Successes and challenges of the Baby Friendly Hospital Initiative in accredited facilities in the Cape Town Metro Health District
Henney, Nicolette M.
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Breastfeeding impacts on the health of both the mother and infant and has been noted as being influenced by physiological, physical, socio-economic and environmental factors. The undisputed benefit of exclusive breastfeeding for both the mother and child has led to the global prioritisation of the promotion, protection and support of breastfeeding with the adoption of the Baby Friendly Hospital Initiative (BFHI) strategy. Baby Friendly Hospital (BFH) status is awarded to a maternity unit when they are found to be complying with set criteria Ten Steps to successful Breastfeeding. South Africa has implemented a re-evaluation system for retention of accreditation status, by reassessing accredited facilities every three years. The respective provinces are tasked with monitoring the implementation of BFHI in their public health facilities. Internal monitoring reports, completed by the Western Cape Provincial Department of Health, reflect erosion of key steps between national reassessments. Aim: To describe the experiences, challenges and successes of BFHI implementation in the BFH accredited facilities in the Cape Town geographical health district. Methodology: An explorative qualitative study was conducted. One key informant interview, ten in-depth interviews with champions for BFHI in the maternity facilities and two focus group discussions with frontline staff working at these facilities were used to collect data. The data was analysed using thematic content analysis to identify the main themes related to the successes and challenges experienced with the maintenance of the required practices related to BFHI accreditation. Results: Participants reported that the implementation of the BFHI impacted positively on the health of both mothers and infants. Fewer children were being admitted for common childhood illnesses such as diarrhoea subsequent to BFHI implementation. Mothers were recovering more quickly after delivery and less complications related to delivery, such as postpartum bleeding, were observed after the implementation of BFHI. BFHI implementation had a positive impact on the attitudes of maternity staff to breastfeeding promotion, protection and support. Subsequent to being awarded BFH status, facilities are tasked with maintaining the implemented practices. Challenges to maintaining the practices included lack of implementation of BFHI practices at clinics, lack of support from facility managers and support staff such as counsellors. The internal assessments implemented as supportive monitoring structures are considered by participants to be a demotivating process and concerns were raised about non nursing staff assessing nursing practices. Conclusion: The potential impact of this strategy on infant and maternal health must be realized by the implementers of BFHI, before the strategized aim is achieved. Co-ordination and support by all role players is vital to the success and elimination of challenges experienced with implementation and maintenance of the BFH strategy.