The Guide for Monitoring and Reassessing Baby-Friendly Hospitals

Tool Name: The Baby-Friendly Hospital Monitoring and Reassessment Tool

Origin / Source: WHO in collaboration with Wellstart International & UNICEF

Technical area: Maternal and Newborn Health

To Tool:
http://whqlibdoc.who.int/hq/1999/WHO_NHD_99.2_(sectionI-II).pdf (3MB)
http://whqlibdoc.who.int/hq/1999/WHO_NHD_99.2_(sectionIII-IV).pdf (3MB)

The Baby-Friendly Hospital Initiative

Basic Description: Health facility assessment tool designed for the purposes of monitoring and reassessing the Baby Friendly status of accredited Baby Friendly institutions. The tool may be used for self-assessment or external evaluation.

Country Applications: The tool has been used in many different countries including Oman, Malaysia, Brazil & China.

Language(s) Available: English, Russian

Purpose: Monitoring and reassessment/evaluation

Technical Scope/Purpose: Facility assessment

Method: Qualitative and quantitative

Frequency of Administration: According to individual and country requirement and capacity. The Baby Friendly Hospitals Initiative (BFHI) recommend self monitoring every 6 months to a year and external reassessment every 2 or 3 years.

Key Users of the Information:

Accredited Baby Friendly institutions & Baby Friendly coordinators, ministries of health.

Objectives and Scope of the Tool:

The Baby Friendly Hospitals Initiative is an accreditation process that requires facilities to reach specific standards related to ten breastfeeding and newborn care criteria in order to be designated as ‘Baby Friendly.’ To achieve this status the hospital must:

  1. Have a written breast-feeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within a half-hour of birth.
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
  6. Give newborn infants no food and drink other than breast milk, unless medically indicated.
  7. Practise rooming-in - allow mothers and infants to remain together - 24 hours a day.
  8. Encourage breast-feeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

The monitoring and reassessment tool is designed for 2 audiences

  • Individual facilities who want to sustain and improve their breast feeding management
  • Health system managers who want to monitor or reassess the BFHI status of their accredited maternities at a national or regional level.

Tool Design

The tool is a prototype that requires adaptation in each setting. The monitoring tool has 6 components. These include,

  • Infant feeding forms
  • Staff training forms
  • A facility review and observation form (of facility policies and health promotion practices)
  • Interview with the mother
  • Interview staff member on staff breast feeding knowledge and practices (optional)
  • Follow-up interview with mother (optional)

A total of thirty mother interviews are recommended over a time frame from one week to one month. A minimum of ten staff interviews is suggested.

The reassessment tool includes:

  • Summary infant feeding report
  • Summary staff training report
  • Review and observation form
  • Interview with mother
  • Interview with staff member
  • Interview with pregnant woman
  • Interview with mother of baby in special care

The reassessment is generally more comprehensive in scope than monitoring and usually involves the need for additional resources. Full details of how to carry out the sampling for a national assessment are included in the original BFHI accreditation process Guide for External Assessors.

Key indicators

In addition to the above 10 criteria, the monitoring and reassessment tool also includes several additional indicators grouped in 3 criteria. These are,

  1. Free and low cost milks substitutes and samples not provided
  2. Breast feeding practices for babies _ months old. (This has 3 components:
    • Percent of babies breast fed once in the last 24 hours
    • Percent of babies breast fed exclusively in the last 24 hours
    • Percent of babies not drinking from a bottle with a nipple
  1. Data from records on infant practice. (This has 5 components:
    • Percent of discharged babies breast fed within an hour of birth
    • Percent of discharged babies breast feeding at discharge
    • Percent of discharged babies breast feeding exclusively
    • Percent of discharged babies not bottle fed during admission
    • Percent of discharged babies rooming in during stay

The percentage score for each criteria is averaged over the individual components. Program or facility managers need to decide the acceptable standard for passing each criteria, for example 80 % as a general cut-off point for each of the steps, or an overall score of 80%.

Implementation and Training

Since this is an accreditation process, assessors must be experienced staff with extensive knowledge and experience related to both breastfeeding management and evaluation techniques.

Data Processing and Analysis:

Summary data collection sheets and excel spreadsheets accompany the tools.

Cost

The monitoring process can be relatively inexpensive when organized by individual facilities. No cost data were provided for national assessment.

Contact Person
Randa Saadeh,
Nutrition for Health and Development,
World Health Organisation,
20, Avenue Appia,
CH-1211 Geneva 27,
Switzerland
Email: saadehr@who.int