How to strengthen the sustainability of the ten steps
to successful breastfeeding and the three items in
mother baby friendly (MBFI) accredited facilities in
Sekhukhune district, Limpopo Province
(Action Research Foundation for Professional
Development in affiliation with Yale school of Public
Health) for completion of Advanced Health
Management Program
Presented by Tebogo Morotoba
Department of Health Limpopo
Sekhukhune District
1
Presentation outline
• Aim of the Study
• Background of MBFI in Sekhukhune
• Why did the researcher do the action
research
• Findings
• Recommendations
• conclusion
• Acknowledgements
2
The aim of the study
• To address the decline in breastfeeding
practices at mother baby friendly
accredited facilities in Sekhukhune
District, Limpopo Province, South Africa
3
Background of MBFI in Sekhukhune
District
Financial
year
Number of
MOUs
(maternity
obstetrics unit)
2013/2014 16 facilities
(7 hospitals 3
CHC and 6 big
clinics)
Number of
MOUs that
are MBFI
designated
Number of
MOUs that
are internally
re-assessed
MOUs that
passed
internal reassessment
7 hospitals
1 CHC
2 big clinics
10
3 hospitals
4
Why Action Research?
• MOUs that accredited mother baby friendly
initiative (MBFI), six months after
assessment when they are re-assessed
internally step 3, 4, 5, 10 and item 2 and 3
are no longer 100% practised (according to
2013/14 internal assessment report).
5
Findings of internal assessment
• 2 out of 10 mothers had information about
the benefits and management of
breastfeeding(step 3)
• Skin to skin were not frequently practised
and if practised, mothers were not given
reasons for the practise (step 4)
6
Findings of internal assessment
• 8 out of 10 Mothers were unable to demonstrate
how to position and attach the baby to the breast,
and also Milk expression technique (step 5)
• The above necessitated Action Research to
enable researchers to implement the study as part
of their day-to-day work
7
What did the action researcher do?
1. Seven failed facilities were selected randomly for
action research and mothers/caregivers were
conveniently sampled during their clinic visit
2. Gave feedback results and discuss with each
individual facility( 1 week and two days).
3. Action plans were drawn with each facilities(1 week
and two days).
4. The study was conducted through a period of one
year and is still continuous as part of work
8
Breastfeeding in-service training
We changed from
the way we used to
conduct training in a
standard classroom
format . We visited
facilities and conduct
in-service trainings
in the morning before
they start their daily
routine.
9
Roadshows
• Roads shows aimed at
reaching out to other
community members that
include: fathers, grandmothers,
traditional healers and faith
based healers
• It was also making pregnant
women aware of what should
they expect from health
workers during child birth at
hospitals and clinics
10
Roadshows
11
Stakeholder’s Involvement
The district executive manager was leading in stakeholder
involvement by briefing stakeholders about importance of
breastfeeding to the community breastfeed. There was a lot of
support from the municipalities, counsellors started to talk about
the importance of breastfeeding during community meetings.
12
Breastfeeding walks
The roadshows included
breastfeeding walks in
communities.
The senior managers and
health went out to
communities to sent
breastfeeding messages
13
Door to Door campaigns
• Convenience sampling was used to
visit mothers/caregivers of 0 –
59months at their homes.
•
Sixteen teams we deployed and
reached 120 households
• Data collection, education/counselling
were done.
14
Door to door campaigns
The reason for the home
visit was to explore why
mothers mixed feed
immediately after discharge
and after three months
Common reasons for
mixed feeding were
cultural beliefs and
crying child
15
Door to door campaigns
Door to Door campaigns
included counselling of
exclusive breastfeeding of
infant and young child
feeding messages
Education on road to
health booklet
16
Re-Assessment
• Six months after the implementation of
community mobilization
• Facilities were re-assessed
• Results were compared with the baseline
• There was a huge improvements
17
Impact of the action research
Name MOU
Baseline results
2013-2014
Action research
results
Philadelphia
34%
96%
Groblersdaal
30%
100%
Matlala
38%
92%
Mecklenburg
23%
92%
Zaaiplass
42%
96%
Kwarielaagte
53%
100%
Nchabeleng
48%
98%
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New facilities that were accredited in
2014/2015 after the community
mobilization
Name MOU
Tshehlwaneng
Action research
results
100%
Burgesfort
92%
Schnoord clinic
85%
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Recommendations
• It is recommended that community
mobilization in a form of dialogues, door
to door, stakeholder involvement and
roadshows be taken in high recognition
as some of the great interventions that
improves the community breastfeeding
practices.
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conclusion
• In this small convenience sample of
facilities selected, we have seen
improvements in breastfeeding practices
through community mobilization as the
intervention to address the decline in
breastfeeding practices.
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•
•
•
•
Acknowledgement
FPD for giving me the opportunity to study with them
Team of breastfeeding assessors in Sekhukhune district
CHC workers who participated during the roadshows
and door to door campaign
• DEM and HSP senior manager for their support during
the action research
• The district nutrition team for their dedicated effort in
making sure facilities and communities understand MBFI
• Facility management and staff
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THANK YOU
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