Plan de Renforcement de l’Allaitement Maternel au Bénin 2016-2020

Objectives

The 2016-2020 plan aims to reduce infant mortality and improve the nutritional status of children aged 0 to 24 months in Benin by strengthening appropriate breastfeeding practices during the first 1,000 days.[1][2][3]It targets 80% initiation of breastfeeding within one hour of birth, 60% exclusive breastfeeding to six months, and 70% continued breastfeeding with complementary feeding to 24 months by 2020.[1][4]

• Strengthen the political, legislative and institutional environment for breastfeeding, including application of provisions governing maternity leave, breastfeeding hours and the marketing of breast-milk substitutes and infant foods.[1][5][6]
• Promote the Baby-Friendly Hospital Initiative and extend breastfeeding-supportive practices across health facilities.[5][7][8]
• Build the capacity of health and social-health personnel to counsel mothers on early initiation, exclusive breastfeeding, continued breastfeeding, positioning and attachment, and expression and storage of breast milk.[1][5][9]
• Organise communities and empower women through breastfeeding-support groups, community counsellors, family engagement and improved access to breastfeeding rights for employed mothers.[1][10][9]
• Strengthen communication, social mobilisation, multisectoral coordination, supervision, monitoring, evaluation, research and innovation.[5][11][12][13]

The strategic rationale is low exclusive breastfeeding and early initiation despite high overall breastfeeding prevalence. The 2016 assessment reported overall breastfeeding practice of 90.9%, exclusive breastfeeding of 26.7% and initiation within the first hour of 60.4%, alongside limited maternal and health-worker knowledge and weak community support.[14][15]

Implementation

Implementation combines policy reform, routine health-service delivery, community mobilisation and multisectoral coordination. Activities are phased through preparation, initiation and intensification in 2016 and 2017, followed by consolidation from 2018 to 2020.[3]Governance is led by the Council for Food and Nutrition for resource mobilisation, intersectoral coordination and follow-up, while the Ministry of Health and its Directorate for Maternal and Child Health lead planning, delivery, monitoring, evaluation and accountability.[16][3][17]

• Integrate breastfeeding promotion into antenatal, delivery, newborn, postnatal, family-planning, child-health, sick-child and vaccination services, with practical counselling and referral arrangements provided through public and private facilities.[18][19]
• Establish a national relaunch committee, departmental and health-zone focal points, and a breastfeeding-support subgroup within the Child Survival Technical Working Group.[7][12]
• Update, disseminate and apply breastfeeding policy texts and implementing regulations through an ad hoc committee, workshops and collaboration with health, communication, social-affairs and justice authorities.[6]
• Conduct annual Baby-Friendly Hospital accreditation and renewal activities, integrate breastfeeding into pre-service curricula, and provide continuing training, tutoring, supervision and refresher training for personnel.[7][8]
• Establish at least one breastfeeding-support group in each village or urban neighbourhood, train community counsellors and relays, and engage women’s groups, municipalities, employers, community radio, faith-based organisations and youth groups.[1][10][12]
• Develop pilot “baby-friendly” community and workplace models, define recognition criteria and reward high-performing facilities and support groups.[13]

Delivery responsibilities span national, intermediate and peripheral levels. Departmental health directorates plan activities, build staff competence, manage tools, analyse data, supervise implementation and follow up recommendations, while health-zone teams integrate breastfeeding and infant and young child feeding activities into annual plans and coordinate hospitals, health centres and communities.[19]Stakeholders include social affairs, agriculture, labour, education, commerce, communication and finance institutions; municipalities; civil-society and professional organisations; communities; research bodies; and development partners including the World Health Organization, UNICEF, the United Nations Population Fund, the United States Agency for International Development, the World Bank and bilateral agencies.[20][21]

Monitoring uses the National Health Information and Management System, six-monthly facility monitoring, supervision at national, departmental and peripheral levels, annual reviews, coverage surveys, epidemiological studies and national surveys.[16][22]Process monitoring includes committee and focal-point establishment, training and supervision reports, accreditation records, communication outputs, partnership agreements and advocacy records.[7][8][10][11][12]Outcome monitoring covers early initiation, exclusive and continued breastfeeding, maternal and staff knowledge, counselling quality, breastfeeding rights, support-group coverage and facility performance.[1][4][23][9]The plan provides for a 2018 mid-term evaluation and final evaluation, with indicators incorporated into annual health-sector performance reviews and facility performance assessment, including performance-based financing arrangements.[24][13][3]

Resource mobilisation is assigned to the Council for Food and Nutrition, the Ministry of Health and national coordination structures, with technical and financial support envisaged from development partners.[3][21][17]The available extracts do not provide a quantified budget, costed activities, financing allocation or funding-gap analysis.[25][17]

Monitoring & Evaluation

The plan establishes a multi-level monitoring, evaluation and accountability system for breastfeeding promotion, combining routine health-information reporting, supervision, periodic reviews, surveys and evaluations. It links process and resource-readiness measures to results against objectives and longer-term effects on child morbidity and mortality.[16][22]Key outcome targets include breastfeeding initiation within one hour, exclusive breastfeeding to six months, continued breastfeeding with appropriate complementary feeding to 24 months, and reductions in neonatal and infant mortality.[2]

• Integrate breastfeeding indicators into the National Health Information and Management System and the health sector’s annual performance review.[12][24]
• Maintain nutrition-status databases, measure implementation periodically at different health-system levels, and publish regular bulletins on breastfeeding conditions and activities.[16]
• Conduct six-monthly monitoring in health facilities, twice-yearly supervision of providers and breastfeeding-support groups, and supervision at national, departmental and peripheral levels.[24][16][22]
• Use annual internal reviews, external mid-term and final reviews, coverage surveys including Lot Quality Assurance Sampling, epidemiological studies, and national surveys such as Demographic and Health Surveys, Multiple Indicator Cluster Surveys and EMICOV.[16][22]
• Undertake a mid-term evaluation in 2018 to adjust implementation, followed by a final evaluation supported by evaluation reports.[13][3]

The indicator framework spans outcomes, intermediate results and implementation processes. Core indicators include exclusive breastfeeding to six months and continued breastfeeding with complementary feeding to 24 months, verified through national and SMART surveys.[4]Intermediate measures cover early initiation, maternal knowledge and breastfeeding technique, expression and storage of breast milk, access to breastfeeding rights, community support, support-group coverage, health-worker knowledge and counselling quality, maternity-staff practices, and awareness of relevant legislation.[4][23][9]

Activity-level monitoring uses documentary evidence such as committee-installation minutes, appointment letters, activity and supervision reports, training reports and attendance lists, communication records, accreditation records, partnership contracts and advocacy reports.[7][8][10][11]Process indicators include the existence of coordination structures and focal points, accreditation sessions and labelled facilities, curriculum updates, personnel trained, operational support groups and counsellors, experience-sharing sessions, employers reached through advocacy, and distribution of strategy documents.[7][8][10][11]Policy-update actions are also tracked through collection and dissemination of legal texts and the number of texts put into application.[6]

Governance assigns overall supervision to the Conseil de l’Alimentation et de la Nutrition and lead implementation to the Nutrition Service within the Directorate of Maternal and Child Health.[16]The Ministry of Health is responsible for planning, monitoring and evaluation, accountability and enforcement of the code governing marketing of breast-milk substitutes and infant foods, while the Council has a follow-up role.[3]Departmental health directorates analyse data from the National Health Information and Management System, supervise activities, organise follow-up and track recommendations; health-zone teams supervise implementation across facilities and communities and report upwards.[17][19][26]

Accountability mechanisms include incorporating breastfeeding indicators into health-facility performance assessment, including performance-based financing arrangements, and recognising high-performing facilities and support groups.[24][13]Baby-Friendly Hospital Initiative facilities are assessed for certification against ten conditions, with label renewal every four years.[27]Pilot initiatives are monitored through counts of initiatives and follow-up visits, while advocacy and partnerships are documented through reports, consultation minutes, contracts and agreements.[12][13]

The plan responds to previous monitoring weaknesses. The 2016 analysis reported overall breastfeeding at 90.9%, exclusive breastfeeding at 26.7%, and initiation within one hour at 60.4%.[14]It also found weakened reassessment, evaluation and control of Baby-Friendly facilities, insufficient supervision and refresher training, and a lack of effective sanctions for breaches of marketing regulations.[28][29]

Costing & Financing

Available material identifies resource mobilisation and external technical and financial support as necessary for implementation, but does not provide a costed budget, allocation amounts, unit costs, quantified funding gap or financing schedule.[3][21][17][30]Funding availability for equipment and products is identified as a critical implementation assumption.[2]

• Mobilise resources through the Conseil de l’Alimentation et de la Nutrition, which holds responsibility for intersectoral coordination, follow-up and financing of implementation.[3][17]
• Coordinate partner resources through the Directorate of Maternal and Child Health, which is assigned resource-mobilisation and development-partner coordination functions.[17]
• Seek technical and financial support from development partners, including the World Health Organization, UNICEF, the United Nations Population Fund, the United States Agency for International Development, the World Bank and bilateral cooperation agencies.[21]
• Increase the health sector’s annual budget to enable Ministry of Health investment in breastfeeding promotion, although no amount is specified.[30]

Previous experience highlights financing constraints. A 2004 PROFILES advocacy process identified economic losses and human-development consequences associated with inadequate breastfeeding and argued that nutrition investment could avert these losses.[29]Recommended programmes were not implemented because of insufficient political commitment and financing, while limited and non-decentralised resources constrained World Breastfeeding Week activities.[29]Although the plan introduces estimated intervention costs and a budget summary by strategy, the available extract contains no figures or funding-source breakdown.[25]