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Infant and young child feeding counselling: an integrated course: trainer’s guide. Web annex C: toolkit for supportive supervision/mentoring and monitoring

October 15, 2021 World Health Organization

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Infant and young child feeding counselling: an integrated course Trainer’s guide, second edition Web Annex C. Toolkit for supportive supervision/mentoring and monitoring ii WHO/HEP/NFS/21.44 Director’s guide, second edition – Trainer’s guide, second edition (including Web Annex A. Guidelines for follow-up after training; Web Annex B. Supportive supervision/mentoring and monitoring; and Web Annex C. Toolkit for supportive supervision/mentoring and monitoring) – Participant’s manual, second edition – Counselling cards for health workers – Guidance on the use of counselling cards – Course handouts © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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Design and layout: Christopher Yuen iii Contents Acknowledgements iv Infant and young child feeding (IYCF) support activities 1 Tool 1: IYCF support activities 1 Tool 2: Skills for the different IYCF support activities 2 List of Job aids for health workers and tools for mentor-supervisors 5 IYCF health-worker Job aids 5 Instructions for conducting a supervision visit 5 Supervision tools 5 Self-assessment in infant and young child feeding: competency practice and progress tracking form 5 Monitoring Job aids for health workers and tools for mentor-supervisors 5 Exit interview form 5 IYCF health-worker Job aids 7 IYCF health-worker Job aid 1: IYCF assessment 7 IYCF health-worker Job aid 2: How to facilitate an action-oriented group 9 IYCF health-worker Job aid 3: How to facilitate an IYCF support group 10 IYCF health-worker Job aid 4: IYCF recommended contact points 12 IYCF health-worker Job aid 5: What to discuss at postnatal contacts 14 IYCF health-worker Job aid 6: What to discuss at ongoing contacts 15 Instructions for conducting a supervision visit 17 Supervision of IYCF programme activities 17 Conducting a “mentoring-supportive supervision” visit 17 Keeping records 17 Supervision tools 19 Supportive supervision tool 1: Assessment of basic IYCF programme implementation 19 Supportive supervision tool 2: Monitoring IYCF activities at facility level 22 Supportive supervision tool 3: Breastfeed observation checklist 26 Supportive supervision tool 4: Observation checklist for IYCF counselling 27 Supportive supervision tool 5: Observation checklist for facilitation of an action-oriented group 29 Supportive supervision tool 6: Observation checklist for facilitation of an IYCF support group 30 Supportive supervision tool 7: Supervisor’s record for tracking individual health-worker progress 31 Self-assessment in infant and young child feeding: competency practice and progress tracking form 33 Monitoring Job aids for health workers and tools for mentor-supervisors 37 IYCF health-worker monitoring Job aid 1: Monthly activity log for a health worker who provides IYCF support to pregnant women and mothers–children (0 up to 24 months) 37 Supportive supervision monitoring tool 1: Supervisor’s log – summary of monthly activities 38 Supportive supervision monitoring tool 2: Monitoring IYCF activities at facility level – supervisor’s record for tracking individual health-worker progress 39 Supportive supervision monitoring tool 3: Monthly/quarterly/period summary reporting form – supervisor’s and health worker’s activity data 41 Exit interview form 43 iv Acknowledgements Many people from numerous countries contributed their valuable time and expertise to the development and field-testing of the different counselling courses used as a basis for this course. The development of this course was led by the World Health Organization (WHO) Department of Nutrition and Food Safety. The following deserve special recognition for the roles they played in the development of this course: Ruth Bland, Consultant, Africa Centre for Health and Population Studies, who was the primary author and who also acted as Director of the course in all the field-tests for the first edition; Randa Saadeh, WHO, who oversaw development of the first edition; Peggy Henderson, Nigel Rollins and Constanza Vallenas, WHO, who contributed to the revision of the first edition; Carmen Casanovas, WHO, who contributed to the development and revision of the first edition; Juan Pablo Peña Rosas, Pura Rayco-Solon and Lisa Rogers, WHO, who led the initiation, development and production of the second edition, respectively; Mary Lungaho and Maryanne Stone-Jimenez, consultants, who contributed to the development and testing of the course materials; and Maaike Arts and France Begin, United Nations Children’s Fund (UNICEF), who reviewed the course and provided comments. Special thanks are due to Helen Armstrong, Genevieve Becker, Hilary Creed-Kanashiro and Felicity Savage King, who were the authors of the original training courses on breastfeeding counselling, complementary feeding counselling, and HIV and infant-feeding counselling; and to Adelheid W. Onyango and Mercedes de Onis who were authors of the training course on child growth assessment. Thanks are also due to Ilgi Ertem and Cutberto Garza, for their technical input, and to Patricia Whitesell Shirey and Florence C Johnson, for developing the modules for the training course on child growth assessment. The contribution of the many individuals from the countries where the course and counselling tools were field-tested, namely Eswatini, Ghana, Kenya, Zambia and Zimbabwe, and the staff of the UNICEF and WHO regional and country offices concerned, is also gratefully acknowledged. Thanks are due to the Bill & Melinda Gates Foundation and the Government of the Republic of Korea, for providing financial support for updates to this second edition. 1Infant and young child feeding (IYCF) support activities Tool 1: IYCF support activities Messaging • This involves provision of limited and relevant information on IYCF promotion that can reach large audiences: caregivers, influential community members and communities at large. • Development is based on formative research. Action-oriented groups • IYCF practices are incorporated into group activities in a way that personalizes information and encourages participants to try an action that is new or different. • Facilitators are trained on skills of Observe, Think, Try and Act, to use stories, mini-dramas or visuals. • This requires additional training, time and resources. Support groups • An IYCF support group is a group of pregnant women, mothers, fathers, caregivers, etc., who share IYCF experiences and information, and provide mutual support. • The group should be facilitated by experienced mothers who have IYCF knowledge and have mastered some techniques of group dynamics. • These groups are labour and time intensive. Individual counselling • This is effective but highly skills based and resource intensive. • It involves individual assessments of mothers’/caregivers’ feeding practices. • It is based on the World Health Organization (WHO)-recommended counselling guidelines of Listening and learning skills and Skills for building confidence and giving support, and the United Nations Children’s Fund three-step counselling of Assess, Analyse and Act. • The intent is to move mothers/caregivers in small, do-able steps towards an ideal practice. Individual counselling IYCF support groups (8–12 persons) Action-oriented groups (20–30 persons) Messaging (mass communication: radio, TV, billboards, posters, leaflets) 2Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Tool 2: Skills for the different IYCF support activities Skills for individual counselling Skills for action-oriented group facilitation Skills for IYCF support group facilitation Apply Listening and learning skills Use helpful non-verbal communication (keep your head level with the mother/caregiver, pay attention, remove physical barriers, take time/allow the mother or caregiver time to talk, use appropriate touch) Ask open questions Use responses and gestures that show interest Reflect back what the mother/caregiver says Empathize – show that you understand how the mother/caregiver feels Avoid using words that sound judging Apply Skills for building confidence and giving support Accept what a mother/caregiver thinks and feels Recognize and praise what a mother/caregiver and baby are doing right Give practical help Give a little, relevant information Use simple language Make one or two suggestions, not commands Use Assess Use Observe Facilitate IYCF support group Obtain correct infant age What happened in the story/drama or visual? The facilitator(s) introduce themselves to the group Ask about the number of older children What are the characters doing in the story/drama or visual? The facilitator(s) clearly explain the day’s theme* Check on recent child illness How did the character feel about what they were doing? Why did they do that? The facilitator(s) ask questions that generate participation Check understanding of child growth curve (if growth monitoring and promotion [GMP] exists in the area) Use Think The facilitator(s) motivate the quiet women/men to participate Breastfeeding (with mother): • Assess the current breastfeeding status • Check for breastfeeding difficulties • Observe a breastfeed (if necessary) Who do you know that does this (recommended behaviour/practice)? The facilitator(s) adequately manage content List of Job aids for health workers and tools for mentor-supervisors 3 Skills for individual counselling Skills for action-oriented group facilitation Skills for IYCF support group facilitation Complementary feeding: • Assess intake of “other fluid” • Assess intake of “other food” How have they been able to do this (recommended behaviour/practice)? Mothers/caregivers share their own experiences Active feeding: Ask about whether the child receives assistance when eating What is the advantage of adopting the practice described in the story/drama or visual? The participants sit in a circle Hygiene: Check on hygiene related to feeding Discuss the key messages of today’s topic The facilitator(s) invite participants to attend the next IYCF support group (place, date and theme) Complete IYCF assessment before providing any information The facilitator(s) thank the participants for attending the IYCF support group Use Analyse Use Try The facilitator(s) ask participants to talk to a pregnant woman or breastfeeding mother before the next meeting, share what they have learnt, and report back Compare information obtained during assessment to age-appropriate feeding recommendations If you were the mother (or another character), would you be willing to try the new practice? The support group attendance form is checked Identify and prioritize any difficulties: stated by mother or deviation from age-appropriate recommended practices Would people in this community try this practice in the same situation? Why? Use ACT Use ACT Praise the mother/father/caregiver for doing recommended practices What would you do in the same situation? Why? If difficulty is identified, address the reasons Discuss a limited amount of information, depending on the analysis What difficulties might you experience? Reach an agreement/negotiate How would you be able to overcome them? Ask the mother/caregiver to repeat the “agreed-upon-action” Can you repeat the key messages? Suggest where to find additional support Set a time for the next meeting and encourage group participants to come ready to talk about what happened when they tried the new practice or encouraged someone to try it, and how they managed to overcome any obstacles 4Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Skills for individual counselling Skills for action-oriented group facilitation Skills for IYCF support group facilitation Agree upon a date/time for a follow-up session Refer, as necessary Use appropriate materials: Counselling cards and other Job aids, according to the age and situation of the child Use appropriate materials 5List of Job aids for health workers and tools for mentor-supervisors IYCF health-worker Job aids IYCF health-worker Job aid 1: IYCF assessment IYCF health-worker Job aid 2: How to facilitate an action-oriented group IYCF health-worker Job aid 3: How to facilitate an IYCF support group IYCF health-worker Job aid 4: IYCF recommended contact points IYCF health-worker Job aid 5: What to discuss at postnatal contacts IYCF health-worker Job aid 6: What to discuss at ongoing contacts Instructions for conducting a supervision visit Supervision tools Supportive supervision tool 1: Assessment of basic IYCF programme implementation Supportive supervision tool 2: Monitoring of IYCF activities at facility level Supportive supervision tool 3: Breastfeed observation checklist Supportive supervision tool 4: Observation checklist for IYCF counselling Supportive supervision tool 5: Observation checklist for facilitation of an action-oriented group Supportive supervision tool 6: Observation checklist for facilitation of an IYCF support group Supportive supervision tool 7: Supervisor’s record for tracking individual health-worker progress Self-assessment in infant and young child feeding: competency practice and progress tracking form Monitoring Job aids for health workers and tools for mentor-supervisors IYCF health-worker monitoring Job aid 1: Monthly activity log for a health worker who provides IYCF support to pregnant women and mothers–children (0 up to 24 months) Supportive supervision monitoring tool 1: Supervisor’s log – summary of monthly activities Supportive supervision monitoring tool 2: Monitoring IYCF activities at facility level – supervisor’s record for tracking individual health-worker progress Supportive supervision monitoring tool 3: Monthly/quarterly/period summary reporting form – supervisor’s and health worker’s activity data Exit interview form

7IYCF health-worker Job aids IYCF health-worker Job aid 1: IYCF assessment Name of mother/caregiver: Name of child: Age of child (completed months): Number of older children: Observation of mother/caregiver: Child illness: (tick one) Child ill Child not ill Child recovering Growth curve increasing: (tick one) Yes No Levelling off/static Tell me about breastfeeding Currently breastfeeding? (tick one) Yes Frequency: times/day and night How is breastfeeding going (record any difficulties)? If No: when did breastfeeding stop? Tell me about any liquids your child receives Is your child getting anything else to drink? What: Frequency: times/day Amount: how much (reference 250 mL) Bottle use? Yes/No Other milks Other liquids 8Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Tell me about complementary foods Is your child getting anything else to eat? What: Frequency: times/day: Amount: how much (reference 250 mL) Texture: how thick/ consistent Animal: meat/fish/offal/ poultry/eggs/dairy (milk) products Legumes (beans, other local examples) Vegetables/fruits (local examples) Staple (porridge, other local examples) Other challenges (note REASONS underlying challenges): Mother/caregiver assists child Who assists the child when eating? Does the child have their own plate? Hygiene Feeds baby using a clean cup and spoon Washes hands with clean, safe water and soap before preparing food, before eating, and before feeding young children Washes child’s hands with clean, safe water and soap before they eat IYCF health-worker Job aids 9 IYCF health-worker Job aid 2: How to facilitate an action-oriented group Introduce yourself (and co-facilitator) Introduce today’s topic for discussion by: • Telling a story OR • Conducting a mini-drama or role-play OR • Using a visual Observe, Think and Try ► After the story, drama or visual, ask the group participants what they Observe ¤ What do you hear/see in the story/drama or visual? ¤ What recommended practice(s) is/are demonstrated? ► Ask the group participants what they Think ¤ What do you think about this (the behaviour/practice)? ¤ Is there anything you disagree with – or think would not be possible? Please explain. ¤ What are the advantages of adopting the recommended practice(s)? ► Ask the group participants what they would be willing to Try ¤ If mothers/caregivers in this community were in the same situation, would they be willing to try the recommended practice(s)? Why? Why not? ¤ If YOU were the mother/caregiver would YOU be willing to try the new practice(s)? ¤ What difficulties might you experience? ¤ How would you be able to overcome them? ¤ Ask the mother/caregiver to repeat the recommended practice(s). Reminder: If appropriate, set a time for the next meeting and encourage group participants to come ready to talk about what happened when they tried the new practice or encouraged someone to try it. How did they manage to overcome any obstacles? 10 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C IYCF health-worker Job aid 3: How to facilitate an IYCF support group Before the support group • If possible, arrange for someone to watch the older children during the support group session • Arrange the seating in a circle so that all participants (maximum 12) can see each other Welcome participants • Support group facilitator(s) is/are part of the circle and sits/sit on the same level as participants • Welcome all participants, including babies and young children, and thank all for coming • Introduce yourself (and co-facilitator) • Ask participants of the support group to introduce themselves • Remind participants that everything said is confidential Introduce today’s topic for discussion • Use participants’ names • Ask questions that generate participation: – Does anyone here know someone who does this? – Why do you think they do this? – Does anyone want to share their experience? – Does anyone want to share a different experience? – What do you think “so and so” would say if you decided to do “such and such”? – What advantages does this practice have for the child/mother/family? – What difficulties have you experienced in this situation? – Were you able to resolve the difficulties? How? Why not? • Encourage mothers/caregivers to share their own experiences • Use Listening and learning skills and Skills for building confidence and giving support • Motivate quiet women/men to participate Manage the content • Share information-giving source(s) (ministry of health, doctors, health personnel) • Let participants know where they can receive the nearest support • Give advice only when asked • Summarize ideas during the session • Keep the group focused on the theme • Summarize the main points at the end of the session • Make a note of any questions or issues that require more information; let the group know you will seek this information from an expert IYCF health-worker Job aids 11 Close the session • Thank the participants for attending the IYCF support group • Invite participants to attend the next IYCF support group meeting (place, date, time and topic) • Ask the group participants to: – talk to a pregnant woman and a breastfeeding mother or a father before the next meeting; share what they have learnt during the IYCF support group, and report back – come to the next meeting prepared to talk about what happened when they tried the new practice or encouraged someone to try it. How did they manage to overcome any obstacles? What are their children’s early signs of hunger? What tips do they have for getting their children to try a new food? 12 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C IYCF health-worker Job aid 4: IYCF recommended contact points Contact 1 – Antenatal • The health worker discusses benefits and management of breastfeeding, including about early skin-to-skin contact, to prevent surprises. • At a second antenatal contact, the health worker discusses more details and the mother’s concerns. Contact 2 – At delivery, in a maternity facility or at home • The baby is placed on the mother’s naked chest immediately after delivery for early skin-to-skin contact, and allowed to crawl to the breast to attach and suckle. Contact 3 – Postnatal 1, within 24 hours • This may be within 6 hours in a maternity facility (by the birth attendant), or on the first day after a home delivery. • The health worker counsels the mother; helps her to position and attach the baby at the breast; and informs her about follow-up support and mothers’ groups Contact 4 – Postnatal 2, at 2–4 days • The health worker checks the condition of the mother and baby; follows up on previous contacts; observes a breastfeed; counsels the mother about any difficulties; helps with positioning and attachment; explains the feeding pattern; and encourages exclusive breastfeeding. ANTENATAL BIRTH 4 months 2 months Contact 1 Contact 7 Ongoing contacts Contact 6 Contact 2 Contact 3 Contact 4 Contact 5 12 months 6 weeks 4 weeks 2 weeks 8 weeks 24 months POSTNATAL IYCF health-worker Job aids 13 Contact 5 – Postnatal 3, at 5–8 days • The health worker checks the condition of the mother and baby; follows up on previous contacts; observes a breastfeed; counsels the mother about any difficulties; helps with positioning and attachment; explains the feeding pattern; and encourages exclusive breastfeeding. Contact 6 – Postnatal 4, between 14 and 28 days • The health worker checks the condition of the mother and baby; follows up on previous contacts; observes a breastfeed; counsels the mother about any difficulties; helps with positioning and attachment; explains the feeding pattern; and encourages exclusive breastfeeding. Contact 7 – Postnatal 5, between 6 and 8 weeks • This may take place at the mother’s postpartum contact (6 weeks). • The health worker checks the condition of the mother and baby; makes sure that breastfeeding is going well; counsels the mother about any difficulties; and encourages exclusive breastfeeding. Ongoing contacts – after 2 months • These should take place at all growth monitoring and immunization contacts, or when the mother and baby are in contact for illness or family planning. • The health worker checks that breastfeeding is going well; counsels the mother about any difficulties; encourages exclusive breastfeeding up to 6 months; and, from 6 months, introduction of complementary foods with continued breastfeeding to 2 years. • Mothers who are living with HIV may need referral for further individual counselling, according to national policy. 14 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C IYCF health-worker Job aid 5: What to discuss at postnatal contacts • Use counselling skills – Listening and learning skills and Skills for building confidence and giving support • Follow up on previous observations and questions Age: Determine age of infant Ask: • How is breastfeeding going – how many times, length of feeds, comfort, condition of breasts? • Is the baby receiving other fluids or foods, bottles, dummies? • Baby’s health and behaviour • Pregnancy, delivery, early feeds • Mother’s condition and family planning • Previous infant feeding experience • Family and social situation – support at home, work Observe: • Condition of the mother • Condition of the baby • A breastfeed – including condition of the breasts • Child’s growth curve – weight and/or length/height, as appropriate Help mother to: • Position and attach her baby if necessary • Express milk and cup-feed her baby – if necessary, if not done before Explain or recap as needed: • How milk “comes in” • Recognizing hunger cues (either add here or in the previous list on “Help mother to:”) • Feeding pattern – demand feeding (baby with mother, respond day and night, let baby finish first breast, offer the second breast) • Exclusive breastfeeding – supplements not needed • Signs the baby has what they need – passing urine, contented Respond to any other questions and worries: • Help (including possible referral) if needed with any difficulties: – Poor (or excessive) weight gain – Concerns about “not enough milk” – Concerns about baby’s crying – Suckling difficulties – Flat, inverted or large nipples – Sore nipples – Engorgement – Mastitis – Refusal to feed IYCF health-worker Job aids 15 IYCF health-worker Job aid 6: What to discuss at ongoing contacts • Use counselling skills – Listening and learning skills and Skills for building confidence and giving support • Follow up on previous observations and questions Age: Determine age of infant or young child Ask: • How is breastfeeding going – how many times, length of feeds, comfort, condition of breasts? • Is the baby receiving other fluids or foods, bottles, dummies? • Baby’s health and behaviour • Pregnancy, delivery, early feeds • Mother’s condition and family planning • Previous infant feeding experience • Family and social situation – support at home, work Observe: • (Condition of the mother) • Condition of the baby • (A breastfeed, including condition of breasts, if there is any difficulty) • Child’s growth curve – weight and/or length/height, as appropriate Discuss: • The importance of exclusive breastfeeding to 6 months • Introduction of complementary foods from 6 months – AFATVRH: age-appropriate, frequency, amount, thickness, variety, responsive feeding and hygiene • Continuing to demand feed as often as the infant wants, day and night • Family support – talk to family if possible • Family planning • Preparation for returning to work • Any other questions Respond to any other questions and worries: • Help (including possible referral) if needed with any difficulties: – Poor (or excessive) weight gain – Concerns about “not enough milk” – Concerns about baby’s crying – Suckling difficulties – Flat, inverted or large nipples – Sore nipples – Engorgement – Mastitis – Refusal to feed

17 Instructions for conducting a supervision visit Supervision of IYCF programme activities A supervisor should ensure that information identifying the elements of the facility’s IYCF programme activities is available. Complete Supportive supervision tool 1: Assessment of basic IYCF programme implementation from record review and discussion with facility personnel. Once basic information has been obtained, periodic basic monitoring of a facility’s IYCF programme can be conducted by a generalist-supervisor (who may oversee many of the facility’s programmes and functions, but have insufficient time to provide mentoring to individual workers). Supportive supervision tool 2: Monitoring of IYCF activities at facility level provides suggestions for a combination of record review and observation of a few randomly selected workers conducting IYCF programme activities, to obtain an impression of the quality of the programme. Conducting a “mentoring-supportive supervision” visit 1. Schedule a time for your visit with the facility in advance, to ensure availability of the health workers to be supervised. 2. Review the health worker’s records and activities conducted since your last mentoring visit. 3. Ask how the health worker feels about their work: what is going well; are they experiencing any difficulties? How did the worker do with any changes they have worked on since the last mentoring visit? Praise what is going well. 4. Observe an IYCF counselling activity. Ask the health worker to introduce you to the mother/caregiver and explain briefly why you are there. You should then ask mother’s/caregiver’s permission to observe, and explain that you will record no names and that all personal information will remain confidential. 5. Sit so that you can observe the health worker and mother, but not distract either. 6. As the health worker talks with the mother/caregiver, make notes on the Observation checklist, so that you can provide feedback to the health worker once the session has ended and the mother/caregiver has departed. (You will not have to complete the checklist or submit it to anyone; rather, it is for your guidance in observing and mentoring the health worker). 7. In any one counselling session, there will not be an opportunity for the counsellor to use all of the skills listed in the checklist; therefore, make brief notes to help you remember those skills that were used, and, as importantly, those that were not used when there was an appropriate opportunity. 8. To help you evaluate the appropriate information for IYCF counselling, the counselling checklist, for example (see pages 33 and 41), is divided into three parts: (i) skills related to the three-step counselling process; (ii) skills related to the appropriate handling of content and materials related to breastfeeding or complementary feeding; and (iii) skills related to communication. A counsellor’s total score for a counselling session can range from 0 to 6 points. 9. If a counsellor passes along misinformation or fails to correct misinformation provided by a group member, find a way to present the correct information to the mother/caregiver without having the IYCF counsellor lose credibility in their role in the community. 10. At the end of the session (and after the mother has departed), discuss your observations with the health worker, and together decide on a change, or a small, do-able action, etc. that the health worker can perform to improve before the next mentoring visit. Keeping records 11. Following the supportive supervision/mentoring session, transfer key information for your ongoing work with the health worker onto the Supportive supervision monitoring tool 2: Monitoring IYCF activities at facility level – supervisor's record for tracking individual health-worker progress, and record the date of your supervision activity in Supportive supervision monitoring tool 1: Supervisor’s log – summary of monthly activities. You will compile this information with other data into Supportive supervision monitoring tool 3: Monthly/quarterly/ period summary reporting form – supervisor’s and health worker’s activity data, which will be submitted (monthly/quarterly/periodically) to the district office (other). 12. Gather monitoring data. A mentoring visit may be an opportunity for the supervisor to talk with mothers/caregivers about their experiences around IYCF, and to periodically collect data from a small number of mothers/caregivers to help track progress towards results. NOTE that it will be necessary for every programme to adapt these or similar forms to ensure a smooth fit with district (or other) monitoring systems.

19 Supervision tools Supportive supervision tool 1: Assessment of basic IYCF programme implementation Instructions: If reliable information is available from another source, it is only necessary for the supervisor (generalist or mentor-supervisor) to fill in gaps in the information. This information should be updated as the elements of IYCF programming supported by the facility change. Supervisor’s name Name of health facility Date of assessment Name of person(s) interviewed or consulted Job title(s) of person(s) interviewed or consulted Policies related to IYCF IYCF Policy 1 Is there a policy (guidance) on who should receive IYCF counselling?  Yes  No IYCF Policy 2 What are the criteria for receipt of counselling for pregnant women? IYCF Policy 3 What are the criteria for receipt of counselling for mother–baby pairs 0–24 months? IYCF Policy 4 Is there an Antenatal care guideline related to IYCF?  Yes  No IYCF Policy 5 Is there a Delivery policy related to IYCF?  Yes  No IYCF Policy 6 Is there a Supportive supervision/mentoring policy that includes IYCF?  Yes  No 20 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C 1. Training Training 1 Does the facility have at least one health worker trained in IYCF counselling?  Yes  No Training 2 Do other (untrained) health workers conduct IYCF counselling (facilitate other IYCF support activities)?  Yes  No 2. Implementation of IYCF support activities IYCF support activity 1 Is any IYCF counselling being offered by health workers? If No, skip to IYCF support activity 4  Yes  No IYCF support activity 2 In what services is IYCF counselling being offered? Check all that apply.  ANC  PNC  GMP  Immunization  Sick baby  PMTCT  CMAM  IMCI  Other (specify) IYCF support activity 3 From what services is there referral to IYCF counselling? Check all that apply.  ANC  PNC  GMP  Immunization  Sick baby  PMTCT  CMAM  IMCI  Other (specify) IYCF support activity 4 Are action-oriented groups being offered (on a regular basis) by health workers?  Yes  No IYCF support activity 5 Are support groups being offered (on a regular basis) by health workers?  Yes  No IYCF support activity 6 Is information on recommended practices being provided by health workers?  Yes  No IYCF support activity 7 Are food demonstrations being offered by health workers?  Yes  No Supervision tools 21 3. Supplements used in IYCF programme Supplements 1 What supplements are available in your IYCF programme? Iron–folate Micronutrient powders Vitamin A  Yes  No  Yes  No  Yes  No Supplements 2 Are special nutritional products available for children aged 6–24 months?  Yes  No 4. Communications/information, education and communication materials Materials 1 Are adequate materials for IYCF counselling/support (guidelines, training manuals, Job aids, Counselling cards) available?  Yes  No Materials 2 Are there posters/charts visible that cue health workers and caregivers to age- appropriate information?  Yes  No Materials 3 Have health workers been trained to use them?  Yes  No 5. Supportive supervision/mentoring Supportive supervision/ mentoring 1 Is there a process in place to help health workers improve their knowledge/ skills related to IYCF counselling?  Yes  No Supportive supervision/ mentoring 2 Describe the activities 6. Monitoring Monitoring 1 Does the facility have updated demographic information that allows determination of the target population size? Number of pregnant women Number of children aged 0–23 months  Yes  No  Yes  No Monitoring 2 Are targets set for counselling (recommended number of contact points; % of pregnant women counselled, etc.)  Yes  No Monitoring 3 Are monitoring tools (activity logs, tally sheets/forms/registers) available and adapted to track IYCF counselling contacts?  Yes  No Monitoring 4 Do registration books make it possible to track the provision of IYCF counselling to the same caregiver/child over time?  Yes  No Monitoring 5 Is information on IYCF counselling (or other IYCF support activities) included in monthly (periodic) reports?  Yes  No Monitoring 6 Are data on IYCF counselling included in the health management information system?  Yes  No ANC: antenatal care; CMAM: community-based management of acute malnutrition; GMP: growth monitoring and promotion; IMCI: Integrated Management Of Childhood Illness; PMTCT: prevention of mother-to-child transmission of HIV; PNC postnatal care. 22 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Supportive supervision tool 2: Monitoring IYCF activities at facility level (Adapt according to district needs) Supervisor’s name Name of health facility Date of assessment Name of person(s) interviewed or consulted Job title(s) of person(s) interviewed or consulted 1. Training Training 1 Percentage of health workers who have received IYCF training .................. % What are the criteria for receipt of counselling for pregnant women?  Yes  No 2. Implementation of IYCF support activities: IYCF counselling IYCF counselling 1 WHO is receiving IYCF counselling (from records)? Number/% of pregnant women (meeting criteria: e.g. attending antenatal care during third trimester) counselled on IYCF Number/% of caregivers of children aged 0–24 months counselled/referred for IYCF counselling (by service: meeting criteria outlined in policy/guidance?) Number ...................................................... Percentage .................................................. Number ...................................................... Percentage .................................................. Supervision tools 23 IYCF counselling 2 WHO is receiving IYCF counselling (from observation)? Pregnant women in antenatal care Caregivers of children aged 0–24 months (or meeting criteria) receiving IYCF counselling All .............................................................. Some .......... according to policy OR describe (only first in line, etc.) None .......................................................... All .............................................................. Some .......... according to policy OR describe (only first in line, etc.) None .......................................................... IYCF counselling 3 Number of health worker(s) observed today .......... IYCF counselling quality 1 Did observed health worker(s) use Counselling cards? Place a tick mark in the appropriate line for each health worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never IYCF counselling quality 2 Did observed health worker(s) refer to Job aids (including posters visible to the health worker)? Place a tick mark in the appropriate line for each worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never IYCF counselling quality 3 Did observed health worker(s) ask BRIEF and AGE-APPROPRIATE QUESTIONS about feeding (as they provide a particular service, e.g. antenatal care, weighing child in growth monitoring and promotion, etc.)? Place a tick mark in the appropriate line for each worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never IYCF counselling quality 4 Did health worker(s) ask questions in a way that invites mothers to identify any problems, ask questions or confirm that feeding is going well? Place a tick mark in the appropriate line for each worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never 24 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C IYCF counselling quality 5 Did health worker(s) find one reason to PRAISE the mother? Place a ü in the appropriate line for each worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never IYCF counselling quality 6 Did health worker(s) refer the mother/caregiver (if appropriate)? Place a √ in the appropriate line for each worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never 3. Supplements used in IYCF programme Supplements 1 Were there sufficient supplies of the following today'? Iron–folate Micronutrient powders Vitamin A Special nutrition supplements  Yes  No  Yes  No  Yes  No  Yes  No Supplements 2 Did health worker(s) discuss commodity use with caregivers? (from observation) Place a tick mark in the appropriate line for each worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never Supplements 3 Did health worker(s) demonstrate appropriate use of commodities with the caregiver (as necessary)? (from observation) Place a tock mark in the appropriate line for each worker observed Health worker 1  Always  Sometimes  Never Health worker 2  Always  Sometimes  Never Health worker 3  Always  Sometimes  Never Supplements 4 % of targeted pregnant women/children less than 24 months who receive (commodities: complementary feeding supplements, micronutrient powders, other) (from record review) .......... % Supervision tools 25 4. Supportive supervision/mentoring Supportive supervision/ mentoring 1 What mechanisms are in place to support improvement of health-worker performance? Training of health workers in IYCF Periodic refresher training Peer observation and feedback of health worker Supervisor observation and feedback of health worker  Yes  No  Yes  No  Yes  No  Yes  No 5. Monitoring Monitoring 1 Does regular monitoring of IYCF support occur (data collection on IYCF activities, coverage, quality)?  Yes  No Monitoring 2 Does the programme track progress towards targets?  Yes  No Monitoring 3 Are results discussed with workers? How? ............................................................................................... ....................................................................................................... .......................................................................................................  Yes  No 26 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Supportive supervision tool 3: Breastfeed observation checklist Name of health worker: Date: Facility: Name of mentor-supervisor: Health worker and mentor-supervisor observe and check ü to indicate whether the following points are covered correctly. Compare and discuss Breastfeed observation checklists. Mother's name: Baby's name: Date: Baby's age: Signs that breastfeeding is going well: Signs of possible difficulty: GENERAL Mother: □ Mother looks healthy □ Mother relaxed and comfortable □ Signs of bonding between mother and baby Mother: □ Mother looks ill or depressed □ Mother looks tense and uncomfortable □ No mother/baby eye contact Baby: □ Baby looks healthy □ Baby calm and relaxed □ Baby reaches or roots for breast if hungry Baby: □ Baby looks sleepy or ill □ Baby is restless or crying □ Baby does not reach or root BREASTS □ Breasts look healthy □ No pain or discomfort □ Breast well supported with fingers away from nipple □ Breasts look red, swollen, or sore □ Breast or nipple painful □ Breasts held with fingers on areola BABY'S POSITION □ Baby’s head and body in line □ Baby held close to mother’s body □ Baby’s whole body supported □ Baby approaches breast, nose to nipple □ Baby’s neck and head twisted to feed □ Baby not held close □ Baby supported by head and neck only □ Baby approaches breast, lower lip/chin to nipple BABY'S ATTACHMENT □ Baby’s mouth open wide □ Lower lip turned outwards □ Baby’s chin touches breast □ More areola seen above baby’s top lip □ Baby’s mouth not open wide □ Lips pointing forward or turned in □ Baby’s chin not touching breast □ More areola seen below bottom lip SUCKLING □ Slow, deep sucks with pauses □ Cheeks round when suckling □ Baby releases breast when finished □ Mother notices signs of oxytocin reflex □ Rapid shallow sucks □ Cheeks pulled in when suckling □ Mother takes baby off the breast □ No signs of oxytocin reflex noticed Supervision tools 27 Supportive supervision tool 4: Observation checklist for IYCF counselling Name of health worker: Date: Facility: Name of mentor-supervisor: Health worker and mentor-supervisor observe and check (ü) Y (yes) or N (no) to indicate whether the following points are covered correctly. Compare and discuss Observation checklists for IYCF counselling. Skills Y N Comments/observations Skill 1: Obtain correct infant age Skill 2: Step 1 – Assess infant feeding Assess the current breastfeeding status Check for breastfeeding difficulties Observe a breastfeed (if necessary) Assess use of infant feeding bottle Assess “other food” and “other fluid” intake Assess “FATVR”: circle age-appropriate recommendation Frequency Amount Thickness Variety Responsive feeding Skill 3: Step 2 – Analyse Consider deviation from age-appropriate recommended practices Consider issues reported by mother Correctly prioritize the most important issues for action Skill 4: Step 3 – Act Praise the mother/caregiver for positive practices If a difficulty is identified, address the reasons Discuss limited and relevant information Help mother/caregiver to problem-solve, as appropriate Encourage mother/caregiver to try new practice Agree upon action Skill 5: Appropriate use of materials Use of Counselling cards to reinforce good breastfeeding practices Point out characteristics of complementary feeding using appropriate Counselling card for age group Use of Counselling cards to reinforce good hygiene practices Show how to add micronutrient supplements for home fortification Show how to add micronutrient supplements for home fortification 28 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Skills Y N Comments/observations Skill 6: Communication skills Use helpful non-verbal communication Ask open questions Use responses and gestures that show interest Reflect back what the mother/caregiver says Empathize – show that you understand how the mother/caregiver feels Avoid using words that sound judging Accept what a mother/caregiver thinks and feels Recognize and praise what a mother/caregiver and baby are doing right Give practical help Give a little, relevant information Use simple language Make one or two suggestions, not commands Supervision tools 29 Supportive supervision tool 5: Observation checklist for facilitation of an action- oriented group Name of health worker: Date: Facility: Name of mentor-supervisor: Health worker and mentor-supervisor observe and check (ü) Y (yes) or N (no) to indicate whether the following points are covered correctly. Compare and discuss Observation checklists for facilitation of an action-oriented group. Skills Y N Comments/observations Skill 1: Observe After the story, drama or visual, ask group participants what they Observed: a. What happened in the story/drama or visual? b. What are the characters doing in the story/drama or visual? c. What recommended practice(s) is/are demonstrated? d. How did the character feel about what they were doing? Why did they do that? Skill 2: Think Ask the group participants what they Think about what they observed: a. Who do you know that does this (recommended behaviour/practice)? b. How have they been able to do this (recommended behaviour/practice)? c. Discuss: what are the key messages of today’s topic? d. Discuss: what is the advantage of adopting the practice described in the story/drama or visual? Skill 3: Try Ask the group participants whether they would be willing to Try what they observed. Why, why not? a. If you were the mother (or another character), would you be willing to try the new practice? b. Would people in this community try this practice in the same situation? Why? Skill 4: Act Ask the group participants whether they could Act in the same way. Why, why not? a. What would you do in the same situation? Why? b. What difficulties might you experience? c. How would you be able to overcome them? Skill 5: Share Ask group participants to come ready to talk about what happened when they tried the new practice and how they managed to overcome any obstacles; ask them to Share what they have learnt with a pregnant woman or breastfeeding mother. 30 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Supportive supervision tool 6: Observation checklist for facilitation of an IYCF support group Name of health worker(s)/group facilitator(s): Theme:* Date: Facility: Name of mentor-supervisor: Health worker and mentor-supervisor observe and check (ü) Y (yes) or N (no) to indicate whether the following points are covered correctly. Compare and discuss Observation checklists for facilitation of an IYCF support group . Skill 1: manage the process Y N Comments/observations • Participants sit in a circle • Facilitator(s) introduce themselves to the group • Facilitator(s) clearly explain the day’s theme • Facilitator(s) ask questions that generate participation • Facilitator(s) motivate the quiet women/men to participate Skill 2: Use counselling skills Did the facilitator(s) appropriately apply: • Listening and learning skills • Skills for building confidence and giving support Skill 3: Facilitate discussion The facilitator(s): • encourage mothers/caregivers to share their own experiences • draw out ways that other participants have solved problems • guide discussion Skill 4: Manage content and materials The facilitator(s): • ensure that “correct/good” behaviours/beliefs and attitudes are emphasized • correct any misinformation, as necessary • note any unanswered questions • use Counselling cards and Job aids, as appropriate Skill 5: Motivate continued participation • The facilitator(s) thank the participants for attending the IYCF support group and invite them to attend the next IYCF support group (place, date and theme) • The facilitator(s) ask participants to talk to a pregnant woman or breastfeeding mother before the next meeting, share what they have learnt, and report back Skill 6: Monitor attendance • The facilitator(s) complete and submit(s) support group attendance form *The day’s theme might change if there is a mother/caregiver who has a feeding issue they feel an urgent need to discuss. Supervision tools 31 Supportive supervision tool 7: Supervisor’s record for tracking individual health- worker progress1 Name of health worker: Year: Facility: Name of mentor-supervisor: Activities Date of visit Yes No Comments/agreed-upon recommendations 1. Health-worker monthly activity log reviewed: IYCF health-worker monitoring Job aid 1 Q1 Q2 Q3 Q4 2. Follow-up issues identified during last supportive supervisory session Q1 Q2 Q3 Q4 Skills observed Individual counselling Score Positive aspects Areas for improvement 3. Three-step counselling process • Assess • Analyse • Act Q1 Q2 Q3 Q4 4. Management of materials: breastfeeding and complementary feeding Q1 Q2 Q3 Q4 5. Communication skills Q1 Q2 Q3 Q4 1 This supportive supervision monitoring tool can be used for both monitoring (to obtain, compile and review quality of IYCF support services, as is used in Supportive supervision monitoring tool 2) and mentoring (to support enhanced or improved provider performance, as is used here in Supportive supervision tool 7), in order to contribute to not only improved worker performance but also strengthened programmes and systems. 32 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Facilitation skills Yes/No Prioritized actions Comments/agreed-upon recommendations 6. Facilitation of action-oriented group Q1 Q2 Q3 Q4 7. Facilitation of an IYCF support group Q1 Q2 Q3 Q4 Activities Yes/No Prioritized actions Agreed-upon recommendations 8. Prioritized action before next supervisory visit Q1 Q2 Q3 Q4 Date Concrete steps before next visit 9. Date of next supervisory visit Q1 Q2 Q3 Q4 33 Self-assessment in infant and young child feeding: competency practice and progress tracking form Instructions: • Track your practice by putting a ü in the first box (column) for each skill you have practised. • In the second box (column), enter a ü for competency where a peer has observed you and provided feedback. • In the third box (column), enter a ü for competency observed by a mentor-supervisor who provided feedback. Competencies Practised Peer observed and feedback Mentor- supervisor observed and feedback Core competencies 1. Use the six Listening and learning skills to counsel a mother or caregiver 2. Use the six Skills for building confidence and giving support to counsel a mother or caregiver 3. Assess a breastfeed using the Job aid: Breastfeed observation 4. Help a mother to position herself and her baby for breastfeeding • The four key signs of good positioning • Demonstrate different positions: – Cradle – Cross-cradle – Side-lying – Underarm – Cross-position for twins 5. Help a mother to attach her baby at the breast • The four key signs of good attachment • How to hold the breast • Signs of effective suckling 6. Explain how the breast makes milk 7. Explain to a mother about the optimal pattern of breastfeeding • Unrestricted or demand feeding • Day and night • Let baby finish first breast; offer the second one 8. Help a mother to express her breast milk by hand 9. Help a mother to cup-feed her baby 10. Plot and interpret a child’s growth chart 11. Take a feeding history for an infant aged from 0 up to 6 months using the Job aid: Feeding history – 0 up to 6 months 34 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Competencies Practised Peer observed and feedback Mentor- supervisor observed and feedback 12. Counsel a pregnant woman about breastfeeding (importance and management) 13. Inform a woman about optimal infant feeding (early skin- to-skin contact, early initiation of breastfeeding, exclusive breastfeeding for 6 months, and continued breastfeeding to 2 years) Compound competencies 1. Help a mother to initiate breastfeeding within an hour after delivery 2. Support exclusive breastfeeding for the first 6 months of life 3. Help a mother to continue breastfeeding up to 2 years of age or beyond 4. Help a mother with “not enough milk” 5. Help a mother with a baby who cries frequently 6. Help a mother whose baby is refusing to breastfeed 7. Help a mother who has flat or inverted nipples 8. Help a mother with engorged breasts 9. Help a mother with sore or cracked nipples 10. Help a mother with mastitis 11. Help a mother to breastfeed • a low birth-weight-baby • a sick baby • twins 12. Help a mother to increase her breast milk or to start breastfeeding again (relactate) 13. Help mothers who are in employment to breastfeed 14. Explain the importance of continued breastfeeding 15. Explain why there is an optimal age for children to start complementary feeding 16. List the local foods that can help fill the energy gap 17. Explain the reason for recommending using foods of a thick consistency 18. Describe ways to enrich foods 19. List the local foods that can fill the nutrient gaps for iron and vitamin A 20. Explain the importance of animal-source foods 21. Explain the importance of legumes Self-assessment in infant and young child feeding: competency practice and progress tracking form 35 Competencies Practised Peer observed and feedback Mentor- supervisor observed and feedback 22. Describe age-appropriate frequency, amount, thickness, and variety of foods for an infant aged 6–9 months 23. Describe age-appropriate frequency, amount, thickness, and variety of foods for an infant aged 9–12 months 24. Describe age-appropriate frequency, amount, thickness, and variety of foods for an infant aged 12–24 months 25. Describe the importance of responsive feeding 26. Describe hygiene practices for the mother/caregiver/baby 27. List the recommendations for feeding a non-breastfed child aged over 6 months 28. Use the Job aid: Food intake – 6 up to 24 months or IYCF health-worker Job aid 1: IYCF assessment 29. Explain why children need to continue to eat during illness 30. Describe appropriate feeding during illness and recovery 31. Conduct a food demonstration with a mother/caregiver to help feed her child aged 6–24 months

37 Monitoring Job aids for health workers and tools for mentor-supervisors IYCF health-worker monitoring Job aid 1: Monthly activity log for a health worker who provides IYCF support to pregnant women and mothers–children (0 up to 24 months) District (facility, supervision area or other identifying information: adapt as appropriate): Name of health worker: Month: Individual counselling Date of activity Pregnant woman (number of women, mark with a /) Child 0 up to 24 months (number of caregiver–child pairs) Action- oriented group (number of groups conducted) IYCF support group (number of groups facilitated) Number of women counselled for the first time Number of women counselled during repeat or follow-up session Number of women counselled for the first time Number of women counselled during repeat or follow-up session Total for the month: NOTE below any issues to be discussed with the mentor-supervisor: check on when to make referrals. 38 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Supportive supervision monitoring tool 1: Supervisor’s log – summary of monthly activities Name of health worker: Position: Location: Monthly or quarterly report: Year: Activities Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total number of visits per year 1. Total number of health workers assigned to supervisor 2. Number of supervision visits scheduled 3. Number of planned supervision visits completed 4. Percentage of planned supervision visits completed 5. Tracking number of visits to individual health workers*: transfer this information from IYCF health-worker monitoring Job aid 1 for each health worker a. Health worker 1, name: b. Health worker 2, name: c. Health worker 3, name: d. Health worker 4, name: e. Health worker 5, name; f. etc. *NOTE: Names of ALL health workers mentored by the supervisor should be included in this list. Monitoring Job aids for health workers and tools for mentor-supervisors 39 Supportive supervision monitoring tool 2: Monitoring IYCF activities at facility level– supervisor’s record for tracking individual health-worker progress1 Name of health worker: Position: Facility: Name of mentor-supervisor: Year: Activities Date of visit Yes No Comments/agreed-upon recommendations 1. Health-worker monthly activity log reviewed: IYCF health-worker monitoring Job aid 1 Q1 Q2 Q3 Q4 2. Follow-up issues identified during last supportive supervisory session Q1 Q2 Q3 Q4 Skills observed Individual counselling Score Positive aspects Areas for improvement 3. Three-step counselling process • Assess • Analyse • Act Q1 Q2 Q3 Q4 4. Management of materials: breastfeeding and complementary feeding Q1 Q2 Q3 Q4 5. Communication skills Q1 Q2 Q3 Q4 1 This supportive supervision monitoring tool can be used for both monitoring (to obtain, compile and review quality of IYCF support services, as is used here in Supportive supervision monitoring tool 2) and mentoring (to support enhanced or improved provider performance, as is used in Supportive supervision tool 7), in order to contribute to not only improved worker performance but also strengthened programmes and systems. 40 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C Facilitation skills Yes/No Prioritized actions Comments/agreed-upon recommendations 6. Facilitation of action-oriented group Q1 Q2 Q3 Q4 7. Facilitation of an IYCF support group Q1 Q2 Q3 Q4 Activities Yes/No Prioritized actions Agreed-upon recommendations 8. Prioritized action before next supervisory visit Q1 Q2 Q3 Q4 Date Concrete steps before next visit 9. Date of next supervisory visit Q1 Q2 Q3 Q4 Monitoring Job aids for health workers and tools for mentor-supervisors 41 Su pp or ti ve s up er vi si on m on it or in g to ol 3 : M on th ly /q ua rt er ly /p er io d su m m ar y re po rt in g fo rm – s up er vi so r’ s an d he al th w or ke r’ s ac ti vi ty d at a Su pe rv is io n a re a: M en to r- su pe rv is or n am e: R ep or ti n g m on th : Ta bl e fo r ag gr eg at in g da ta fr om h ea lt h- w or ke r m on th ly (q ua rt er ly /p er io d) a ct iv it y lo gs In st ru ct io n s: r ec or d su m m ar y da ta fo r ea ch h ea lt h w or ke r fo r th e re po rt in g pe ri od (m on th ly /q ua rt er ly /o th er ). I n fo rm at io n in th e ro w fo r he al th w or ke r 1 s ho ul d su m m ar iz e: th e n um be r of p re gn an t w om en th e he al th w or ke r co un se lle d fo r th e fi rs t t im e; th e n um be r of p re gn an t w om en th e he al th w or ke r co un se lle d on a r ep ea t v is it ; t he s am e in fo rm at io n fo r co un se lli n g m ot he r– ch ild u n de r 24 m on th p ai rs ; t he n um be r of a ct io n -o ri en te d gr ou ps c on du ct ed (w he re a pp lic ab le ); th e n um be r of I YC F su pp or t g ro up s es si on s th e he al th w or ke r fa ci lit at ed d ur in g th e re po rt in g pe ri od (w he re a pp lic ab le ) ( fr om I YC F h ea lt h w o rk er m o n it o ri n g Jo b ai d 1: M o n th ly a ct iv it y lo g f o r a h ea lt h w o rk er w h o p ro vi d es I YC F su pp o rt t o p re g n an t w o m en a n d m o th er s– ch il d re n (0 u p to 2 4 m o n th s) ); an d w he th er th e he al th w or ke r r ec ei ve d a su pe rv is io n vi si t a nd w as o bs er ve d pr ov id in g in di vi du al co un se lli n g (n um be r or y es /n o) o r fa ci lit at in g an a ct io n -o ri en te d gr ou p (n um be r or y es /n o) ; o r an I YC F su pp or t g ro up (n um be r or y es /n o) (S u pp o rt iv e su pe rv is io n t o o l 5: O bs er va ti o n c h ec kl is t fo r fa ci li ta ti o n o f an a ct io n -o ri en te d g ro u p an d Su pp o rt iv e su pe rv is io n t o o l 6: O bs er va ti o n c h ec kl is t fo r fa ci li ta ti o n o f an I YC F su pp o rt g ro u p, w he re a pp lic ab le ). H ea lt h- w or ke r ac ti vi ty Su pp or ti ve s up er vi si on /m en to ri n g In di vi du al co un se lli ng Ac tio n- or ie nt ed gr ou p se ss io n s IY C F su pp or t gr ou p se ss io n s* Su pe rv is io n , n um be r or Y /N P re gn an t w om an C hi ld 0 u p to 2 4 m on th s In di vi du al co un se lli ng Ac tio n- or ie nt ed gr ou p IY C F su pp or t gr ou p Fi rs t v is it R ep ea t v is it Fi rs t v is it R ep ea t v is it H ea lth w or ke r 1 H ea lth w or ke r 2 H ea lt h w or ke r 3 H ea lth w or ke r 4 TO TA Ls

43 Exit interview form (Adapt according to objectives) Interview process • Random selection of pregnant woman/mother/caregiver exiting from service point • Ask mother/caregiver whether she is willing to answer a few questions about her experience in the health centre/clinic/ post today, with regard to her own nutrition and that of her infant or young child • The main objective of this interview is to determine what is working well and what can be improved • The goal is to collect information that will help health workers deliver the best care for pregnant women/mothers/infants and young children • All information provided will be confidential Exit interview: pregnant woman (PW) attending antenatal care PW exit interview 1 Did you discuss how you plan to feed your baby with the health worker?  Yes  No PW exit interview 2 What did the health worker discuss with you? Yes No Importance of breastfeeding Keep the mother and newborn baby together, skin-to-skin Putting the baby to the breast within first hour after birth Do not discard colostrum [OR feed the first breast milk] No prelacteal feeds Frequent feeding in first days PW exit interview 3 Did the health worker discuss what will happen at delivery?  Yes  No PW exit interview 4 Did the health worker ask whether you had any concerns?  Yes  No PW exit interview 5 Do you have any questions that were not answered?  Yes  No Exit interview: caregiver (C) of child aged 0–24 months C exit interview 1 What was the purpose of your visit today? C exit interview 2 What is your child’s name? And how old are they? C exit interview 3 Did the health worker ask whether you had any concerns?  Yes  No C exit interview 4 Did the health worker discuss your child’s growth with you?  Yes  No C exit interview 5 What did the health worker tell you?  Yes  No 44 Infant and young child feeding counselling: an integrated course. Trainer's guide, second edition. Web Annex C C exit interview 6 Did the health worker talk with you about how to feed your child?  Yes  No C exit interview 7 What did the health worker discuss with you? C exit interview 8 What was the most important message you heard about how to feed your baby? C exit interview 9 Did you agree to make any changes in how you are feeding NAME?  Yes  No C exit interview 10 Do you think you will change the way you feed NAME because of speaking to the health worker?  Yes  No C exit interview 11 Would you tell another woman who had issues similar to yours to talk with the health worker?  Yes  No Notes

For more information, please contact: Department of Nutrition and Food Safety World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland Email: nutrition@who.int Website: https://www.who.int/health-topics/nutrition

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date October 15, 2021

Source World Health Organization