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Report of

Capacity Building

Training on Infant and

Young Child Feeding

(IYCF) Counselling for

10 Districts of Haryana

Ambala

Kurukshetra

Panchkula

Yamuna Nagar

Faridabad

Palwal

Gurgaon

Mahendragarh

Mewat

Rewari

Bhiwani

Fatehabad

Hisar

Kaithal

Sirsa

Jhajjar

Karnal

Panipat

Rohtak

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© Breastfeeding Promotion Network of India (BPNI)/IBFAN Asia 2014 PUBLISHED BY: Breastfeeding Promotion Network of India (BPNI) BP-33, Pitampura, Delhi-110034, India Tel: +91-11-27343608, 42683059 Tel/Fax: +91-11-27343606 Email: [email protected], [email protected] Website: www.bpni.org, www.ibfanasia.org

BPNI is a registered, independent, non-profit, national organisation that works towards protecting, promoting and supporting breastfeeding and appropriate complementary feeding of infants and young children. BPNI works through advocacy, social mobilization, information sharing, education, research, training and monitoring the company compliance with the IMS Act. BPNI is the Regional Focal Point for South Asia for the World Alliance for Breastfeeding Action (WABA) and Regional Coordinating Office for International Baby Food Action Network (IBFAN) Asia.

As, a policy, BPNI does not accept funds of any kind from the companies producing infant milk substitute, feeding bottles, related equipments, or infant foods (cereal foods) or from those who have been ever found to violate the IMS Act or the International Code of Marketing of Breast-milk-Substitute or from organization/ industry having conflict of interest.

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Acknowledgement

Breastfeeding Promotion Network of India (BPNI) is extremely grateful to National Rural Health Mission (NRHM)- Haryana for the opportunity to implement the training programme on Infant and Young Child Feeding (IYCF) Counselling for Middle Level Trainers in 10 District of Haryana.

We are thankful to Mrs. Navraj Sandhu, Additional Chief Secretary to Govt. of Haryana, Health Department and Dr Rakesh Gupta, Mission director, NHM Haryana for their guidance and trust in BPNI for this endeavour.

Our special gratitude for Dr. Suresh Dalpath, Deputy Director (Child Health)/State EPI officer, Haryana for his deep insight in supporting capacity building of MLT workers in IYCF Counselling, and Dr. Shibani Sharma, Consultant Child Health, NHM Haryana for her constant support in implementing the training programme.

BPNI wishes to thank the Civil Surgeons & Deputy Civil Surgeons, their staff and nodal officers of the districts where these training have been conducted. Their cooperation was extremely useful for the success of this work. They provided all the facilities and logistic support for smooth conduct of the training courses.

BPNI is grateful to all the trainers who contributed to the success of these trainings.

Lastly, we would like to thank all the participants for their commitment, eagerness to learn and willingness to support mother and infant to practice successful breastfeeding.

Dr. JP Dadhich National Coordinator,

Breastfeeding Promotion Network of India (BPNI)

Ms. Fariha Siddiqui Programme Officer (Training),

Breastfeeding Promotion Network of India (BPNI)

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Contents

Acknowledgements 3

Message from Additional Chief Secretary, Government of Haryana Health Department 7

Message from Mission Director, National Health Mission, Haryana 9

Preface 11

Introduction 13

BPNI’s Training Course on Infant and Young Child Feeding Counselling 16

Implementing Training of MLTs in Haryana 19

Training Workshops 20

Pre-and Post- Training Assessment 24

Glimpses from Training Sessions 25

Epilogue 27

Annexures 29

11

Preface

The report of “Capacity Building Training on Infant and Young Child Feeding (IYCF) Counselling for 10 Districts of Haryana” is an example of the recognition of the true need to build skills of health workers for counseling on breastfeeding and infant feeding decisions. These issues have been in discussion on the global and national agenda for over twenty years ever since 1993 when W.H.O. provided the first ever training course for health workers. This effort of BPNI in partnership with Government of Haryana would lead to further training of family level workers who in turn would be able to counsel mother and family members. It is crucial that quality of training is maintained, as it is not like routine passing of information. In this case, it is actually learning to understand and pass on skills on how breastfeeding is controlled by hormones, especially the flow of mothers’ milk from breast to the baby. It is so much under the influence of state of mind of the mother. And It’s her confidence that matters and therefore training need to focus around that skill building that’s why its so special.

We thank Government of Haryana for taking these steps and hope that these are continued effectively down to family level.

BPNI has been pioneering this effort in India since 22 years and led the development of unique world class training programme based on WHO materials, and it will continue to update it year after year incorporating latest scientific and programmatic needs.

I wish every success to the efforts of programme managers and the health workers who are keenly involved in this work.

Dr Arun Gupta Central Coordinator, BPNI

Regional Coordinator, IBFAN Asia

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Introduction

This is the report of an innovative collaborative training programme on Infant and Young Child Feeding (IYCF) Counselling implemented in the state of Haryana, India, by the National Rural Health Mission (NRHM) – Haryana along with Breastfeeding Promotion Network of India (BPNI). The programme included training of Middle Level Trainers (MLTs) for Medical officers, AYUSH Doctors, Staff Nurses, Nutritionists, Dentists, Public Health Nurses (PHNs) and Supervisors of 10 districts of Haryana. A total of 95 MLTs were trained over a period of one month (two were held in the month of March & two were held in the month of April 2014).

Importance of Optimal Infant and Young Child Feeding (IYCF) for Child Survival and Nutrition The National Rural Health Mission (NRHM), India’s flagship programme, aims to lower down maternal and infant mortality. Government of India seeks to work towards bringing down IMR faster than what is going on now. Early and exclusive breastfeeding for the first six months have been recognised to be key interventions for this purpose. The recommended optimal feeding of children is to initiate breastfeeding within one hour of birth, practicing exclusive breastfeeding for the first six months of life and continued breastfeeding through the second year of life along with timely, appropriate and adequate complementary feeding from the family pot after 6 months.

The National Guidelines on Infant and Young Child Feeding, Government of India (2006) point out that malnutrition among children occurs almost entirely during the first two years of life and is virtually irreversible after that. These guidelines call for building skilled support to women through health care system. National Nutrition Policy and Plan of Action on Nutrition included specific activities like “Ensuring that health care providers received high quality training in breast feeding and appropriate complementary feeding practices, Lactation management etc., using updated training material and techniques”..

Guidelines on Enhancing Infant and Young Child Feeding Practices (2013) by the Ministry of Health and Family Welfare, Government of India has also emphasised a strong need for capacity building of the health care providers in the institutions as well as the community.

The Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, Amendment Act 2003, which recognise that child mortality is closely linked with inappropriate feeding and malnutrition, and poor infant feeding is caused by pervasive promotion of baby foods, against little promotion of breastfeeding by the State, and this is a contributing factor to malnutrition and deaths of children.

Relevance of Breastfeeding and Optimal Infant and Young Child Feeding (IYCF) for Child Survival and Nutrition The Global Strategy for Infant and Young Child Feeding as well as the National guidelines on infant and young child feeding in India recommend early initiation of breastfeeding within one hour and exclusive breastfeeding for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.1,2

1 WHO. Global Strategy on Infant and Young Child Feeding, 2003. World Health Organization, Geneva.

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The Global Strategy for Infant and Young Child Feeding also states that “Even though it is a natural act, breastfeeding is also a learned behaviour. Virtually all mothers can breastfeed provided they have accurate information, and support within their families and communities and from the health care system. They should also have access to skilled practical help from, for example, trained health workers, lay and peer counsellors, and certified lactation consultants, who can help to build mothers’ confidence, improve feeding technique, and prevent or resolve breastfeeding problems.”

Scientific evidence is available to establish breastfeeding and optimal IYCF practices as an effective tool to improve child health, prevent malnutrition and reduce neonatal, infant and child mortality. Initiation of breastfeeding within an hour of birth is known to reduce infection specific neonatal mortality, and this impact is independent of the effect of exclusive breastfeeding during the first month of life.3 Globally sub-optimal breastfeeding is estimated to be responsible for 1.4 million child deaths and 43.5 million Disability Adjusted Life Years (DALYs), with non-exclusive breastfeeding during 0-6 months accounting for 77 percent (1.06 million) of the deaths and 85 percent of the DALYs. Partial breastfeeding (breastmilk plus other milks or foods) increases child mortality by 2.8 times as compared to exclusive breastfeeding.4 A systematic review of effective interventions for improving child survival concluded that for three major causes of child morbidity and mortality i.e. neonatal sepsis, diarrhoea and pneumonia, universalization of breastfeeding (exclusive breastfeeding for the first six months and continued breastfeeding for second six months) is a highly effective preventive intervention which could prevent 13% of all child deaths. An additional 6% death can be prevented with appropriate complementary feeding. 5 It is well documented that optimal breastfeeding reduces the risk of infectious diseases like diarrhoea and pneumonia sub.6,7Optimal complementary feeding could substantially reduce stunting and related burden of disease.8 Breastfeeding may also enhance effect of some vaccine.9 In addition to preventing morbidities and mortality in children, breastfeeding also have long term effects on health and have a protective role in hypertension, diabetes type II, obesity and hypercholesterolemia.10

Status of IYCF practices in India and Haryana India has dismal rates of infant feeding practices and these are not rising satisfactorily. National rates for initiation of breastfeeding within one hour of birth are 24.5 percent; exclusive breastfeeding for the first six months of life is only 46.4 percent and Introduction of complementary feeding along with continued breastfeeding between 6-9 months is 55.8 percent. For Haryana, IMR is 41.7 percent, initiation of breastfeeding within one hour is 22.3 percent, exclusive breastfeeding for first six months of life is 16.9 percent and introduction of complementary feeding

2 Ministry of Women and Child Development, Food and Nutrition Board, Government of India. National guidelines on Infant and Young Child Feeding, Second Edition, 2006. 3 Edmond KM, Kirkwood BR, Amenga-Etego S, Owusu-Agyei S, Hurt LS. Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of the causal links with observational data from rural Ghana. Am J Clin Nutr 2007; 86: 1126-1131. 4 Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243-260. 5 Jones G, Steketee RW, Black RE, Bhutta ZA, Morris S S, and the Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003; 362: 65-71. 6 WHO. Diarroheal disease. Fact sheet no. 330, August 2009. Available at: http://www.who.int/mediacentre/factsheets/fs330/en/index.html Accessed 20th February 2012. 7 Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization 2008; 86(5):408-16. 8 Bhutta ZA et al. What works? Interventions for maternal and child undernutrition and survival. Lancet 2008; 371(9610):417 – 440. 9 Jackson KM. Breastfeeding, the Immune Response, and Long-term Health. JAOA 2006; 106 (4 ): 203-207. 10 Horta BL, Bahl R, Martines JC, Victora CG (Eds.). Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analysis. World Health Organization, Geneva, 2007.

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along with continued breastfeeding between 6-9 months is 44.8 percent.11 Where as in District Level Household and Facility Survey-3 which was done in 2007-2008 shows initiation of breastfeeding within one hour of birth 16.5 percent; exclusive breastfeeding for the first six months of life 9.4 percent and Introduction of complementary feeding along with continued breastfeeding between 6-9 months is 74.1 percent.12

Table 1: One Key Indicator of IYCF Practices in Districts of Haryana S.No. Districts Children breastfed within one

hour of birth (%) 1 Gurgaon 18.5 2 Palawal 7.8 3 Mahendragarh 23.3 4 Rohtak 20.3 5 Panipat 12.3 6 Kaithal 18.5 7 Jhajjar 15.7 8 Hisar 23.0 9 Faridabad 10.9 10 Mewat 7.5

Source: District Level Household and facility Survey 3, 2007-08. Ministry of health and family welfare, Government of India. Available at http://www.rchiips.org/pdf/rch3/report/hr.pdf), accessed on march 3rd,2014.

11International Institute for Population Sciences. National Family Health Survey - 3. Available at: http://www.nfhsindia.org/NFHS-3%20Data/VOL-1/Chapter%2010%20-%20Nutrition%20and%20Anaemia%20%28608K%29.pdf. Accessed on 31st May, 2012. 12 District Level Health Survey – 3 Available at : http://www.rchiips.org/pdf/rch3/report/HR.pdf. Accesses on 31st May ,2014.

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BPNI’s Training Course on Infant and Young Child Feeding Counselling

The Breastfeeding Promotion Network of India (BPNI) conducts training of trainers (Middle Level trainer – MLTs) of the health functionaries at state and district level. The skill training of trainers and frontline workers is accomplished using the training package titled “Infant and Young Child Feeding Counselling : A Training Course, (Integrated Breastfeeding, Complementary feeding, Infant feeding & HIV Counselling and Growth Monitoring)- The 4 in 1Course”. This course is a comprehensive and integrated course developed by BPNI along with its partners. This course is based on WHO / UNICEF Training Courses – “Breastfeeding Counselling – A Training Course”, “HIV and Infant Feeding Counselling – A Training Course” and “Complementary Feeding Counselling – A Training Course”. The training module for the frontline workers has been field tested by National Institute of Public Cooperation and Child Development (NIPCCD), Government of India. The course has also been endorsed by the Indian Academy of Paediatrics (IAP), Indian Medical Association (IMA) and Indian Academy of Preventive and Social Medicine (IAPSM).

This is a cascade-training course in which four national trainers from BPNI train 24 Middle Level Trainers at state or district level in a seven days training workshop. Three such Middle Level Trainers train 30 Frontline Workers like ANMs, ASHAs, AWW etc. at block or district level. The flow of the training is depicted in the pictorial (Figure -1) below:

Figure – 1: Schema of the training for the Middle Level Trainers

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BPNI has also listed training tools necessary for conducting the training of MLTs (See Table 2). BPNI wither supply these tools or request the organizing agency to arrange them for each participant.

Table 2: Training kit for Middle level trainers S.No. Training Material 1 Training Guide for Training MLT 2 Teaching Aids (CD) 3 Manual for Frontline Workers (Hindi) 4 Counselling Guide for Frontline Workers (Flip Chart)-Hindi 5 Breastfeeding and Complementary Feeding: A Guide for

Parents (Hindi) 6 CD “Maa Ka Pyaar Shishu Ahaar” 7 The Law to Protect Promote and Support Breastfeeding

Table 3: Training Tools for Middle level trainers S.No. Training Tool 1 Doll 2 Breast Model 3 Syringe, Breast Pump 4 Bowl, Cup 5 Measuring jar 6 Full & Quarter Plates, Spoon, 7 Writing Pad, Pen. Pencil, Eraser, Sharpener

Table 4: Training kit for Frontline worker S.No Content

1 Manual for Frontline Workers (Hindi)

2 Counselling Guide for Frontline Workers (Flip Chart)-(Hindi)

3 Breastfeeding and Complementary Feeding: A Guide for Parents (Hindi)

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Implementing Training of MLTs in Haryana

NRHM Haryana & BPNI Delhi jointly implemented the training programme for MLTs (Medical Officers, AYUSH Doctors, Staff Nurses, Supervisors & PHN etc) with an objective to enhance early and exclusive breastfeeding for the first six months and initiation of timely complementary feeding along with importance of growth monitoring in Haryana State.

Submission and approval of project proposal for trainings • A Preliminary meeting of BPNI Team was held with MD, NRHM Haryana in Panchkula

regarding for training of MLT on IYCF Counselling Course. • The process for this activity started when BPNI submitted a proposal to NRHM Government of

Haryana, for training of Middle Level Trainers on IYCF Counselling in all the districts of Haryana in August 2012. BPNI got an approval in 17th October 2013 to conduct four MLT Trainings in Haryana for 10 Districts of Haryana.

• In reference with the proposal, BPNI signed a Memorandum of Understanding (MOU) with NRHM Haryana in January 2014. (Annexure-1,2)

Actions for successful implementation of the programme were identified and task of work assigned as follows:

BPNI ensured • Coordinating arrangements for trainings with nominated districts health officials at training

venues. • Deputing National trainers for trainings. • Conducting Training of nominated Middle Level trainers at District Level. • Arranging Training materials / Training Tools at the address of nominated district health

officials at training venue. • Ensuring quality control in training • Report writing and submission to NRHM Haryana for individual MLT training workshop. NRHM Haryana undertook following activities • Nomination of Nodal officers for training at every district and at training venues. • Nomination of district level health and nutrition care functionaries for 7 days Middle Level

trainers (MLTs) workshops • Facilitating identification of training venue and arrangements at training venue. • Facilitating arrangements of caterer for lunch / tea / water. • Facilitating arrangements of mothers with newborns for clinical practice. • Facilitating identification of two assisting staff at training venues. • Facilitating hotel accommodation for national trainers of BPNI. • Making stay arrangements for MLTs • Making arrangements for reimbursement of TA/ DA to participants of MLT trainings. • Availability of CMHO / other senior official for valedictory Function

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Training Workshops

Middle Level Trainers were trained with 4-in-1 integrated course on Breastfeeding, Complementary feeding, HIV & Infant Feeding and Growth Monitoring in 7 days training workshop having 2 phases.

The First phase, which is refered as the Preparatory Phase, comprised of a total of 27 sessions, including 22 theoretical sessions, 3 clinical practices and 2 practice sessions. In this phase, the participants were first explained about the objectives of the course, training methodology and training tools. National Trainers then prepared them about various methods to take interactive sessions like:

• Didactic Lecture using Power point presentations: Majority of sessions have theoretical content which was explained to the participants with the used of PowerPoint presentations.

• Conducting skill session using demonstrations: Listening & Learning Skills, Building Confidence, Positioning and Breastfeeding by working mothers etc. are few of the skills which were taught to the participants using innovative demonstrations as a training techniques. These demonstrations made the topic easier to understand in an interesting way.

• Enacting Role plays to convey important information and message: To convey important information and messages, trainer enacted role plays in front of the group. Such a method is useful for practicing skill like counseling and for exploring how people react in specific situation. The role-play objective is an attitudinal change dealing with feeling and emotion. Role-plays have many advantages like: - The trainees are involved in problem solving, actively participate which stimulates interest and it helps in understanding and developing behavior of self and others.

• Clinical Practice: Certain practice sessions requires working in the clinical settings and conducted in hospital premises in Pediatric and Gynaec ward and OPD. In these clinical practice sessions participants worked with the mother-baby dyad at bed side to learn communication skills, assess and observe breastfeeding and complementary feeding, and take growth measurements in real situation. These Clinical practice sessions were advantageous as trainees got hands on experience on topic which they learned and discussed in class by communicating and working with the mother and baby. They also has first hand experience of many real situations and got ideas about how to solve them.

• Practical Sessions: In special designated sessions, participants also learned to prepare replacement feeds and complementary foods. This exercise provided them first hand experience of various logistic needs, time consumed etc. in preparing these feeds. Participants were also explained the use of the Counseling Flip Chart while counseling the mother.

The Second Phase, which is referred as the Consolidation Phase, provided an opportunity to the Middle Level Trainers to conduct various assigned sessions under the supervision of BPNI National Trainers. Each of them led a group for Group work, Demonstration, Practice sessions and bed side Clinical practice session. Frontline Workers, who function as the family level counselors require skills on counseling in normal as well as in difficult circumstances. The second phase of MLT training armed the Middle Level Trainers to address these specific needs of skill building in counselling of frontline workers.

95 Middle Level Trainers from 10 districts of Haryana were trained in four training workshops of 7 days each. Two simultaneous training workshops were held on 24th to 30th March 2014 at Gurgaon

21

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Pre-and Post- Training Assessment

To assess the improvement in the knowledge of trainees, self-administered pre- and post test questionnaire were designed. The pre- and post test questionnaire aimed at capturing the change in knowledge levels and handling practical issues in IYCF counselling. Assessment findings are given in the table 5.

Table 5: Pre- and Post-Intervention assessment of knowledge of MLT trainers

S.No. Question pertaining to Correct Responses N=95 Pre Test (% ) Post Test (%) 1. Knowledge about optimal infant and young child

feeding practices 68 (71.58) 88(92.63) 2. Composition of breast milk 46 (48.42) 65(68.42) 3. Benefits of breastfeeding mother 40(42.11) 81(85.26) 4. Dangers of pre lacteal feeds 66(69.47) 87(91.58) 5. Duration Of breastfeeding 78(82.11) 93(97.89) 6. Factors which enhance prolactin reflex 61(64.21) 83(87.37) 7. Functions of Oxytocin reflex 15(15.79) 86(90.53) 8. Factors which hinder Oxytocin reflex 20(21.05) 50(52.63) 9. Key for enhancing breastmilk production 34(35.79) 74(77.89) 10. Sign of good attachment 38(40.00) 90(94.74) 11. Causes of sore nipples 45(47.37) 80(84.21) 12. Reliable sign of enough milk being received by baby 16(16.84) 72(75.79) 13. Questions Regarding IMS (Infant Milk Substitute) Act 45(47.37) 67(70.53) 14. Appropriate age of starting complementary foods 78(82.11) 93(97.89) 15. Foods rich in Vitamin A 65(68.42) 92(96.84) 16. Foods for children in disease 62(65.26) 80(84.21) 17. The Growth Chart used in NRHM/ ICDS has How

many curves 20(21.05) 43(45.26) 18. A Child who is shorter than expected age 49(51.58) 82(86.32) 19. which indices are used for Growth Monitoring 69(72.63) 82(86.32) 20. What should happen at a routine 'well-child' Visit 80(84.21) 91(95.79)

Analysis of data (Table 5) showed that after training there was a significant improvement in knowledge about various facets of breastfeeding and complementary feeding and Growth monitoring among participants. Post-intervention, a high proportion of participants responded with correct answers as compared to Pre-intervention on question related with sign of good attachment (40% to 94%) , food for child in disease (65% to 84%), Key for enhancing breast milk production (35% to 77%) and functions of Oxytocin reflex (15.79% to 90.53%) etc.

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27

Epilogue

NRHM Haryana & Breastfeeding Promotion Network of India (BPNI) worked together with an objective to enhance early and exclusive breastfeeding for the first six months and initiation of timely complementary feeding along with importance of growth monitoring in 10 districts of Haryana state through capacity building of the district level like Medical officers, AYUSH Doctors, Staff Nurses, Supervisors, PHN etc. For BPNI training team, this was a very satisfying experience due to an enthusiastic participation by the trainees and appropriate administrative assistance at state and district level. Trainees were also very happy to get new insight in the subject and to acquire knowledge and skills on this important aspect of maternal and child care. The training programme has once again established the fact that it is possible and feasible to impart skill training with in the health system in reasonable resources. We hope, this endeavour will help in improving infant and young child feeding practices in Haryana. This will be useful to assess knowledge, attitude and practices of trainees in future to provide any refresher course if required. The success of the trainings provided to the Middle Level Trainers rests in using their training skills to train the frontline workers who will provide appropriate counseling and skilled support on infant and young child feeding to pregnant and lactating women.

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Annexures

Annexure 1: Cover letter from BPNI to NRHM for Memorandum of Understanding (MOU) Annexure 2: Copy of signed MOU between NRHM, Haryana and BPNI Annexure 3: List of Middle Level trainers who were trained. Annexure 4: List of BPNI National Trainers who provided training to MLTs Annexure 5: Course Contents for Training of the Middle Level Trainers Annexure 6: Time Table for Training of the Middle Level Trainers Annexure 7: Specimen of Certificate given to MLTs. Annexure 8: Experience of BPNI in conducting trainings in IYCF counselling Annexure 9: BPNI Training Cell.

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Cover

r letter frrom BPNNI to NRHHM for M(MOU)

emoranddum of U

Ann

Understa

nexure -1

anding

Copy off Signed MOU Beetween NNRHM, Haaryana a

Ann

and BPNI

nexure -2

I

32

37

Annexure -3

List of Middle Level Trainers Who Were Trained

Training - 1 (Gurgaon) • Dr. Sonia Chaudhary • Dr. Suchita • Ms. Suman Kumari • Ms. Kavita • Ms. Mamta Arora • Ms. Kamlesh Sharma • Ms. Gyanbati • Ms. Darshna • Dr. Sahadev Singh

• Dr. Tanuj Kumar • Dr. Manoj Kumar • Dr. Satyabir • Dr. Bhupendra Kumar • Dr. Amit Kumar • Dr. Prachi Singh • Ms. Sanehlita • Dr. Pushpendra

• Dr. Reena Aggarwal • Dr. Deepak Jha • Dr. Parikshit Yadav • Ms. Sarita • Dr. Shweta • Dr. Meenu • Dr. Prashant • Dr. Shibani Sharma

Training – 2 (Rohtak) • Ms. Sudesh Kumari • Ms. Sushila • Dr. Bharat Jindal • Mr. Satpal Singh • Dr. Vivek Gupta • Ms. Babita • Dr. Suman Bala • Dr. Jyoti

• Dr. Sunil Arora • Dr. Sushil Jaglan • Dr. Pramod Kumar • Ms. Sonia • Ms. Geeta Devi • Ms. Manisha • Ms. Sushma Rani • Dr. Mamta Mehla

• Dr. Kamlesh Bhana • Dr. Arun Kumar • Dr. Sunil Sharma • Dr. Haripal Budhwar • Mr. Suresh Kumar • Dr. Neena

Training – 4 (Rohtak)

• Dr. Kiran Solanki • Dr. Archana Sehgar • Dr. Vaibhav Bidani • Dr. Sachin Pahwa • Dr. Anita Saini • Dr. Aman Suhan • Ms. Pushpa Devi • Ms. Sushma • Dr. Preeti Dalar

• Ms. Veeran Thakral • Dr. Pallavi Mehta • Ms. Bimla Devi • Ms. Renu Rani • Ms. Krishna Devi • Ms. Krishna Rani • Ms. Santosh Devi • Dr. Amit • Dr. Raj Mehta

• Ms. Raj Bala • Dr. Barkha Sharma • Dr. Gaurav Punia • Dr. Vivek • Dr. Anuj Chaudhary • Dr. Sanjeev Kumar • Dr. Shakuntla Arora • Ms. Darshana • Dr. Aruna Garg

Training - 3 (Gurgaon) • Dr. Zubair Ahmed • Dr. Sanjay Kumar • Dr. Aslam • Dr. Aslam Ali • Dr. Hemraj • Dr. Archana Yadav • Dr. A.K. gaur

• Ms. Anita Yadav • Ms. Tripta • Dr. Ashish Tyagi • Dr. Mohammad Qasim • Dr. Mohammad Arshad

Ghayaas • Ms. Kaushalya Hooda

• Ms. Varsha rani • Ms. Babita rani • Dr. Upasana Dahiya • Ms. Raman Kumar • Dr. Rashmi Budhiriya • Dr. Geetanjali Arora

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Annexure -4

List of BPNI National Trainers who provided training to MLTs

S. No. Trainers Contact No Email 1 Dr.MMA Faridi 9868399740

Delhi [email protected]

2 Dr. Pardeep Kanna 9416120304 Rohtak

[email protected]

3 Dr. Anita Gupta 9810617023 Delhi

[email protected]

4 Dr. K.C. Aggarwal 9811486506 Delhi

[email protected]

5 Dr. Kundan Mittal 9416514111 Rohtak

[email protected]

6 Dr. B.B. Gupta 9721458886 Gorakhpur

[email protected]

7 Dr. Sangeeta Rani 9911964084 Delhi

[email protected]

8 Ms Fariha Siddiqui 8860025078 Delhi

[email protected]

9 Ms. Ulka Jamal 9425478301 Indore

[email protected]

10 Ms. Lubna Umar 9893518745 Bhopal

[email protected]

11 Ms. Nupur Bidla 9958163610 Delhi

[email protected]

12 Ms. Arnika Sharma 9999483669 Delhi

[email protected]

39

Annexure -5

Course Contents for training of the Middle Level Trainers

Infant and young child feeding counselling: A Training Course

Introduction

Session 1 Why Optimal Infant and Young Child Feeding

Session 2 Production and intake of breast milk

Session 3 Assessing and Observing a Breastfeed

Session 4 Listening and Learning

Session 5 Building Confidence, Giving Support and Checking Understanding

Session 6 Antenatal Preparation and Establishing Community Breastfeeding Support

Session 7 Positioning Baby at the Breast

Session 8 Breast conditions

Session 9 Refusal to breastfeed and crying

Session 10 Expressing breast milk

Session 11 Not enough milk

Session 12 Breastfeeding Low Birth Weight Babies & Twins

Session 13 Complementary Feeding - Foods to Fill the Nutrient Gap

Session 14 Feeding Techniques and Strategies

Session 15 Institutionalizing Skilled Infant and Young Child Feeding Counselling

Session 16 Nutrition of Lactating Mothers and their Health and Fertility

Session 17 Breastfeeding by Working Mothers

Session 18 Breastfeeding in Special Circumstances Specially HIV & Infant Feeding

Session 19 Clinical Practice 1 Listening and learning, confidence building, giving support Assessing a breastfeed and Positioning a baby at the breast

Session 20 Clinical Practice 2 Listening and Learning, Building confidence, giving support Counselling for Complementary Feeding

Session 21 IMS Act

Session 22 Growth Monitoring and Measuring

Session 23 Growth Monitoring by Growth Charts

Session 24 Measuring Growth: Taking Action

Session 25 Clinical Practice 3: Measuring weight & length, Counselling for infant feeding

Session 26 Practice 1: Preparation of complementary feed

Session 27 Practice 2: Preparation of Replacement feed

40

Annexure - 6

Time Table for Training of the Middle Level Trainers

Phase 1 (Preparatory Phase) Day 1

Time Sessions Minutes 9-10am Registration. Introduction- participants, course material. Expectations 60 10-10.30am Tea 30 10.30-11.30am Session 1: Why Optimal Infant and Young Child Feeding 60 11.30-12.30 pm Session 2: Production and Intake of Breastmilk 60 12.30-1.30 pm Session 3: Assessing and Observing a Breastfeed 60 1.30-2.30 pm Lunch 60 2.30-3.30 pm Session 4: Listening and Learning 60 3.30-4.00pm Tea 30 4.00-5.00 pm Session 5: Building Confidence, Giving Support and Checking Understanding 60 5.00-5.30pm Session 6: Antenatal preparation & establishing community breastfeeding

support 30

5:30-6:00 pm Trainers’ meeting 60 Day 2

9.00-10.00am Session 7: Positioning Baby at the breast 60 10.00-10.30am Tea 30 10.30-12.30 pm Session 19 : Clinical Practice-1[Listening and learning, confidence building,

giving support, taking feeding history. Assessing a breastfeed and Positioning a baby at the breast]

120

12.30-1:00 pm Session 8: Breast conditions 30 1:00-1:30 pm Session 10: Expressing Breastmilk 30 1:30-2:30 pm Lunch 60 2:30-3:00 pm Session 22: Growth monitoring and measuring 30 3:30-4:00 pm Tea 30 4.00-5.00 pm Session 23- 24 : Growth monitoring by charts and taking action 60 5.00-5.30 pm Session 12: Breastfeeding Low Birth Weight Babies & Twins 30 5:30-6:00 pm Trainers’ meeting

Day 3 9.00-10.10am Session 13: Complementary Feeding - Foods to Fill the Nutrient Gap 70 10.10-10.30am Tea 20 10.30-11.30 am Session 14: Feeding Techniques and Strategies 60 11.30-1.30 pm Session 20 : Clinical Practice-2 [Communication skills, taking measurements,

plotting on the charts, Counseling for Complementary Feeding] 120

1.30-2.30 pm Lunch 60 2.30-3.30 pm Session 11:Not enough milk 60 3.30-4:00 pm Practical-2 Preparation of complementary feed 30 4:00-4:10 pm Tea 10 4:10-4:30pm Session-21 IMS Act 20 4:30--5:00 pm Session 18: Breastfeeding in special circumstances especially HIV & IF

60

5:00-5:30 pm Session 9: Refusal to Breastfeed and Crying 30 5:30-6:00 pm Trainers’ meeting 30

Phase 2 (Consolidation Phase) Day 4

9-10am Introduction of course material, Expectations 60 10-10.30am Tea 30 10.30-11.30am Session 1: Why Optimal Infant and Young Child Feeding 60 11.30-12.30 pm Session 2: Production and Intake of Breastmilk 60 12.30-1.30 pm Session 3: Assessing and Observing a Breastfeed 60 1.30-2.30 pm Lunch 60 2.30-3.30 pm Session 4: Listening and Learning 60 3.30-4.00pm Tea 30 4.00-5.00 pm Session 5: Building Confidence, Giving Support and Checking Understanding 60

41

5.00-5.30pm Session 6: Antenatal preparation & establishing community breastfeeding support

30

Day 5 9.00-10.00am Session 7: Positioning Baby at the breast 60 10.00-10.30am Tea 30 10.30-12.30 pm Clinical Practice-1[Listening and learning, confidence building, giving support,

taking feeding history. Assessing a breastfeed and Positioning a baby at the breast]

12.30-1:00 pm Session 8: Breast conditions 45 1:00-1:30 pm Session 10: Expressing Breastmilk 30 1:30-2:30 pm Lunch 2:30-3:00 pm Session 18: Breastfeeding in special circumstances especially HIV & IF

30

3:30-4:00 pm Tea 30 4.00-5.00 pm Session 9: Refusal to breastfeed and crying 45 5.00-5.30 pm Session: 27 Practical-1 Preparation of Replacement feed 45

Day 6 9.00-10.10am Session 13: Complementary Feeding - Foods to Fill the Nutrient Gap 70 10.10-10.30am Tea 20 10.30-12.30 am Clinical Practice-2 [Communication skills, taking measurements, plotting on the

charts, Counseling for Complementary Feeding]

120

12.30-1.30 pm Session 14: Feeding Techniques and Strategies 60 1.30-2.30 pm Lunch 60 2.30-3.30 pm Session 22: Growth Monitoring and Measuring

60

3.30-4:00 pm Session21: IMS Act 30 4:00-4.30 pm Tea 30 4:30--5:00 pm Session23: Growth Monitoring by Growth charts

60

5:00-5:30 pm Session 24: Measuring Growth- taking action 30 5:30-6:00 pm Trainers’ meeting 30

Day 7 9.00-10.00am Session 11: Not enough milk 60 10.00-10.30am Tea 30 10.30-12.30 pm Clinical Practice-1[Listening and learning, confidence building, giving support,

taking feeding history. Assessing a breastfeed and Positioning a baby at the breast]

120

12.30-1:00 pm Session12: Breastfeeding low birth weight babies 45 1:00-1:30 pm Practical -2 Preparation of complementary feed 60 1:30-2:30 pm Lunch 2:30-3:00 pm Session 17: Breastfeeding by working woman

30

3:30-4:00 pm Tea 30 4.00-5.00 pm Session 15: Institutionalizing skilled IYCF counseling 30 5.00-5.30 pm Valedictory Function

Specim

men of Ceertificatee given too MLTs

Annnexure -7

42

7

43

Annexure -8

Experience of BPNI in Conducting Trainings In IYCF Counselling

Training on lactation management and breastfeeding and complementary feeding counselling has been a regular activity undertaken by BPNI since its inception in 1991. BPNI developed with its partners the integrated course on breastfeeding, complementary feeding and HIV and infant feeding counselling in 2003-04.A fourth component of growth monitoring was added in 2011. The integrated counselling course of BPNI has two major elements. The first is to develop “Infant and young child feeding counselling specialist” and the second is to develop “middle level trainers” and “family counsellors”. Following is the list of training programmes conducted by BPNI during last 5 years in collaboration with various state governments, medical colleges, and international agencies.

S.No. Name of the Project Supporting organization Duration of the project

1 Training of MLTs and Frontline Workers in IYCF for 38 districts of Bihar Venue: NMCH Medical College, Patna

Women & Child Development Department Bihar(ICDS), with UNICEF, Bihar

Oct. – Dec. 2013

2 International Training of Trainers on IYCF Counselling & IYCF Counselling Specialists Venue: UCMS & GTB Hospital, Delhi

BPNI, Department of Paediatrics, UCMS & GTB Hospital, Delhi

24 june- 7 july 2013

3 IYCF Counselling Specialists training Venue: Kalawati saran Hospital, Delhi

BPNI, Department of Paediatrics, Kalawati saran Hospital, Delhi

17-23 June 2013

4 Training of Middle level Trainers in IYCF. Venue: SHIFW, Panchkula

National Rural Health Mission, Haryana

March 2013

5 Training of MLTs and Frontline Workers in IYCF for Districts Punjab Venue: Civil Hospital Tarn Taran and Muktsar (PUNJAB)

Department of Health and Family Welfare, National Rural Health Mission, Government Of Punjab

Jan-Feb 2013

6 Preparation of IYCF Counselling Specialists The “4 in 1” Venue: Govt Hospital, Hindupur, AP

Women Development & Child Welfare Department, Government of Andhra Pradesh

21-27 June 2012

7 Training of Trainers on IYCF Counselling & IYCF Counselling Specialists Venue: UCMS & GTB Hospital, Delhi


14-27 May 2012

8 Training of Middle Level Trainers and Yashodas in 33 district of Rajasthan Venue: District Hospitals, Rajasthan

NRHM Rajasthan and NIPI India

Dec 2011-Mar 2012

9 Preparation of IYCF Counselling Specialists Venue: G R Medical College, Gwalior

BPNI, Department of Paediatrics G R Medical College, Gwalior

14-20 Nov 2011

10 Preparation of IYCF Counselling Specialists Venue: Govt Hospital, Hindupur, AP


10-16 Oct 2011

11 Preparation of IYCF Counselling Specialists Venue: UCMS & GTB Hospital, Delhi


26 Sep - 2 Oct 2011

12 Capacity Building of State Mentors Plan International (India Chapter) & 26th April - 3rd

44


Improving breastfeeding and other IYCF practices in Bihar Venue: Eras Medical College Lucknow, UP

Eras Medical College Lucknow, UP

May, 2011

13 Capacity Building of State Mentors Improving breastfeeding and other IYCF practices in Uttar Pradesh Venue: Eras Medical College Lucknow, UP

Plan International (India Chapter) & Eras Medical College Lucknow, UP

28th March - 4th April, 2011

14 Training of MLTs and Frontline Workers in IYCF for 8 districts of Punjab Venue: 8 District Hospitals

Department of Health & Family Welfare, National Rural Health Mission, Government of Punjab

October 2010- March 2011

15 International Outreach Course on Breastfeeding: Advocacy & Practice Course Venue: BRD Medical Colledge, Gorakhpur, UP

UCL Institute of Child Health, London, BRD Medical College, Gorakhpur & BPNI

Nov 21-Dec 4, 2010



1-7 Nov 2010; 23-29 Nov 2010; 16-22 Feb 2011



26 Nov-3 Dec 2010

18 Preparation of IYCF Counselling Specialists Venue: Govt Hospital, Hindupur, A P

BPNI, District Hospital, Hindupur

10-16 Oct 2011



23-29 August 2010

20 Training of MLTs and Frontline Workers in IYCF for districts of Firozpur and Gurdaspur Venue: District Hospital at Firozpur and Gurdaspur


Jan-April 2009

21 Preparation of Middle Level Trainer in the field of IYCF Venue: PGIMER, Rohtak, Haryana

Women & Child Development Department, Government of Haryana

25-30 May 2009; 24-29 Dec, 2008

22 Preparation of State Mentors in the field of IYCF (6 batches) Venue: District Hospital, Hindupur, AP


6-13 Dec 2008; 13-18 Feb 2009; 18-29 Jun 2009; 16-21 July 2009; 16-21Aug 2009; 16-21 Sept 2009

23 Preparation of National Trainers & IYCF Counselling Specialists Venue: PGIMER, Rohtak, Haryana

Department of Health Services, Government of Haryana

21 Nov-3 Dec 2008

24 Preparation of Middle Level Trainers (MLTs)

CARE Jharkhand

26 Sep-1 Oct 2008

25 Preparation of IYCF Counselling Specialists The “4 in 1” Venue: Govt Hospital, Hindupur, AP


21-27 June 2012

26 Training of Trainers on IYCF Counselling & IYCF Counselling


14-27 May 2012

45


Specialists Venue: UCMS & GTB Hospital, Delhi

27 Training of Middle Level Trainers and Yashodas in 33 district of Rajasthan Venue: District Hospitals, Rajasthan

NRHM Rajasthan and NIPI India

Dec 2011-Mar 2012



14-20 Nov 2011



10-16 Oct 2011



26 Sep - 2 Oct 2011

31 Capacity Building of State Mentors Improving breastfeeding and other IYCF practices in Bihar Venue: Eras Medical College Lucknow, UP


26th April - 3rd May, 2011

32 Capacity Building of State Mentors Improving breastfeeding and other IYCF practices in Uttar Pradesh Venue: Eras Medical College Lucknow, UP


28th March - 4th April, 2011

33 Training of MLTs and Frontline Workers in IYCF for 8 districts of Punjab Venue: 8 District Hospitals


October 2010- March 2011

34 International Outreach Course on Breastfeeding: Advocacy & Practice Course Venue: BRD Medical Colledge, Gorakhpur, UP

UCL Institute of Child Health, London, BRD Medical College, Gorakhpur & BPNI

Nov 21-Dec 4, 2010



1-7 Nov 2010; 23-29 Nov 2010; 16-22 Feb 2011

46

Annexure -9

BPNI Training Cell (2011-2014)

Chairperson Prof. (Dr) K.P. Kushwaha Principal & Dean B.R.D Medical College Gorakhpur, Uttar Pradesh email: [email protected]

Co-Chairperson Prof. (Dr) MMA Faridi Professor & Head, Department of Pediatrics University College of Medical Science & GTB Hospital Dilshad Garden, Delhi-110095 Email: [email protected]

Coordinator Mr. P.K. Sudhir BPNI BP-33, Pitampura, Delhi-110034 Email: [email protected] Members Dr. Kesavulu Civil Surgeon Government Hospital (Hindupur) Andhra Pradesh-515201 Email: [email protected]

Dr Pardeep Khanna Senior Professor & Head Department of Community Medicine Pt. B.D. Sharma P.G.I.M.S. Rohtak-124001, Haryana Email: [email protected], [email protected]

Dr Ramneek Sharma Surya Foundation House No- 3139, Sector 28-D Chandigarh-160002 Email: [email protected] [email protected]

Dr. Rajinder Gulati Medical Officer Pediatrician Punjab Civil Medical Servicer 46-L, Model Town, Ludhiana-141002 Punjab Email: [email protected]

Dr. Anita Gupta Chief Medical Officer Department of Community Medicine UCMS & GTB Hospital Delhi-110092 Email: [email protected]

Dr. Sangeeta Rani Guru Gobind Singh Govt. Hospital Raghubir Nagar Delhi Email: [email protected]

Dr. S. Aneja Professor & Head of Pediatrics Lady Harding Medical College Bangla Sahib Road, Delhi-110001 Email: [email protected]

Breastfeeding Promotion Network of India (BPNI)BP-33, Pitampura, Delhi-110034tel: +91-11-27343608, 42683059.tel/fax: +91-11-27343606e-mail: [email protected]: www.bpni.org

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