MINISTRY OF HEALTH

NATIONAL HEALTH BOX

Plurinational State of Bolivia
NATIONAL OFFICE OF NUTRITION SERVICES Ministry of Health and Sports

ACCREDITATION WITH THE INITIATIVE

OF FRIENDLY HOSPITALS OF THE
MOTHER AND CHILDHOOD - IHAMN
 1989 meeting of WHO and UNICEF experts
they mention in their document:
Protection, Promotion, Encouragement and Support of the
Natural Breastfeeding: The special function of services
of maternity.

August 1, 1990, Florence, Italy is launched the

INNOCENTI DECLARATION on Protection,
Promotion, Encouragement, and Support of Breastfeeding
Materna...
That document outlined the '10 Steps
Towards a Happy Natural Breastfeeding", base of the
Friend of Children Hospital Initiative
proposal in 1991.

For Bolivia since the enactment of the Law

3460 good year 2006 has been considered the '11
Steps for a Natural and Safe Breastfeeding.
Eradicate the practice of free distribution and
indiscriminate use of substitutes for breast milk in the
hospitals.
 IHAMN SITUATION IN BOLIVIA

Law No. 3460 on Promoting Breastfeeding and

Marketing of its substitutes in Bolivia and 2009
D.S. 0115 approves the Regulation of Law No. 3460
Promotion of Breastfeeding and Marketing of its
Substitutes.

LAW 3460
AUGUST 15
2006 and its
Regulation
D.S. 0115 06
May 2009
 IHAMN SITUATION IN BOLIVIA

2006: Relaunch of the Friends Hospitals Initiative

2013 with R.M. Nº 0089 approval of IHAMN strategy for EL
National Health System.

R.M. 0089
FEBRUARY 14
2013
R.A. 282
OCTOBER 15
2010
D.S. Specific Regulations on Offenses and
Sanctions to Law 3460 and D.S: 0115 on Promotion to the
Breastfeeding and the Marketing of its
Substitutes in Bolivia

R.M. 0988
AUGUST 8
2014
In 2015, approved with R.M. No. 1701 the
Informed Consent for administration
artificial milk for children under 6 months

The Ministry adopts the strategy of Nominate as

Friends of Breastfeeding to establishments
of health at the First level. (steps 4 to 7)
 The Friends of the Hospital Initiative
Mother and Childhood (IHAMN), is the strategy
that implements the 11 steps for a
Successful Breastfeeding.
PURPOSE
Modify the practices of the services of
maternity, ensuring that these
promote and support a good start of the
breastfeeding.
PURPOSE
Promote and support breastfeeding
as the only suitable food for the
newborns that guarantees the best
beginning of life.
 Implement the steps for breastfeeding
successful and stop the distribution of the
free or low-cost substitutes in the
health services.
Proposes transformation in the model of
attention in maternity wards:

Political decision
Capacity for self-criticism
Staff training
Socialization of the institutional project
Follow-up
 HEALTH INSTITUTION THAT ASSUMES THE
RESPONSIBILITY OF:

COMPLETE 11 STEPS
2. EVITAR PROMOCION Y/O DISTRIBUCION DE
SUBSTITUTES FOR BREASTFEEDING
3. PROMOTE A CULTURE OF SUPPORTING L.M. IN
THE STAFF AND THEIR FAMILIES
4. CREATE INFRASTRUCTURE CONDITIONS
Favorable for L.M.
5. CARRY OUT SELF-EVALUATION
PROCESS IMPROVEMENT
ASSISTANTS AND ADMINISTRATIVE
2. STRENGTHEN CONTINUING MEDICAL EDUCATION
AND NON-PROFESSIONAL TRAINING.
3. STRENGTHEN MANAGEMENT PROCESSES:
IMAGE AND INSTITUTIONAL CULTURE,
MONITORING AND EVALUATION
4. FAVORABLE INSTITUTIONAL ACCREDITATION
 1. POLITICAL DECISION
INSTITUTIONAL
WORK
MANAGERIAL 2. FORMATION OF THE CLM

3. PLAN DEVELOPMENT
OF ACTIVITIES OF
CLM
 DECISION FORMATION PLAN
POLICY CLM DEVELOPMENT
Commitment Multidisciplinary •Misión-Visión
ejecutivo Regulations of SWOT
Influence to functioning Objectives
lower levels •POA, PLAN and •Lines of action
Clear rules and ACTA •Follow-up and
visible evaluation
BARRIERS TO ACCREDITATION:

PLAN OF
LACKOF DEVELOPMENT
PROCESS CONTINUITY
MANAGERIAL OF THE PROGRAM
The CNS has managed to accredit 3 with the IHAM.
hospitals at the national level out of a total of 23
credited as of the date representing 13% and
son
Maternal and Child Hospital CNS Oruro - 2009
CNS Workers' Hospital
Trinidad -2011
Maternal and Child Hospital
CNS Santa Cruz - 2012
 IHAMN – IN THE INSURANCES OF
HEALTH
The Ministry of Health and INASES in the use of their
attributions in management 2008 instruct the
Formation of Breastfeeding Committees
intra-hospital
Regulations for formation and operation of
breastfeeding committees

R.A. 475
04 OF
DECEMBER 2008
The Breastfeeding Committee is a team
multidisciplinary responsible for the preparation,
implementation, supervision, monitoring and
evaluation of the compliance with the program of the
IHAMN and Law 3460 FLM.

They aim to be accredited as a hospital.

Friend of the Mother and Childhood
The Committee will define the strategies for implementation
of the 11 steps for a successful breastfeeding, for which purpose
will present an Action Plan.
Develop an activity plan and schedule
training for the committee and all institutional staff.
Set the goal of being accredited as a Friendly Hospital.
Mother and Childhood and institutionalize the practice of promotion
to Breastfeeding
It will carry out self-assessments of the implementation of the
IHAMN and request external evaluation.
STEP 1.
Provide a written norm that
meet all the health staff.
STEP 2.
It will train all health personnel.
STEP 3.
Will inform the pregnant women, the partner and the
family, of the benefits that it offers
natural breastfeeding.
STEP 4.
Place the baby in skin-to-skin contact.
Mom, immediately after the
birth.

STEP 5.
Show mothers and fathers how it should be given
to breastfeed the baby.
STEP 6.
Do not give anything else to the newborns.
food or drink, unless they are
indicated medications

STEP 7.
Facilitate the joint accommodation 24
hours of the day.
STEP 8.
Encourage breastfeeding on demand
from the baby and/or the mother.

STEP 9.
Do not give bottles to babies, nor
pacifiers
STEP 10.
Form support groups for breastfeeding
natural.

STEP 11.
Prohibit free distribution and
indiscriminate use of milk substitutes
maternity in the hospital
Designation and formation
of the C.L.M.
Appointment of the coordinator of
C.L.M.
Designation of the C.L.M.
formation with character
multidisciplinary
Public invitation to the staff to
that they adapt to the C.L.M.
Incorporation Act of C.L.M.
The Committee composed:

• Carry out the first self-assessment with

participation of Service Chiefs and
personal with good knowledge of
institutional functioning.
Other activities of the CLMI:
SWOT Analysis of the Institution in relation to the
breastfeeding.
Elaboration of the Mission.
Development of the Vision.
Development of the Action Plan.
Actions to include in the Institutional POA
funds to fulfill the actions of your Plan
(sustainability)
Requirements covered and insured of the
satisfactory compliance with regards to
less than 80% of the steps, requests
External Evaluation by letter addressed to the
Nutrition Department of MSD, to the Department.
Quality Management of the CNS
attaching the latest Self-Assessment.
External evaluators are carried out at the level
national composed of:
Nutrition Unit of MSD
INASES
SEATS
For a period of 3 days to 1 week
depending on the complexity it has
the Health Establishment.
Upon approving the indicated percentage,
believes like:
"MOTHER AND FRIEND HOSPITAL"
CHILDHOOD
They receive the plates: One from the MSD, from
INASES and another from UNICEF
The event is hosted by the Establishment of
Health and SEDES.
TURNING AN HOSPITAL FRIENDLY
OF THE MOTHERAND CHILDHOOD
Committee with quality, committed, with
training capacity in L. M.
facilitator of continuing education
of the health personnel in L. M., who
conduct scientific research;
framed in norms and regulations
institutional, aimed at contributing
in the solution the problems
health dominants in the District, with
evidence-based.
Leading committee in promotion and protection
from L. M., resource trainer
Humans in health, competitive in the
teaching activity, with processes
managerial developed, aimed at
quality comprehensive medical care
evidence-based.
STRENGTHS
Maternal and child hospital
OPPORTUNITIES
Adequate administrative organization Zero Malnutrition Initiative.
Sufficient infrastructure Relaunch hospital program
Friend
Personal inclined to change
Moderately qualified personnel Law to Promote L.M.
Regulation

WEAKNESSES
Outdated regulations are not being followed.
THREATS
Rules not available in areas. Propaganda from production companies
of substitutes
Insufficient training process.
Allows promotion of substitutes
Medical views
Without continuity or evaluation.
Lack of budget POA
1.Develop a plan for resource mobilization
intended for the program.
Achieve 100% participation of
personnel in the Hospital Friend initiative.
3.Update breastfeeding guidelines.
4. Develop training plan,
follow-up and evaluation for staff,
according to the work area.
Technical Standards of LM, based on the
generic standards of MSD / INASES
adapting to the characteristics of the Hospital
the Health Center.
Regulations of the Maternal and Child Hospital
Other bibliography

Free distribution to all staff,

with receipt signature.
Dissemination of the standards
General and area-specific training
Recycling
Preparation and distribution of material
for dissemination to maternity staff and
pediatrics.
Talks about late tying and attachment
precocious for maternity professionals
and pediatrics.
Training on the use of the cup for
neonatal nurses
Bibliography distribution (evidence
scientific) to the components of the C.L.M.,
library.
Mass dissemination, by areas and shifts of
video Early attachment (provided by
UNICEF.
Preparation of the institutional video of
Precocious Attachment
Preparation of dissemination material such as
triptychs, banners with information of the 11
steps for critical areas.

Creation of banners prohibiting propaganda,

marketing and use of substitutes.

New edition printing of standards, brochures,

educational posters, material for staff
scientific information for professionals.
The Peace
 The authorities and the
CNS staff
we must assist in the
implementation of the
Hospital Initiative
friends of the Mother and the
Childhood and reaching until a
30% with the accreditation
in this management.