The BFCI programme is a comprehensive nutrition and health education package developed by the National Nutrition Agency (NaNA) to improve the health and nutritional status of communities. The concept of the BFCI is based on the UNICEF/WHO global strategic initiative of the Baby Friendly Hospital Initiative. The BFCI was piloted in 12 communities in Lower River Region (LRR) in 1995 and the initiative focuses on the communities using a holistic approach to ensure optimal infant and young child feeding practices. The components of the BFCI include maternal nutrition, infant and young child feeding, personal hygiene and environmental sanitation, growth monitoring and promotion. Since its inception, the BFCI has served as a motivating tool for promoting optimal maternal, infant and young child nutrition; water, hygiene and sanitation; growth monitoring and promotion in the implementing communities.
Based on the successful implementation of the programme in the pilot communities, it has been gradually expanded to 326communities across the country. Continued expansion to include all Gambian communities is underway. The overall objectives of the BFCI are to:
The attainment of these objectives requires changes in attitudes, behaviours and practices. However, these changes are difficult and slow to achieve. Trained and motivated trainers and VSGs can help in achieving these and facilitate the creation of an enabling environment for such desirable changes to happen. The BFCI training is therefore aimed at increasing knowledge and developing the skills needed to achieve these changes in attitudes, behaviours and practices.
The implementation of the BFCI takes the following steps:
The first expansion was supported by the Participatory Health, Population and Nutrition Project (PHPNP) and subsequent expansions were supported by the Rapid Response Nutrition Security Improvement Project (RRNSIP), UNICEF and the Government of The Gambia. The MCNHRP further supported the scaling up of the BFCI from 776 communities to an additional 256 communities, which brought the total number of communities implementing the BFCI to 1032 as of June 2019. There are 20 communities in LRR, 30 in URR, 145 in CRR, 20 in NBW and 41 in NBE. Since the scaling up of the BFCI is linked to the expansion of Primary Health Care (PHC), currently all the existing and identified PHC villages now have trained VSGs and are implementing the BFCI. During the period of scaling up of the BFCI under the MCNHRP 2,048 VSG members have been trained.
To facilitate the conduct of cleaning the environment, sanitary materials were procured and distributed to the BFCI communities. The criteria for becoming baby friendly include having a trained Village Support Group on Infant and Young Child Feeding Practices. An enabling environment created for mothers to practice optimal infant and young child feeding including breastfeeding. An enabling environment is where mothers will not be faced with constraints when they want to feed and look after their babies, as advised by the VSGs. Village Support Groups are groups of 5 women and 3 men voluntarily selected by their communities to promote the BFCI strategy including the Village Health Worker and Community Birth Companion (CBC), known before as the Traditional Birth Attendant. They are formed and trained in the following areas: