A Selection of Recent Programme Aids & Tools for Improving Infant and Young
Child Feeding (IYCF)
Over the past decade, a variety of global tools for IYCF programming and implementation have been developed and
used by UNICEF, WHO and other partners to enable better programming. Following a review of available tools and
identification of gaps, the IYCN Unit at UNICEF HQ focused on developing/revising tools in several areas related to
the identified gaps. Available tools and lessons learned, constraints and related gaps, and actions taken to address
them are as follows:
A. Programme guidance
The Global Strategy for Infant and Young Child Feeding, adopted by the World Health Assembly and UNICEF
Executive Board, is the main policy and strategy document which is guiding general strategic directions. There is also
a Planning Guide, but it is too generic and does not lead the program planner to the level of concrete planning cycle.
Gaps and lessons learned
The strategy and planning guide did not provide detailed information on “how” to program for implementation of
IYCF actions at various levels. More detailed program guidance was needed to facilitate implementation and scale-up
of successful strategies.
Actions based on lessons learned and identified gaps
Programming Guide on Infant and Young Child Feeding on “how” to progr amme
at country level has been developed by the IYCN Unit of the nutrition section. It
provides comprehensive and detailed guidance for managers on how to design,
plan and implement strategies to improve breastfeding and complementary feeding
at national, health system and community level, including design and
implementation of effective programme communication, monitoring, evaluation,
and integration with other programmes and services, as well as IYCF in difficult
circumstances such as emergencies and the context of HIV. It contains listings and
weblinks with many resources for IYCF implementation. It is based in part on the
outcomes of various reviews of programme experiences and results in different
countries.
WEBLINK:
Programming Guide on infant and young child feeding (UNICEF 2012)
http://www.unicef.org/nutrition/files/Final_IYCF_programming_guide_June_2012.pdf
Results of 2010-2011 assessment of key actions for comprehensive infant and young child feeding interventions in
65 Countries. (UNICEF, 2012).
http://www.unicef.org/nutrition/files/IYCF_65_country_assessment_report_UNICEF.pdf
Consolidated report of six-country review of breastfeeding programmes (UNICEF/AED 2010)
http://www.unicef.org/nutrition/files/IYCF_review_6_country_consolidated_report_Sept._2010.pdf
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B. IYCF indicators
Infant and young child feeding indicators were developed in 1990s, and UNICEF/WHO led the process of developing
and maintaining IYCF databases based on these indicators.
Gaps and lessons learned
There was a need to review these indicators based on emerging scientific evidence and research and to develop an
updated set of core indicators which would include early initiation of breastfeeding and quality complementary
feeding given emerging strong evidence on their importance for child survival and growth.
Actions based on lessons learned and identified gaps
UNICEF, WHO and partners have recently finalized a new, comprehensive set of Indicators For Assessing Infant and
Young Child Feeding Practices, with a Measurement Guide to facilitate data collection and harmonization of
approaches to assessment of IYCF practices, including questionnaires covering all the indicators.
WEBLINKS:
 Indicators for assessing infant and young child
feeding practices: Part 1, definitions.
(WHO/UNICEF/IFPRI/USAID/AED/FANTA/UC
Davis 2008)
http://www.unicef.org/nutrition/files/IYCF_upda
ted_indicators_2008_part_1_definitions.pdf

Indicators for assessing infant and young child
feeding practices: Part 2, measurement
(WHO/UNICEF/USAID/AED 2010)
http://www.unicef.org/nutrition/files/IYCF_Indic
ators_part_II_measurement.pdf
 Introduction to interpreting and using area graphs. (UNICEF 2010)
http://www.unicef.org/nutrition/files/Area_graphs_introduction_SinglePg.pdf
 Infant and Young Child Feeding Practices. Collecting and Using Data: A Step by Step Guide (Care USA, 2010)
http://www.ennonline.net/resources/743
 LQAS questionnaires, training materials and guide have recently been developed by UNICEF in collaboration with
the Liverpool School of Tropical medicine; they include the exclusive breastfeeding and minimum acceptable
diet indicators, indicators/questions on IYCF counselling and communication for households and IYCF counselling
services by CHWs and health facilities. Contact Christiane Rudert crudert@unicef.org
C. Assessment and programming
The ProPAN (Progress for the Promotion of Child Feeding) Manual: In 2003, PAHO developed this tool, which was
successfully used in Latin America for a comprehensive approach to improving child complementary feeding
practices, from assessment to analysis and development of recommendations based on the situation analysis in a
particular setting.
Gaps and lessons learned
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With the increasing attention to comprehensive programming and the need for context-specific solutions for
complementary feeding, countries needed better state-of-the art tools incorporating the available technical updates
to facilitate programming. ProPAN was an outdated tool, there was a lack of harmonization with new IYCF global
indicators, and its application was limited to Latin America.
Actions based on lessons learned and identified gaps
Together with other partners, the IYCN Unit is updating the ProPAN manual and software to enable comprehensive
assessment and planning for IYCF actions. The updated version should be issued during the first half of 2012.
WEBLINK FOR ORIGINAL VERSION OF ProPAN (PAHO 2003)
http://www.paho.org/common/Display.asp?Lang=E&RecID=6048
D. Health service tools
Within the health services, a number of materials were used. The Baby Friendly Hospital Initiative (BFHI) (2009)
and its training course have been used as the main IYCF tool for maternities. Additionally, the Infant and Young Child
Feeding Counseling: an Integrated Course (2007) was used worldwide as a comprehensive package of knowledgebased training for health professionals mainly at the primary health care level.
Gaps and lessons learned
The impact of BFHI has proven to be limited to mothers who deliver only in health facilities, and globally only 27% of
maternity facilities have been ever-certified as baby-friendly, mostly through the traditional hospital-by-hospital
project approach with limited institutionalization to ensure sustainability. As for the Integrated Course, it is targeting
health professionals and is not usable for training of low-level-education community workers; therefore, in many
countries the vitally important community workers were lacking training aids. In addition, implementation of the
Integrated Course for primary health professionals, which is intended for in-service training, has not been carried out
at scale in most countries. It also has rarely been well-integrated in health systems and programs, and
institutionalization and sustainability have been limited, creating a great need for a good-quality pre-service training
curriculum. Both the BFHI materials and Integrated Course require updating to reflect the 2010 UN
recommendations on HIV and infant feeding, and the updating of the latter commenced in late 2011.
Actions based on lessons learned and identified gaps
The IYCF Model Chapter (2009) was developed by WHO with inputs from UNICEF as a main tool for pre-service
training of health professionals in IYCF. In addition, the UNICEF programme guidance mentioned above provides
additional direction for ensuring sustainability of BFHI and its links with skilled birth delivery at community level.
WEBLINKS:
 Baby-friendly Hospital Initiative: Implementation, 20 hour (3 day) training course and assessment. (Section 5 external assessment available on CD upon request to the Nutrition Section). UNICEF/WHO (2009). The section on
HIV is in process of being updated in light of the 2010 recommendations on HIV and infant feeding
http://www.unicef.org/nutrition/index_24850.html

Infant and young child feeding: Model Chapter for textbooks for medical students and allied health
professionals (WHO 2009). NB the section on HIV and infant feeding needs to be updated in light of the 2010
recommendations.
http://www.who.int/nutrition/publications/infantfeeding/9789241597494/en/index.html

Infant young child feeding counselling: An integrated course (WHO/UNICEF 2006). The section on HIV is in
process of being updated in light of the 2010 recommendations on HIV and infant feeding
http://www.who.int/nutrition/publications/infantfeeding/9789241594745/en/index.html
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E. Tools for community based programming and training
At the community level, generic tools for planning and training in community-based IYCF counseling did not exist.
Countries used a variety of training tools that mainly “bombarded” community workers with information without
enabling them to counsel and influence feeding practices.
Gaps and lessons learned
The approaches and materials used did not build counseling, communication and problems solving skills. A recent
Review of Large-scale Community-based Breastfeeding Programmes in 10 countries provided valuable insight on
the lessons-learned and gaps for improving IYCF at scale. One of the main finding of the review stated that: “More
attention needs to be given during training of community health workers to interpersonal counseling and
communication skills and to approaches and aids for training and capacity building of community workers different
from those applied to health professionals”.
Actions based on lessons learned and identified gaps
Together with a team of external IYCF experts, the IYCN Unit has developed a comprehensive training package for
community-based infant and young child feeding counseling. It is based on best practices for developing counseling,
problem solving and communication skills among low-literacy workers, and also includes tools for supportive
supervision and monitoring of counseling practices . A Planning and Adaptation Guide is also included to assist
countries with the design of community based programmes and with the adaptation to the local context, including
the graphics. To date, introduction and implementation of the package has commenced in 17 countries starting in
2011. A French version of the generic materials has been produced, and individual countries have produced various
other language versions. The second edition (August 2012) integrates home fortification using multiple micronutrient
powders and elements of ECD.
WEBLINKS:
Generic community based infant and young child feeding
counselling package (UNICEF 2010)
http://www.unicef.org/nutrition/index_58362.html
Learning from Large-Scale Community-based Programmes to
Improve Breastfeeding Practices: Report of ten-country case
study. WHO/UNICEF/AED/USAID (2008).
http://www.unicef.org/nutrition/files/Learning_from_Large_Sc
ale_Community-based__Breastfeeding_Programmes.pdf
F. Communication
(Communication for development/ behavior change communication)
No generic guidance existed on effective strategies for behavior and social change communication on IYCF.
Gaps and lessons learned
Many countries tended to use approaches which were not very effective, not based on evidence and not applying
state of the art methods. The ubiquitous posters saying “breast is best” or suggesting complementary foods which do
not even exist at community level did not produce behavior change, as highlighted in a number of reviews. Capacity
for communication on IYCF is limited in many countries.
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The Review of large-scale community-based breastfeeding programmes in 10 countries also concluded that
“Effective communication and advocacy are vital to set policy priorities, influence community norms, and improve
household practices”.
In 2008, a review of breastfeeding programmes was conducted in 6 countries representing programs with various
levels of success or failure to improve breastfeeding, showing that: ”Coherent and comprehensive communication
strategies are needed based on well-designed and implemented formative research with clearly identified objectives
and participant groups. A mix of communication channels, can provide valuable guidance for design of strategy.”
Actions based on lessons learned and identified gaps
The IYCN Unit and C4D have developed a webinar and resource manual on state of the art methods for conducting
communication on breastfeeding, which is currently being rolled out to many countries, starting in 2010.
The PowerPoint presentation on Communication for Development for Breastfeeding used in the webinars is
available from Nutrition Section, crudert@unicef.org )
G. Training of programme managers
Capacity building aids on IYCF programming and implementation for UNICEF staff and counterparts were not
available. Staff training has mostly been done through short sessions at general workshops which have not allowed
appropriate discussion and coverage of all steps in the program planning process.
Gaps and lessons learned: The 2008 review of breastfeeding programs showed that “Continuous, effective
leadership moves the agenda and lack of capacity and weak leadership leads to delays, duplication of efforts,
confusion, and ad hoc, often small-scale activities”. In 2010 UNICEF HQ conducted a survey of staff capacity and
training needs in IYCF among UNICEF staff and counterparts. This assessment showed that a large proportion of staff
have never received a training specific to IYCF, indicating a great need for a comprehensive training strategy for
capacity building, which would be accessible to field practitioners and incorporate programmatic guidance as well as
basic knowledge.
Actions based on lessons learned and identified gaps
In collaboration with Division of Nutrition Sciences at Cornell University/United Nations University, the IYCN Unit has
developed an e-learning course for programming in IYCF for capacity building of UNICEF staff and counterparts,
based on the recently finalized IYCF Programme Guidance. It is ready for participants to register as of February 2012.
WEBLINKS:

UNICEF/Cornell e-learning course on
IYCF
www.nutritionworks.cornell.edu/unicef/
about

In addition, UNICEF, ILO, WHO and
IBFAN has developed a Maternity Protection Resource Package, which is designed to:
o bring together information and tools, expertise and knowledge concerning all aspects of maternity
protection at work into one place;
o serve as a resource and a guide for offices, counterparts and partners ready to launch information and
education campaigns and to plan, design or monitor action that will bring about real improvements in
maternity protection in the workplace.
http://mprp.itcilo.org/pages/en/introduction.html

In collaboration with WHO, the UNICEF IYCN Unit has developed an e-learning course on implementing the
International Code of Marketing of Breastmilk Substitutes (to be opened soon).
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