(8) BFHI Monitoring - Summary of Results.pdf

71
Session 4.2 Guidelines and Tools for Monitoring Baby-Friendly Hospitals
BFHI Monitoring: Summary of Results
Health facility name and address:
Dates of monitoring period:
Monitoring team members:
Step 1: Have a written breastfeeding policy that is routinely communicated to all health care staff.
1.1 A review of the breastfeeding or infant feeding policy indicates that it covers the following topics adequately:
The Ten Steps to Successful Breastfeeding (not only listing the Steps but also giving appropriate policy guidance)
The Code of Marketing of Breast-milk Substitutes and regulations the facility and staff need to follow to comply
A requirement that HIV-positive mothers receive counselling, including information about the advantages and
disadvantages of various infant feeding options and specific guidance in selecting the options likely to be suitable for
their situations, supporting them in their choices
Covers all
topics
adequately:
Yes No
1.1
1.2 Observations indicate that the policy is displayed in all appropriate areas of the facility in appropriate languages: Yes No 1.2
1.3 Discussions with managers and staff indicate that staff is aware of the policy and it is being appropriately implemented: Yes No 1.3
Step 2: Train all health care staff in skills necessary to implement this policy.
2.1 A review of the training curriculum, course outlines and attendance sheets indicates that:
At least 80% of the clinical staff members responsible for the care of pregnant women, mothers and infants have been
given training of at least 20 hours in length, and
The training includes at least 3 hours of supervised clinical experience.
Complies with
both 3 criteria:
Yes No
2.1
2.2 The training curriculum or course outlines cover the following topics adequately:
The Ten Steps to Successful Breastfeeding Mother-friendly care
The Code of Marketing of Breast-milk Substitutes HIV and infant feeding (optional)
Support for the non-breastfeeding mother
Covers all
topics
adequately:
Yes No
2.2
2.3 Appropriate refresher training is provided for staff at least every two years: Yes No 2.3
UNICEF/WHO BFHI Section 4: Hospital Self-Appraisal and Monitoring 2009

72 Session 4.2 Guidelines and Tools for Monitoring Baby-Friendly Hospitals
General information on mothers responding to the discharge questionnaire
G.1 The following mothers report that their babies weighed at least 1500 grams (or 3 lbs. 5 oz.) at birth:
[Y = yes, N = no, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q5
G.2 The following mothers report that they gave birth vaginally, by Caesarean section without general anaesthesia, or by
Caesarean section with general anaesthesia:
[V = vaginal, C-WGA = C-section without general anaesthesia, C-GA = C-section with general anaesthesia, 0 = didn’t
answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
V: ___ out of
___ : ___%
C-WGA: ___ out
of ___: ___%
C-GA: ___ out
of ___: ___%
Q6
G.3 The following mothers report that they are breastfeeding exclusively, both breastfeeding and feeding breast-milk
substitutes (mixed feeding) or feeding breast-milk substitutes and not breastfeeding at all:
[BF = breastfeeding exclusively, MF = mixed feeding, NBF = not breastfeeding, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
BF: ___ out of
___ : ___%
MF: ___ out of
___: ___%
NBF: ___ out
of ___: ___%
Q7
Step 3: Inform all pregnant women about the benefits and management of breastfeeding.
3.1 The following mothers report that a staff member gave them information during their antenatal visits on at least two out
of the following three key topics – the importance of immediate skin-to-skin contact, 24-hour rooming-in, and the risks of
giving water, formula or other supplements in the first 6 months if breastfeeding:
[Y = yes, N = no, 0 = didn’t answer or didn’t receive antenatal care]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q3

73
Step 4: Help mother initiate breastfeeding within a half-hour of birth. This Step is now interpreted as:
Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to
recognize when their babies are ready to breastfeed and offer help if needed.
4.1 The following mothers report that they were able to hold their babies immediately or within five minutes of birth or as
soon as they were able to respond (in the case of Caesarean sections with general anaesthesia):
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q8
4.2 The following mothers report that they held their babies “skin-to-skin” that first time:
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q9
4.3 The following mothers report that there was no delay in holding their babies this first time or, if there was, it was for a
justified medical reason (child needed help/observation, mother recovering from anaesthesia, or other valid reason):
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q10
4.4 The following mothers report that they held their babies for an hour or more: [Y = yes, N = no, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q11
4.5 The following mothers report that during the first time their babies were with them the staff encouraged them to look for
signs that their babies were ready to feed and offered help with breastfeeding: [Y = yes, N = no, 0 = didn ‘t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q12

Step 5: Show mothers how to breastfeed, and how to maintain lactation even if they should be separated
from their infants
5.1 The following breastfeeding mothers report that the staff helped them with breastfeeding again within 6 hours of
delivery: [Y = yes, N = no, 0 = didn’t answer or was NBF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q13
(BF)
5.2 The following breastfeeding mothers report that the staff gave them help with positioning and attachment before
discharge: [Y = yes, N = no, 0 = didn’t answer or was NBF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q14
(BF)
5.3 The following breastfeeding mothers report that the staff showed or gave them information on how to express milk by
hand: [Y = yes, N = no, 0 = didn’t answer or was NBF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q15a
(BF)
5.4 The following breastfeeding mothers report that they had tried expressing milk themselves and were at least partially
successful: [Y = yes, N = no, 0 = didn’t answer or was NBF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q15b
(BF)
5.5 The following non-breastfeeding mothers report that someone had offered to how them how to prepare and give their
baby’s feeds and that they were given at least two types of useful advice: [Y = yes, N = no, 0 = didn’t answer or was BF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q16
(NBF)

75
Step 6: Give newborn infants no food or drink other than breast milk, unless medically indicated.
6.1 The following mothers report that their babies had been given nothing other than breast milk since they were born or, if
so, it was for a medically justified reason: [Y = yes, N = no, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q19 &
20 (BF)
& Q14
& 15
(NBF)
Step 7: Practice rooming-in – allow mothers and infants to remain together – 24 hours a day
7.1 The following mothers report that their babies were always with them both day and night or, if not, it was for a justified
reason: [Y = yes, N = no, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q16
(BF)
and
Q13
(NBF)
Step 8: Encourage breastfeeding on demand
8.1 The following breastfeeding mothers report that they had been told to feed their babies whenever they seemed hungry:
[Y = yes, N = no, 0 = didn’t answer or NBF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q17
(BF)
8.2 The following breastfeeding mothers report that they had been told that their babies should suckle for as long as they
wanted to: [Y = yes, N = no, 0 = didn’t answer or NBF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q18
(BF)
Step 9: Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
9.1 The following breastfeeding mothers report that their babies were not fed any fluids in bottles with teats, as far as they
knew: [Y = yes (not fed with bottles and teats), N = no, 0 = didn’t answer or NBF]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q21
(BF)

9.2 The following breastfeeding mothers report that their babies had not sucked on a pacifier, as far as they knew:
[Y = yes (had not sucked on a pacifiers, N = no, 0 = didn’t answer or NBF] Total: ___ out
Q22
1 2 3 4 5 6 7 8 9 10 of ___: (BF)
11 12 13 14 15 16 17 18 19 20 ____%
21 22 23 24 25 26 27 28 29 30
Step 10: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or
clinic.
10.1 The following mothers report that they had been given suggestions about where to get help, if they had problems with Q24
feeding their babies after returning home: [Y = yes, N = no, 0 = didn’t answer] Total: ___ out (BF)
1 2 3 4 5 6 7 8 9 10 and
of ___:
11 12 13 14 15 16 17 18 19 20 Q18
____%
(NBF)
21 22 23 24 25 26 27 28 29 30
10.2 The following mothers are able to describe at least one useful appropriate suggestion for getting help with feeding Q25
problems on return home that they have been given by the staff: [Y = yes, N = no, 0 = didn’t answer] Total: ___ out (BF)
1 2 3 4 5 6 7 8 9 10 and
of ___:
11 12 13 14 15 16 17 18 19 20 Q19
____%
(NBF)
21 22 23 24 25 26 27 28 29 30
Code compliance
C.1 A review of records and receipts indicates that any breast-milk substitutes, including special formulas and other feeding Complies with
supplies, are purchased by the health care facility for the wholesale price or more: Code: C.1
Yes No No BMS used Yes No
C.2 The following mothers report that they have never received leaflets from formula companies promoting formula feeding
Q23
or gifts or samples that include formula, bottles or other related supplies:
Total: ___ out (BF)
[Y = yes (never received), N = no, 0 = didn’t answer]
and
1 2 3 4 5 6 7 8 9 10 of ___:
Q17
____%
11 12 13 14 15 16 17 18 19 20 (NBF)
21 22 23 24 25 26 27 28 29 30

77
Mother-friendly care
MF.1 The following mothers report that during their antenatal visits staff told them that they could have companions during
labour and birth and what alternatives there were for dealing with pain and what was better for mothers and babies:
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q2
MF.2 The following mothers report that they were encouraged to walk and move about during labour or that, if not, there was a
medical reason: [Y = yes, N = no, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q4
HIV and infant feeding [option3wal, to include if covered by the Initiative]
HIV.1 The following mothers report that during their antenatal visits the staff gave them information on the fact that a woman
who is HIV positive can pass the HIV infection to her baby: [Y = yes, N = no, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q3
HIV.2 The following mothers report that during their antenatal visits the staff gave them information on why testing and
counselling for HIV is important for pregnant women: [Y = yes, N = no, 0 = didn’t answer]
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Total: ___ out
of ___:
____%
Q3

Scoring
For continued compliance with the Ten Steps and other BFHI components, the following responses are the minimum required:
Step 1: “Yes” for all items Step 8: 80% for both items
Step 2: “Yes” for all items Step 9: 80% for both items
Step 3: 70% Step 10: 80% for both items
Step 4: At least 80% on 3 items and 70% on 2 Code compliance: “Yes” and 80%
Step 5: At least 80% on 3 items and 50% on 2 Mother-friendly care: 70% for 1 item and 50% for the other
Step 6: 80% HIV and infant feeding: 70% for 1 item and 50% for the other
Step 7: 80%
Review of Monitoring Results and Recommendations
The health facility continues to fully comply with all Ten Steps and other BFHI components: Yes No
Achievements:
Improvements required:
Improvements suggested:

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