BFHI ISSUES IN MALAYSIA

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2 NATIONAL LACTATION CENTRE BFHI ISSUES IN MALAYSIA by DR PARAMJOTHI P. Senior Consultant Department of Obstetrics & Gynaecology and Head National Lactation Centre Hospital Selayang 2 2

3 LACTATION MANAGEMENT BFHI Introduced in years ago Initial euphoria Certification/Plaque - UNICEF Failures - Reassessments 3

4 LACTATION MANAGEMENT BFHI Cross-sectional studies from industrialised and developing countries have clearly shown : Health Professionals, Administrators and Policy Makers lack knowledge about BF and their attitudes and practices are often not supportive of BF. 4

5 LACTATION MANAGEMENT PRIORITY LOW!!! Low at ALL levels Administrators / Policy makers Clinicians (especially Obstetricians) Monitoring - poor 5

6 BFHI Step I POLICY Name-sake only Policy details not implemented No reviews/updates Public not informed 6

7 BFHI Step 2 TRAINING Pitfalls Just a formality No training after course / practice Unable to provide / disseminate 7

8 BFHI Step 2 TRAINING Specialists/Consultants shy-away Medical Officers - compulsory House Officers - not involved! Nurses - excellent Doctors combined with nurses to pass Step 2 8

9 Total Number STAFF TRAINING SELANGOR STATE - HEALTH ANALYSIS - AUGUST 2004 Total Trained Percentage (%) BFHI Step 2 Total NOT Trained Percentage (%) Doctors Nurses

10 BFHI Step 2 TRAINING - DOCTORS Obstetricians - mostly not interested, not trained Refuse to attend courses - no time, boring Training CD - inadequate Courses run by nurses - negative attitude Forced to attend - failure to understand the importance 10

11 11

12 PATIENT TRAINING BFHI Step 3 Needs improvement Importance of Antenatal Education vs at delivery/postpartum Booking/Only delivery at hospital Health Clinics - inadequate - Hospital based programme 12

13 BFHI Step 3 Compliance Ethnic differences Chinese? Educated vs Rest Urban vs Rural Return to work 13

14 LACTATION MANAGEMENT Chinese Mothers : Reasons for not BF Herbs, alcohol, oily food (linseed oil). Mostly eating habits Babies looked after by : Mother, Mother-in-law Baby sitters Professional Confinement Amahs Breast size BFHI - STEP 3 14

15 15

16 LABOUR & DELIVERY BFHI Step 4 Skin to skin Initiation patchy Caesarean section - epidural - spinal Param s Technique 11 Steps Skin to skin & Initiation in OT - not done Separation still practised (private sector) 16

17 17

18 ROOMING-IN BFHI Step 7 18

19 BFHI Step 8 DEMAND FEEDING 19

20 DEMAND AND EXCLUSIVE 20

21 Support BFHI Step 10 Poor / Non-existant Main reason discontinuation Support Group Training Lactation Clinics Doctors input necessary 21

22 BFHI Step 11 / Item 11 Infant Formula Code Gentlemen s agreement No punitive action Purchases?? - Public -Private 4 th Version 1 st August 2008 Infant Formula Companies not helping 22

23 Private Hospitals BFHI MOH plan Dec Only 6 out of Not Compulsary Loose patients / Financial loss Senior Consultants not interested Policy bad Owners / administrators..?? 23

24 LACTATION MANAGEMENT BFHI Certification - UNICEF Plaque Initial euphoria Programme dormant/ sleep mode Activated weeks before reassessment UNICEF plaque - negative impact MOH information of dates for reassessment Ready/Not ready PROGRAMME NOT ACTIVE ACTIVATED ONLY FOR REASSESSMENT 24

25 LACTATION MANAGEMENT MONITORING TOOLS Special training needed Advised by MOH - 3/6 monthly Usually done before assessments (2 years) *Policy must be changed *Monthly *Immediate action to correct problems 25

26 LACTATION MANAGEMENT LACTATION COMMITTEE Obstetrician as Chairman Representatives : Administrators - Senior Senior staff - Specialists, Doctors All wards - Sisters OBGYN & Paediatrics Matron Representatives from all Health Centres referring cases FMS 3 monthly meetings 26

27 LACTATION MANAGEMENT BFHI REASSESSMENTS Sudden - anytime after expiry Ongoing programme Prevent preparation for assessments Punitive action for failures Feeder HCs assessed together (2006 criteria) 27

28 LACTATION MANAGEMENT PRIVATE HOSPITALS BFHI - Problems Serious lack of commitment Practices guided by clients comfort Financial considerations Completely overlook long-term health benefits 28

29 BFHI DOCTORS??? NATIONAL LACTATION CENTRE 29

30 30

31 BFHI BUDGET AND FINANCES??? 31

32 THANK YOU 32

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