scheme on Infant and preteen nestling FeedingHOW DID THE KENYAN STRATEGY ON INFANT AND YOUNG kid FEEDING COME TO BE?A CRITICAL ANALYSIS.*Comm soaply employ AcronymsEBF-Exclusive booby supplyIYCF/N-Infant and teenage tiddler Feeding/NutritionBFHI/CI-Baby Friendly Hospital opening move/Community Initiative.MOPHS-Ministry Of Public wellness and SanitationThe first 1000 age of look are crucial stages for a tiddlers growth and exposement. Damages accrued from dietal deficiencies during this time are correspondingly to lead to poor cognitive development which results into compromised educational fulfilment and hence low economic productivity.(Murage et.al,2013Bhutta et.al,2013).Poor fodder results from inappropriate feeding practices with poor timing, poor quality and inadequate cadence of food.(M.O.P.H.S,2010).Optimal breastfeeding and complimentary feeding practices are essential in meet the nutritional brings of children in the first years of life.The Lancet (2003),indicates that scoop shovel breastfeeding(EBF) for the first 6 months, followed by continue breastfeeding from 6-11 months in addition to antonymous feeding and a continued breastfeeding up-to 2 years of age garter reduce child mortality order by 19%.This would non only be in line with The Kenyan National wellness Sector Strategic Plan II but too importantly can towards attainment of Millennium Development Goal 4(Huffman et.al,2001), and The Kenyan mint 2030.(M.O.H,2000).several(prenominal) worldwide efforts intended to address child malnutrition emerged in the 1990s,championing to make head substance Infant and Young Child Feeding by providing appropriate breastfeeding environment.(M.O.P.H.S,2007/10).These embroil The Innocenti Declaration(1990),World Summit For Children(1990),Earth Summit, multinational Conferences on Nutrition and on Population Development(1992),World adhesion for Breastfeeding causeion(WABA) and the Baby Friendly Hospital Initiative.The 200 3 Kenya Demographic Health Survey(KDHS) results showed only 2.6% of sole(a) breastfeeding( EBF) rates in the country.Addition aloney, the rates of malnutrition were 30% for stunt flying,20% underweight and 6% distasteful malnutrition. Between 2008-2009,Kenya was listed among the top 20 countries with the highest under-nutrition rates.26.9% stunting and 20.3% underweight rates for ages 6-59 months(KDHS 2008/09KNBS,2008).The human immunodeficiency virus pandemic and the attendant risk of M new(prenominal) To Child Transmission continued to pose a threat to unshared breastfeeding even to the non-affected families.A study revealed the change magnitude fear by some(prenominal) m early(a)s and peer counsellors on the risk of human immunodeficiency virus transmission through breastfeeding(Koricho et.al,2010).The peer counsellors were more comfortable if HIV appointed mothers would abstain from EBF and rather opt for replacement feeding which mostly did not meet the WHO suck upline of AFASS(Acceptable, feasible, affordable, sustainable, safe).This led to an adjoin in infant mortality rates and malnutrition(Creek et.al,2006).Over 30 countries vex developed National IYCF(Infant Young Child Feeding) Strategies based on WHO/UNICEF guidelines..(Sagoe et.al,2012WHO,2006).Kenya was also a signatory to whole global conventions meant to improve IYCF practices.(M.O.P.H.S,2007/10).This essay aims to criti look toy analyse the Kenyan scheme on Infant and Young Child Feeding practices (IYCF), developed mingled with 2007-2010. The dodge was intended to provide a strong mechanism, through which the organization and various sectors could in a comprehensive and coordinated manner turn accelerated action to improve IYCF practices in Kenya.(M.O.P.H.S,2007/1O).I will draw upon the Walt and Gilson approach of the health indemnity triangle(1994,cited by Buse et.al,2012) to finely analyse and discuss how the Strategy came into place, what were the key driving pointor s and the stakeholders directd in the insurance form _or_ system of governing body do answer. I will combine the health polity triangle for analysis and s in like mannerl Kingdons policy Windows and 3streams approach to agenda put. The Health Policy Triangle comes in as a more suitable approach, as it acknowledges the impressiveness of smell at content and process of policy reservation any government agency exploring the social function of force out by the state, national and world(prenominal)istic organisations and its influence on policy qualification.(Buse et.al,2012).Kenya is a low income country hence hence a policy making process would involve an interaction among various resistent stakeholders.Buse et.al(2012) defines policy as the decisions made by those with responsibility for a given orbit and a health policy as that which covers courses of action or inactivity that affects the set of institutions, organisations, serve ups and funding arrangements of both backstage and public health care systems.The health policy triangle is divided into four constituent parts, both interrelated and interconnected and which are suitable for describing and understanding the Kenyan IYCF Strategy. These include the context, content, process and actors.Context entails the political, social, economic, cultural, both national and international which may have an effect on health policy(Buse et.al,2012).Further classified into situational, structural, cultural and international/ exogenous factors by Leichter (1979),cited by Buse et.al,(2012).Some of the situational factors that stimulated the development of The Kenyan Strategy on IYCF include the place of HIV and its great influence on exclusive breastfeeding and the increased rates of malnutrition combined with decline in the key indicators of IYCF(M.O.P.H.S,2007/10).A rapid assessment study (Chopra et.al,2009)indicated widespread mis- information on the flummox To Child Transmission(MTCT) of HIV a s a major factor influencing breastfeeding patterns in Kenya.IYCF practices that differ from the commonly seen ones in the union would result in unwanted revealing of HIV status.(Onono et.al,2014).This had a great influence on the duration of breastfeeding and the method of infant feeding used by the mother.Increased malnutrition rates caused by declined exclusive breastfeeding rates from 3.5%(KDHS 1998)to 2.6%(KDHS 2003) was the other factor(M.O.P.H.S,2007/10).Structural factors include inadequate electrical capacity twist on healthcare workers on IYCF ,HIV and breastfeeding leading to decline in procession of Baby Friendly Hospital Initiative(BFHI) and breastfeeding promotion through healthcare facilities(Kimani et.al,2015MOPHS,2007/10).Buse et.al,2012 describes capacity as the mightiness of the government to make and implement policies.Kenya record a decline in BFHI from 600 in 1996 to less than 6 in 2003(M.O.P.H.S,2007/10Chopra et.al,2009).On the other hand, contextual c ultural factors would entail issues such as, the fact that 60-80% of Kenyan women were twisting in labour and agricultural practices with minimal virile involvement in childcare, leading to poor child caring practices(MOPHS,2007/10).Other beliefs and practices in Kenyan families e.g the belief that breast milk alone is not commensurate for a child also played a great employment in influencing the system(MOPHS,2007/10Matsuyama et.al,2013Murage et.al,2013).To most African countries, exclusive breastfeeding(EBF) is alien(Magoni et.al 2005,cited by Onono et.al,2014).Mixed feeding(breastfeeding along with other liquids or fluids) is the most common method of infant feeding globally and is often continued up to 2 years of age.The strategy was developed to mirror the WHO/UNICEF global strategy for IYCF that was developed to improve global IYCF practices.(Murage,2015).Kenyas aim was to actualize this through the BFHI, along with other interventions such as adopting and implementing the WHO Code Of Marketing of Breastmilk Substitutes(MOPHS,2007/10)meant to regulate the marketing of breast milk substitutes.A objurgation of the influence of international factors to the development of this strategy.Content of a policy refers to pith of a particular policy which details its constituent parts.The aim of the strategy was to contribute to improved health, nutritional status development and survival of infants and tender children in Kenya.(MOPHS,2007/2010).Some of the component parts and targets of the strategy between 2008-2010 included change national structures on IYCF to facilitate planning, coordination and advocacy for performance of the strategy modify the existent IYCF policy guidelines and the National policies in the context of HIV, to be in line with WHO consensus and statement on HIV and IYCF(WHO,2006) ,and disseminating it by 2008Enactment of Kenyan National Law for regulation of foods eaten by children aged below 3years and move up a monitor system by 2009revitalization of the Kenyan BFHI to ensure 75% of mothers who deliver in healthcare facilities are initiated on exclusive breastfeeding and providing support and essential information to help them continue up to 6 months of age ensuring support for breastfeeding mothers by employees through the Employment performance and attendance of IYCF Inter-grated Course by 60% health workers, and 80% PMTCT service providers.The nine main strategic components deemed crucial for the attainment of the strategy goals included policies and legislation on IYCF, practices in IYCF and IYCF in difficult circumstances, HIV and infant feeding, capacity make watering on IYCF, communication and advocacy, research on IYCF, partnerships and coordination and ultimately monitoring and evaluation in IYCF.(MOPHS,2007/10).The process of policy making refers to the way in which policies are initiated,developed,formulated,negotiated,communicated, implement and evaluated.(Buse et.al,2012).The Kenyan strateg y on IYCF can be broken down into the four contrastive theoretical stages of policy process named by Sabatier Smith,(1993) cited by Buse et.al,(2012).These are, puzzle identification, policy formulation, policy implementation and evaluation.Kenya had recorded a decline on key indicators on IYCF during the two decades earlier to the formation of this strategy.Exclusive breastfeeding rates were at 3% with virtually no BFHI facilities(MOH,2007-2010).Additionally, only about 52% of mothers would initiate breastfeeding within one hour.Complementary feeds were introduced way too early for the babies.These issues were closely linked to poor IYCF programming at that time(Lancet 2003MOPHS,2007/2010).On formulation, The Strategy was developed as a measure that sought to build on past initiatives and improvements to drive IYCF in Kenya(Murage et.al.2013).It was derived from The Global Strategy on IYCF, the Kenyan Policy Guidelines on IYCF, The National Assessment of IYCF policies, program mes and practices and National food and Nutrition Policy (was still being reviewed in parliament).(MOPHS,2007/10).The rationale for the strategy accrued from among other issues, the increased evidence on interventions to promote exclusive breastfeeding and complimentary feeding practices being able to prevent about a fifth of under-five mortality rates in developing countries(Lancet,2003MOPHS,2007/10).Nutrition is universally recognized as a childs right to enjoyment of the highest attainable standardised of health(UNICEF,2012).Based on the global strategy, an assessment of IYCF policies, programmes and practices was conducted in 2004.(Sagoe et.al,2012).Weaknesses were identified, hence leading to a suggestion of the need for a national programme foc utilize on IYCF, with high trains of advocacy if mothers and children were to practice exclusive breast and complementary feeding.This strategy evolved as a response to that assessment.The strategy would be mainly implemented through BFHI which promotes breastfeeding around the maternity ward during the time of delivery (Murage et.al,2013).It would call for increased political will, public investment and heightened awareness of the critical importance of IYCF amongst health workers, other professionals and community based care providers.(MOH,2007/10).Additionally, involvement of the government, families, communities and community based organisations(CBOs)in collaboration with international organisations and other concerned parties would ensure that necessary action is taken(MOH,2007).The monitoring and evaluation(ME) process would be achieved through reviewing, developing and harmonizing monitoring and evaluation tools for IYCF developing and installing software for IYCF at district level all level monitoring of the National Communication Strategy on IYCF developing and maintaining a data bank for the persons trained on IYCF/BFHI/ label developing ME tools for IYCF in difficult situations including HIV and Infa nt Feeding invariable review of IYCF strategy implementation, among many other evaluation strategies such as ME of the implementation of the communication strategy at all levels.(MOPHS,2007).Actors in a policy refers to individuals, plaques the state and their actions that affect policy(Buse.et.al,2012).They may try to influence policy at local, regional, national and international levels.Buse et.al(2012) merely classifies the actors into interest/pressure groups which refers to a type of civil society group that attempts to influence the policy to achieve specific goals or civil society groups which refers to group or organization which is alfresco the government and beyond the family group.The actors who played different roles towards the formation of this strategy and were to be actively involved in the implementation included the government the non-governmental organisations and community based support groups international organisations industries and enterprises professiona l associations, ministries, mass media and other groups and communities which includes parents and caregivers directly responsible for feeding children.(MOPHS,2007/10).These can be classified as either interest/pressure groups or the civil society groups.The power of international bodies and their influence on the development of this strategy is clearly depicted.Power as defined by Buse et.al,(2012) is the ability to influence and to control resources or the ability to achieve a desired outcome.Being a member of the WHO, Kenya had to comply to the guide it provided on IYCF by creating a National strategy, just like all the other member countries(Jones et.al,2013Sagoe et.al,2012)),especially within the Sub-Saharan Africa, Asia and the Caribbean.The strategy also adopts the BFHI which was sooner launched by WHO/UNICEF(1991) following the Innocenti Declaration, meant to promote exclusive breastfeeding (WHO/UNICEF,2009).A demonstration of the power emanating from WHO as a decision maki ng process.(Dahl,1961 cited by Buse et.al,2012).Development of the strategy would involve using WHO/LINKAGES assessment tool to assess the policies and practices in the country, after which they would be rated after review by national stakeholders and the results used to make a interventions meant to address the gaps(Sagoe et.al,2012).A mixed scanning method of decision making was applied in the formation of the strategy.Mixed scanning would involve a lave of the hassle as a whole followed by a luxuriant analysis of the component parts(Etzoni,1967 cited by Buse et.al,2012).The Ministry Of Health ,at the national level was involved in assessments intended to quantify the levels of different IYCF practices.Whereas the Ministry Of Public Health And Sanitation(MOPHS)went further ahead to come up with different approaches towards addressing the issue e.g revitalizing BFHI, facts of life all health officials on PMTCT(Prevention of Mother to child transfer)and renewing perpetrations to create an environment that enabled Kenyan women to practice optimum IYCF.Additionally,it would collaborate with other ministries and international stakeholders and NGOs towards fulfilment of the objectives of the strategy.Therefore workings as a policy community.A Policy community is a recognizable subdivision of public policy making in which there is sustained interaction between participants through a web of formal and informal relationships(Buse.et.al,2012).It was demonstrated through participation and reference book among different key IYCF stakeholders including the government, international bodies, non-governmental organisations and communities, steered by a technical working group under the auspices of National Infant Feeding manoeuvre Committee(MOPHS,2007/10).A legislative framework that would help support and promote breastfeeding had to be set up in the formation of the strategy.The legislature refers to a personate that enacts the laws that govern a country and ov ersees the executive.(Buse et.al,2012).Its roles would include, legislation to give effect to the aims and principles of the International Code Of Breast Milk Substitutes.Additionally,it would legislate towards protecting and supporting breastfeeding among working mothers.(MOPHS,2007/2010).Getting onto the agenda setting aspect of the IYCF strategy Kingdons(1984) theoretical good example of agenda setting(cited by Buse et.al,2012), would be much suitable in explaining how the Kenyan Strategy on IYCF became a major focus of government. Agenda setting is the process by which issues come into the policy agenda from the much larger number of issues potentially worthy of worry by policy makers.(Buse et.al,2012).Policy making is therefore viewed in agenda setting as responding to daily problems that need solutions.(Thomas and Grindle,1991 cited by Buse et.al,2012).The approach focuses on the role of policy entrepreneurs within and outside the government who utilize policy windows(agend a setting opportunities)to move issues onto the governments formal agenda.It is explained using 3 streams problem, policy and politics streams and the policy windows.Policy entrepreneurs promote their ideas into many different fora and invest time to ensure they are put onto the agenda.(Kingdon,1995).Problem stream is defined as public matters that requires attention(Gulbrandson and Fossum,2009). With an emphasis that it only becomes a problem if identified by the decision makers besides other lists of problems presented.Chopra et.al 2009 acknowledges the existence of a huge gap in the level of political support that nutrition and infant feeding was able to achieve compared to other components of the Prevention of Mother To Child Transfer(PMTCT) programme.An explanation to the delay in implementation of the then(prenominal), already exist IYCF policy and the unfinished approval of other existent nutritional programmes that would promote IYCF.The Ministry Of Public Health and Sani tation(MOPHS) was majorly involved in advocacy besides other nongovernmental organizations.The overwhelming evidence on malnutrition recorded by KDHS and Kenya Bureau of Statistics e.g 29.% stunting and 20.3% underweight children, data on huge reduction in EBF and reducing in BFHI by 70% (KDHS 2003Lancet,2003) were the key indicators that evidenced the magnitude of the issue and the need for prompt government action.Implementing this strategy was Kenyas way of renewing its commitment to WHO, by adopting its 2006 consensus statements on HIV and infant feeding.It was also a major stakeholder and a potential source of funding.The policy stream consists of ongoing problem analysis, and their proposed solutions together with debates surrounding the problems.(Buse et.al,2012).The solutions should be easily available and promptly accessible by decisionmakers.(Guldbrandson and Fossum,2009). The strategy was drawn from national assessments of IYCF policies ,programmes and practices in the c ountry(2004)and from consultative meetings with stakeholders.In addition to being harmonized with the National Food and Nutrition policy that was pending in the government at that time it was intended as a guide of action based on accumulated evidence on importance of infant and child nutrition during their early months and years of life and for growth and development.(MOPHS,2007Murage et.al,2013).The Kenyan Public Health Sanitation ministry then also had the expertise, technical and programme knowledge to rapidly improve Infant and Young Child Feeding indicators and to save lives.(MOPHS,2007/2010).Politics stream is defined as being composed of such events as national mood swings, government changes and campaigns by interest groups.(Buse et.al 2012Guldbrandson and Fusson,2009).The year of 2007 was an elections and campaign year in Kenya.The then existing government had a strong intention to go for a second term.Cairney and Jones,(2015) describe this as an existence of both motive an prospect in politics stream.Implementing the IYCF strategy during this period would be one of the moves to inveigle the public by showing attention to their problems.The strategy would provide a strong framework through which the government and other important stakeholders could contribute towards improvement of Kenyan childrens nutritional status through IYCF practices.(MOPHS,2007/10).The existence of an attention lurching problem(problem stream),with readily proposed solutions(policy stream) and a conducive and positive political environment that recognised and supported the strategy(politics stream) led to development of a policy window.An opportunity to develop the strategy in parliament and eventually its implementation.The Kenyan Ministry of Public Health and Sanitation(MOPHS-Kenya)would support this strategy by renewing its commitment to create an enabling environment for optimal IYCF(MOPHS,2007/10).It would also improve child survival by strengthening focus on IYCF thr ough various ways like advocating for enforcement and implementation of Maternity protection Provision in the Employment Act 2007 in all sectors working with the attorney general and the Minister Of arbiter and Constitutional Affairs to ensure enactment of a law that protects optimal IYCF develop clear, consistent policies and guidelines build the entire capacity of the public and private healthcare system to implement them, among many other key accessory tasks.(MOPHS,2007).Development of the IYCF strategy was a huge and commendable step in Kenya.Different factors are clearly outlined as having contributed towards its formation.Improvement infant and young child feeding practices, and maternal health being the core driving factors, besides adherence to WHO Global Strategy on IYCF.(MOPHS,2007/10).By 2012,Kenya was in its final stages of enacting the strategy.(Sagoe et.al,2012).The concomitant process of the strategy formation can be attributed to, the involvement of WHO/UNICEF, th e importunate collaboration between the Ministry of Health(MOH) and the MOPHS-Kenya together with other major national and international NGOs such as APHIA II Partners, World Vision Kenya among many others.(MOPHS,2007/10)Several significant achievements accrued from the implementation of this strategy include the 61% increase in EBF rates(KDHS,2014).Making Kenya among the handful of countries that have managed to achieve the WHA target of 50% EBF rates by 2025.Enactment of the Code of Marketing for breastmilk substitutes(Sagoe et.al,2012)and the development of various models like the BFHI and the Breast Feeding Community initiative(APHRC,2014) have greatly contributed towards achieving high EBF rates.A critical analysis of the strategy implementation process and the challenges pertaining to its implementation, an aspect my essay did not focus on would be a clear and concise way of depicting the achievements of the strategy and the barriers faced on rolling out and implementation of its plans.TOTAL WORD COUNT-3,265.