Study on the Baby Friendly Hospital Initiative in Latin America and The Caribbean: Review experiences and country adaptation
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Study on the Baby Friendly Hospital Initiative in Latin America and The Caribbean :

Review experiences and country adaptation

Level of experience : Junior 1-3yrs Medium 4-10yrs Senior X more than 10yrs

Location : UNICEF Regional Office for Latin America and the Caribbean LACRO

Language(s) required : Fluency in English & Spanish is required. French is considered an asset.

Closing date for applying to this consultancy : July 27, 2018

Estimated start date of this consultancy : August 2018 Estimated end date : December 2018


There is proven evidence of the benefits for the health and the development of the new born if early breastfeeding is started within the first hour from birth, exclusive breastfeeding is practiced during the first six months and continued, with safe and adequate complementary foods, up to 2 years or beyond.

The first hours and days of a newborn’s life are a critical window for establishing lactation and mothers need support to breastfeed successfully.

UNICEF and WHO have been supporting countries in their efforts to implement the Baby Friendly Hospital initiative (BFHI) programs since 1991 with the goal of protecting, promoting and supporting breastfeeding in facilities that provide maternity and neonatal services.

Even though breastfeeding is a well-known and culturally accepted practice, national efforts and financial support for the BFHI in LAC have been reducing in recent years.

In 2011, it was estimated that 28% of all facilities providing maternity and newborn services had been designated as Baby-

friendly at some point in time. However, as of 2017 , WHO estimated that only about 10% of babies in the world were born in a facility currently designated as Baby-friendly.

Also, many countries who could include BFHI into their health policy were not able to sustain the rules and the requirements of certification as Baby Friendly Hospital .

Many reasons explained this challenge : vertical program supported by donors therefore not sustainable with cessation of donor’s funds -

limited training of health personnel due to no inclusion of the topic within medical and paramedical schools - dissemination of unappropriated messages to mothers and families-

inappropriate behavior from health personnel’s within health facilities such as separation of the mother with the baby; delayed initiation of breastfeeding, provision of pre-

lacteal feeds - limited community support and involvement - persistence of taboos and misinformation’s related to breastfeeding : reject of colostrum, breast milk alone not sufficient for the baby and completed with another alimentation.

In 1989, WHO and UNICEF published the Ten Steps to Successful Breastfeeding , within a package of policies and procedures that facilities providing maternity and newborn services should implement to support breastfeeding followed by the launch in 1991, of the Baby-

friendly Hospital Initiative (BFHI), to help motivate facilities providing maternity and newborn services worldwide to implement the Ten Steps.

Facilities that documented their full adherence to the Ten Steps, as well as their compliance with the International Code of Marketing of Breast-

milk Substitutes (13) and relevant World Health Assembly (WHA) resolutions (the Code) (14) could be designated as Baby-friendly .

In 2017, the BFHI guidelines were revised and the 10 steps reworded by WHO, UNICEF and other organizations during several consultations and technical meetings.

The updated package reflected the new evidence for some of the steps (steps 4 and 8 for example) and their interpretation, and specifically addressed the situation of women living with HIV.

It also includes guidelines for mother-friendly care and described breastfeeding-friendly practices in a variety of facilities and communities.

Standards for providing support for non-breastfeeding mothers were also included to help ensure that ALL mothers , regardless of feeding method, get the feeding support they need.

As the previous version, the revised BFHI focuses on the protection, promotion and support of breastfeeding but at the same time, it also aims to enable appropriate care and feeding of newborns who are not (yet or fully) breastfed, or not (yet) able to do so.

The revised guidance also calls for the integration of the BFHI with other initiatives for maternal and newborn health, health-

care improvement, health-systems strengthening, monitoring and quality assurance.

Various degrees of integration of the BFHI into maternal and newborn health services has already taken place in the past in some countries in LAC and it is important to identify good examples and lessons learned to ensure the revised BFHI guidance is adopted to its fullest advantage and to identify opportunities for the BFHI affecting the quality of birthing and postnatal care practices provided by maternal and neonatal health facilities.


To conduct a review of lessons learned and practices in place in LAC during the implementation of both : past and 2017 revised guidance of Baby Friendly Hospital Initiative (BFHI), by identifying and documenting adaptation made to strengthen maternal and neonatal services in addressing main causes of maternal-

neonatal and child health morbidity and mortality to better respond to country context.

EXPECTED RESULTS (measurable results) :

More specifically the study will look at :

  • A regional panoramic view of appropriation made by countries of both past, BFHI and revised guidance with an estimation of the proportion of maternity and neonatal facilities where it is being implemented
  • Type of utilization made at country level using BFHI to strengthen maternal and newborn health services with prior and recently revised guidance
  • Country in LAC that have expanded the regular BFHI model beyond the 10 steps to include other maternal and newborn health interventions for MNCH strengthening
  • Potential barriers and bottlenecks for rolling out BFHI, its expansion
  • Identifying and documenting countries in LAC with an information system that integrates BFHI indicators- at least the two sentinels (early initiation and exclusive BF during the first six months)
  • Countries in LAC with a BFHI interventions implemented in coordination with other sectors (communication / mass media / C4D and others)
  • Countries in LAC with a Community BFHI model
  • Analyzing program efficiency, efficacity and sustainability
  • Methodological Approach :

    This study will consist of a review of existing BFHI models that are being implemented with supportive policy at country level.

    Program documents in relation to BFHI will be analyzed. Interviews will be conducted to complete information gathered. On site visits performed when indicated for verification and to triangulate information obtained from documents and interviews.

    This approach will entail a comprehensive literature review, analysis of reports and related documents at the national, regional and international level on BFHI.

    The methodology will include focus groups and direct observation where necessary to compile needed information at country and regional level.

    The information will be analyzed and to produce the final report describing the situation in LAC and will include key recommendations on the what it would take to advocate and to implement any successful BFHI model, regular one or any that includes health interventions other than breastfeeding that have been integrated and delivered in a holistic way to reduce neonatal and maternal morbidity and mortality.

    Capacity Strengthening

    The results obtained from this survey will be used across the region to improve existing program and provide guidance, technical assistance and promote South to south cooperation for leaning and capacity building.

    Dissemination and advocacy plan

    The final document will be disseminated within the community of good practice and evidence generation tool to inform colleagues within and outside UNICEF LAC, National Government, the Neonatal alliance and keys partners.

    DELIVERABLES : Description

    Delivery deadline

  • Draft review design, planning and implementation calendar, including proposed methodology and stakeholders to be consulted.
  • Outline of a tentative final report index.
  • 15 days after contract is signed

  • Country review with a BFHI health program intervention in LAC, including programmatic and adaptation made according to country context to improve new born health and child development.
  • 60 days after contract is signed

  • The draft report will describe the situation and highlight specific successful (graphs, tables, images) as well as data-
  • driven narratives, messages, potential areas of intervention and recommendations.

    90 days after contract is signed

    Compilation of the above including observations from UNICEF and relevant partners to previous drafts in a final report that also includes areas of intervention and recommendations to improve BFHI implementation in LAC.

    The final report will include :

  • A final complete report for UNICEF (in either Spanish or English)A final summary document for wider dissemination (20 pages max, in both Spanish and English)A final executive summary for the public (2 pages max, in both Spanish and English)
  • A presentation on the summary and key findings

    120 days after contract is signed


    4 months


  • Advanced University degree with social sciences or public health or other relevant academic background
  • A minimum of 5 to 10 years of experiences leading or conducting research, study or evaluation, application of quantitative and qualitative methodology.
  • Good knowledge of the health sector mainly in maternal, neo-natal and child health.
  • Facility to communicate and to facilitate meetings
  • Good knowledge of English and Spanish
  • Good knowledge of LAC region and culture
  • Knowledge of French and Portuguese will be an asset.

    The consultant will work independently using their own personal premises, materials, and equipment.

    Travel costs will be estimated and added to the contract once they are determined based on UNICEF Financial Rules and Regulations (if applicable)

    FEES :

    Qualified candidates are requested to submit a financial proposal. Proven past experience and financial proposal will be taken into consideration during selection process.

    Travel (if applicable) will be covered by UNICEF as per policy. Travel costs will be estimated and added to the contract once they are determined.


    Consultants and / or Individual Contractors (CIC) will be evaluated based on a cumulative methodology, being the award of the contract made to the CIC whose offer has been evaluated and determined as :

  • Responsive / compliant / acceptable, and;
  • Having received the highest score out of a pre-determined set of weighted technical and financial criteria specific to the solicitation.
  • Technical component score

    Max. 80 points

    Economical component score

    Max. 100 points

    Only candidates obtaining a minimum of 60 points (of the total technical points) would be considered for the Financial Evaluation.

    Completeness of response

    Overall concord between TORS requirements and proposal

    Maximum Points

    Personnel experiences and qualifications and references

    Range and depth of experience with similar projects, especially related to maternal neonatal and child health and research.

    Reference of similar studies.

    Maximum Points

    Proposed Project Methodology and Approach

    Quality of the proposal

    Pertinence of the Methodology

    Maximum Points

    Total Maximum obtained for Technical Criteria

    Note : the total maximum score must be equivalent to the weight assigned to the technical score)

    Minimum score for technical compliance

    Financial Proposal

    In addition, separately from the technical proposal (as in another document), an economic proposal detailing the total costs of the assignment (not including costs for travel yet) must be submitted.

    The total amount of points allocated for the economic component is 20 . The maximum number of points will be allotted to the lowest price proposal and compared among those consultants which obtain the threshold points in the evaluation of the technical component.

    All other price proposals will receive points in inverse proportion to the lowest price; e.g :

    Max. Score for Financial proposal

  • Price of lowest priced proposal
  • Score for price proposal X

    Travel (if applicable)

    Please note, for travel to countries - it will be decided based on agreements with UNICEF and contractor / consultant. For agreed country visits, the contractor / consultant will be responsible in administering its own travel.

    UNICEF will reimburse travel related expenses based on actual costs or on the below criteria whichever is lower and upon presentation of receipts.

    Any travel involved should be budgeted according to UN Travel Standards as a ceiling.

  • Travel : %20-%20OFFICIAL%20TRAVEL%20(SECTION%2010).pdf Section 4, paragraph 4.2 , numerals (d) and (e)
  • Accommodation (Daily Subsistence Allowance, DSA) : (all countries and destinations can be found by navigating on the map)
  • Payment Provisions

    UNICEF's policy is to pay for the performance of contractual services rendered or to effect payment upon the achievement of specific milestones described in the contract.

    UNICEF's policy is not to grant advance payments except in unusual situations where the potential contractor, whether an Individual consultant, private firm, NGO or a government or other entity, specifies in the bid that there are special circumstances warranting an advance payment.

    UNICEF will normally require a bank guarantee or other suitable security arrangement.


    Qualified candidates may submit their application by clicking on either highlighted areas, as shown in the example below :

    The deadline to receive applications is 27 / July / 2018. The pre-selection of candidates will be done after closing date.

    Please note only selected candidates will be contacted.

    Important : In the selection of its consultants, UNICEF is committed to gender equality and diversity, without distinction as to race, sex, or religion, and without discrimination to people with disabilities.

    Opening Date Fri Jul 13 2018 10 : 00 : 00 GMT-0400 (EDT) SA Pacific Standard Time

    Closing Date Sat Jul 28 2018 00 : 55 : 00 GMT-0400 (EDT)

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