BFCI Mentorship and Self Assessment Tools

REPUBLIC OF KENYA
MINISTRY OF HEALTH
BABY FRIENDLY COMMUNITY

INITIATIVE (BFCI)
MENTORSHIP, SUPPORTIVE SUPERVISION
AND
SELF-ASSESSMENT GUIDANCE TOOLS
March 2021
Table of Contents
PREAMBLE 4
THE BFCI MENTORSHIP PROCESS 6

HEALTH FACILITY/COMMUNITY HEALTH UNIT MENTORSHIP PLANNING FORM 8
MENTEE LOG 9
BFCI SUPPORTIVE SUPERVISION AND MENTORSHIP TOOL 10
HEALTH WORKER/CHV MENTORSHIP TOOL 15
SELF ASSESSMENT GUIDANCE AND TOOLS 18

WHAT IS SELF-ASSESSMENT? 18
SAMPLING PROCEDURES FOR BFCI SELF-ASSESSMENT 21

SAMPLING GUIDELINE FOR BFCI SELF-ASSESSMENT 21
TOOLS LAYOUT 21
DATA ANALYSIS AND SCORING 22
FINDINGS 27
INTERPRETATION 27
GUIDANCE TOWARDS BFCI ACCREDITATION 27
BFCI SELF-ASSESSMENT TOOLS 30

SERVICE PROVIDERS QUESTIONNAIRE 30
COMMUNITY LEVEL TOOL 36
FACILITY TOOL 43
GUIDANCE NOTES FOR BFCI SELF-ASSESSMENT 49

Preamble
This guide outlines BFCI processes and procedures during mentorship visits to BFCI implementing community
health units and the link health facilities. It also gives guidance on the process to follow on BFCI self assessment
to determine compliance to the 8 steps that may impact on MIYCN practices. BFCI monitoring and mentorship
will adopt a stepwise approach with the higher-level conducting supportive supervision at lower-level; National,
County, Subcounty, health facility and community health unit.
Approach
Mentorship is part of routine follow up activities after training. All newly trained health workers/CHVs should
receive follow up visits and participate in regular meetings with other BFCI implementors for on-going peer
support.
Mentorship will be triggered by a competency gap identified during a supportive supervision visit or an identified
gap in day-to-day service delivery at the community unit and/or link health facility.
Mentorship will be done by pairing a mentee with a mentor from a pool of highly skilled BFCI implementors. Staff
from various levels will continuously conduct coaching sessions at the health facility and community health unit
till the desired level of competency is achieved.
Community health units and link health facilities that have attained an optimal level of staff competence will
qualify for self-assessment and guided to prepare for external assessment and BFCI accreditation.
Copies of the mentorship planner and mentee log should be maintained at the link health facility
Purpose of Mentorship
During BFCI training, health workers and community health volunteers gain new knowledge and skills to enable
them to provide MIYCN counselling and support mothers/caregivers to feed and care for their infants and young
children.
To gain full competence, they need practice in applying the knowledge and skills to perform particular tasks,
and the ability to decide when applying a skill is appropriate. This requires more practice than can generally be
obtained as part of the training.
Participants are encouraged to practice skills independently following the training and increase their abilities, but
will also need additional mentoring to ensure that they are carrying out a task correctly.
Mentorship objectives
The BFCI mentorship will focus on the following objectives:
a) To review the effectiveness of the mentee’s training and provide refresher training as needed;
b) Provide an opportunity for the mentor to observe the health worker/CHV as they offer BFCI services to
identify gaps and provide mentorship;
c) Compare mentee’s performance against standards outlined in the mentorship checklist to improve their
competence in knowledge and skills to implement the 8 BFCI steps;
d) Provide constructive feedback on strengths and any difficulties the mentees may have;
e) To prepare BFCI implementing community units and link health facilities for BFCI self-assessment through
continuous improvement of individual competencies;
When to conduct mentorship

Mentorship will be conducted; after supportive supervision, self-assessment, community level activities, during
day-to-day service delivery and after training/transfer or recruitment.
Mentorship will prepare BFCI implementing community units and link health facilities for BFCI self-assessment
through continuous improvement of individual and system capacity.
4 MOH-DIVISION OF NUTRITION AND DIETETICS

Qualities of a good mentor
Mentors need to be carefully selected to ensure they have the attitudes and interaction and communication skills
appropriate to mentoring in different cultural settings.
Mentors should have a high level of competence, willingness and commitment to help another person develop
confidence and personal skills.
Some of the key skills of a good mentor include:-
• Experts in BFCI/MIYCN.
• Good interpersonal and communication skills.
• Willingness to share responsibility for learning and personal development.
• Ethical practice.
• Good listening skills.
• A positive attitude.
• Giving and receiving non-judgmental feedback.
Proposed mentorship Team

Mentors will be individuals who have completed the BCFI training and/or BFCI Trainers who may or may not be
attached to a health facility within the geographical area of implementation. The mentor must have undergone
a sensitization in the BFCI mentorship processes and tools to build their skills and strengthen their mentorship
ability. The team of mentors should ideally be multi-disciplinary based on their MIYCN technical capacity.

The BFCI Mentorship Process
Step 1: Preparation for the visit
• The County Nutrition Coordinator will take lead in planning for the mentorship in liaison with the sub-
county nutrition officer and community strategy focal person.
• The facility nutritionist and CHEW will coordinate mentorship of CHVs at the community unit in
collaboration with the facility in-charge and SCHMT.
• Notify the health facility in-charge in advance preferably 1 week notice.
• Print mentorship tools.
• Mentors should orient themselves with the tools and the content.
• Make logistics arrangement.
Step 2: Gap analysis

• Gaps are identified during supportive supervision, self-assessment, community level activities.
• During training, participants with knowledge and skills gaps may be identified for mentorship.
• Mentors may identify gaps in day-to-day service delivery.
• The HINI gap assessment activity/ tool may also highlight areas for mentorship.
• Based on the gaps identify and number of people requiring mentorship, determine the method to apply
to improve BFCI implementation.
• All newly trained, posted, recruited health workers/CHVs should be considered for mentorship
opportunities.
Step 3: Plan to conduct mentorship.

• Plan for individual and/or group mentorship sessions based on the identified gap(s), number of staff,
available resource materials, activities, venue and the time/date of mentorship.
• A list of staff identified for mentorship will be entered in the mentorship planning form (see Annex 1) and
the health facility in charge informed accordingly.
• Contact the facility/mentee (s) a day before to schedule a time for the visit.
Step 4: Conducting a mentoring visit.

a) For an initial mentorship session, discuss the identified gap and agree on how to go about mentorship.
b) In subsequent sessions, review the mentee(s)’s records and activities conducted since the last mentorship
session.
c) Ask how the mentee feels about his/her work: what is going well, and any difficulties experienced.
d) Ask the mentee to introduce you to the mother/caregiver and explain briefly why you are there.
e) 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. Sit so that you can observe the mentee
and mother, without distraction.
f ) Observe the BFCI support activity (individual counselling, or Support Group session) and make notes so
that you can identify areas of immediate mentorship and provide feedback once the session has ended.
ONLY give feedback when the mother/caregiver has departed.
g) Make brief notes to help you remember skills which the mentee has used during the counselling session,
and those which were not used when there was an appropriate opportunity.
h) If mentee passes along any 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 mentee lose
credibility in her/his role in the community.

i) At the end of the session discuss your observations with the mentee, and together decide on a doable
action(s) the mentee should work on to improve before the next mentorship session.
j) Transfer key information for your ongoing work with the mentee onto the mentee log (see Annex2) and
the health facility supervision tool.
Step 5: Follow-up
a) The mentor will follow up the mentee/s on an agreed schedule to determine if the mentorship has had
an impact on the performance of the health worker/CHV.
b) The immediate supervisor will follow up the mentee regularly to ensure they are performing according
to the provided guidelines in each BFCI step.

HEALTH FACILITY/COMMUNITY HEALTH UNIT MENTORSHIP
PLANNING FORM
(This sheet will be used by the mentor to plan for the mentorship sessions in the health facility and community health
unit after conducting the gap analysis)
Name of Mentor: ________________________ Link facility _________________________________
Community Health unit: _________________ County _____________ Sub County: ___________
Staff Identified Activities Date & Venue Methodology Resource

requiring gap (demonstration, time) (specific (CME, group requirement
mentorship discussions) department or individual (references,
(name & and venue) mentorship) equipment,
designation) IEC materials)

MENTEE LOG
(This sheet will be used to monitor progress of the mentorship sessions with the health worker/CHV). Attach a plain
sheet of paper to document findings on every mentorship session
Name of mentee: ______________________________ Name of mentor: __________________________________
Sub county ___________________________________ Community health unit:____________________________
Health facility: ________________________________
Date
Visit number 0 1 2 3 4 5 6 Comments
BFCI STEPS
1. Promote optimal maternal nutrition
among women and their families
2. Inform all pregnant women and
their families about the benefits of
breastfeeding and Risks of artificial
feeding
3. Support mothers to initiate
breastfeeding within the first one
hour of birth, establish and maintain
exclusive breastfeeding for first six
months
4. Encourage sustained breastfeeding
beyond six months to two years or
more alongside timely introduction
of appropriate, adequate and safe
complementary foods
5. Provide a welcoming and conducive
environment for breastfeeding
families
6. Promote collaboration between
healthcare staff, maternal, infant and
young child nutrition support groups
and the local community.

BFCI SUPPORTIVE SUPERVISION AND MENTORSHIP TOOL
Supervision team:
Name Designation
1.
2.
3.
4.
5.
Date of visit (dd/mm/yy):
CRITERIA 1: LINK FACILITY INFORMATION
Name of health facility:
No. of community health unit/s attached to the facility:
No. of community health units implementing BFCI:
No. of Community Mother Support Groups
Target population for BFCI in the catchment area
No. of pregnant women
No. of lactating mothers (total live births)
No. of children 0-23 months
CRITERIA 2: FUNCTIONALITY OF COMMUNITY MOTHER SUPPORT GROUP (CMSG)
Remarks/Recommendations
Is there a CMSG? Yes () No ()
If yes, what is its composition? Yes () No ()
Core members:
CHEW/CHA [ ]
Nutritionist [ ]
Chief/assistant chief [ ]
CHVS [ ]
CHCs representative [ ]
lead mother [ ]
Others (specify) [ ] ________________________

If No why? ______________________________
Does the CMSG committee meet bi-monthly? Yes () No ()
If yes, check minutes/reports

Is there a plan for bi-monthly baby friendly meetings? Yes () No ()
If yes, check minutes/reports

CRITERIA 3: FUNCTIONALITY OF MOTHER-TO-MOTHER SUPPORT GROUPS (MTMSG)
Are there Mother to Mother Support Groups (MTMSG)? Yes () No ()
If Yes, how many? [_________]
Number of PLWs & caregivers of children 0-23 months

in the MTMSGs? [_________]
If more than one MTMSG, provide membership for

each
1.
2.
3.
4.

Does the MTMSG meet monthly? Yes () No ()
If yes, check minutes
Is there a functional (complete) referral system Yes () No ()
between the facility and the MTMSG?
If yes, Check records

CRITERIA 4: TARGETED HOUSEHOLD VISITS
No. of targeted households for BFCI implementation in
the CHU; ________
What proportion of the targeted households were
visited in the previous month? ______%
(Check form 2)
Proportion of maternal indicators whose performance
is <80% ______%
(Numerator: Total maternal indicators performing
<80%
Denominator: 7 maternal indicators *100 )
(Check form 2 for maternal indicators performing
<80%)
Proportion of child indicators whose performance
<80% ___%
(Numerator: Total No. of child indicators performing
<80%
Denominator: 4 child indicators *100)
(check form 2 for child indicators performing <80%)
CRITERIA 5: COMMUNITY BABY FRIENDLY GATHERINGS
No. of community units holding baby friendly
gatherings bi-monthly
Check minutes and reports

What was the composition of community members
who attended the last baby friendly gathering?
Indicate the number who attended in the box

Pregnant women [ ]
Lactating mothers [ ]
Caregivers of children 0-23 months [ ]
Older women [ ]
Youth (18-24) [ ]
Men [ ]
Other sector representatives [ ]
Check CMSG meeting report

Was an MIYCN cooking demonstration conducted Yes () No ()
during the last community baby friendly gathering?
Check report

Was there inclusion of other health promotion and Yes () No ()
nutrition sensitive activities during the community
baby friendly gathering?
If yes, list the activities

1.__________________________
2.__________________________
3.__________________________
4.__________________________
5.__________________________
Check report
CRITERIA 6: COMMUNITY HEALTH VOLUNTEERS (CHVs) MONTHLY REVIEW MEETINGS
Was the CHV review meeting conducted the previous Yes () No ()
month?
Check minutes
What proportion of CHVs attended the meeting?
Total in attendance/Total CHVs in CHU×100% _______
Check minutes
Was BFCI agenda included in the CHVs review meeting Yes () No ()
in the previous month?
Check minutes
Were follow-up actions from the previous meeting Yes () No ()
accomplished?
Check minutes
CRITERIA 7: CAPACITY BUILDING ON BFCI
What proportion of CHVs/Health Care Workers (HCW)
implementing BFCI have been trained?
Total No. of Community Health Volunteers ______
No. trained ______
Proportion [___%]
Total No. of health care workers in the facility ______
No. trained ______
Proportion [___%]
Check training records

What ongoing actions are taken to bridge the training
gap?
Tick as appropriate
Orientation of new staff [ ]
Handing over of BFCI activities by outgoing staff [ ]
Refresher training [ ]
Sensitization [ ]
CMEs [ ]
Mentorship [ ]
On Job Training [ ]
Others (specify) __________________________
Check training records

CRITERIA 8: BABY FRIENDLY COMMUNITY RESOURCE CENTRE
Is there a BFCI resource centre in the facility or Yes () No ()
community?
Ask & Observe

What IEC materials are available in the resource centre?
Tick as appropriate
MIYCN counselling card [ ]
MIYCN policy summary statement [ ]
MIYCN Brochures [ ]
Others (Specify) _________________________
Observe
Is there evidence of use of the resource centre? Yes () No ()
Check visitor’s book/user log (register)
Are there breastfeeding spaces in the facility and Yes () No ()
community?
If yes, observe
Is there evidence of use of the breastfeeding space? Yes () No ()
Observe
CRITERIA 9: MONITORING AND SUPERVISION OF CHEW/CHV
Did the CHEW monitor/supervise CHV activities in the Yes () No ()
previous month?
If yes, Check supervision/monitoring report

Proportion of CHVs monitored/supervised in the last
quarter. __/___ [__%]
Check supervision/monitoring report

What proportion of CHVs submitted form 1 A & B?
_______%
Check CHV review meeting report

Has the CHEW summarised form 1 A & B into form 2? Yes () No ()
If yes, Check form 2 report
Is there an action plan based on analysis of form 2? Yes () No ()
If yes, check records
CRITERIA 10: FACILITY OBSERVATION
Does the facility have a written MIYCN policy - Yes () No ()
summary statement present and displayed in all
relevant areas of the health facility?
If yes, tick as appropriate.
Labour and delivery area  Yes  No  N/A

Antenatal clinic  Yes  No  N/A
Postpartum ward/room  Yes  No  N/A
Well baby clinics/Rooms  Yes  No  N/A
ANC inpatient ward  Yes  No  N/A
Consultation rooms  Yes  No  N/A
Special baby units  Yes  No  N/A
PMTCT clinic  Yes  No  N/A
Waiting Bay  Yes  No  N/A
Paediatric ward  Yes  No  N/A

Is the MIYCN policy simplified through
- Pictorial illustrations  Yes  No
- Video clips  Yes  No
- IEC material  Yes  No
- Other specify ______________________________
that are contextualized and understood by the local
population?
Observe
Are pregnant women attending ANC issued with IFAS Yes () No ()
at the health facility?
Check ANC register and MCH handbook

Are health talks on optimal MIYCN practices Yes () No ()
conducted?
If yes, check health talk schedule and CME records

Are the health workers complying to the BMS Act,
2012?
Observe
If yes
If No, why
Are there hand washing facilities in points accessible Yes () No ()
to mothers/caregivers?
Observe
FOLLOW UP INFORMATION FOR LINK FACILITY
(To be discussed with the facility in-charge and transferred to the facility supervision book)
KEY FINDINGS
1.
2.
3.
4.
5.
Action points/Recommendations Responsible Timeline
person
1.
2.
3.
4.
5.
Signed by: Signed by:
Facility in charge: Supervision lead:
Name: Name:
Date: Date:
Signature: Signature:

HEALTH WORKER/CHV MENTORSHIP TOOL
Name of Mentee:_______________________________ Title of Mentee: __________________________________

Sub-County: __________________________________ Community Unit: _________________________________
Name of Mentor: ______________________________ Title of Mentor: ___________________________________
Date: _______________________________________
BFCI Step 1: National MIYCN policy

Knowledge and skills. Observations/gaps Mentorship conducted Action points
1. MIYCN policy components.
2. Infant feeding in context of HIV.
3. Awareness of the BMS Act,
2012.
Step 2: Train all health care providers and community health volunteers in the knowledge and skills
necessary to implement the MIYCN Policy
1. Trained or sensitized on BFCI?
2. Trained or sensitized on
MIYCN?
Step 3: Promote optimal maternal nutrition among women and their families
1. Recommended number of
ANC visits and its importance.
2. 10 food groups for PLW.
3. Extra meals for PLW.
4. Importance of IFAS.
5. Health worker can
demonstrate weight, MUAC
taking and documentation.
6. CHV can demonstrate MUAC
taking.
7. Recommends a typical day’s
menu using locally available
foods.
Step 4: Inform all pregnant women and their families about the benefits of breastfeeding and Risks
of artificial feeding.
1. Benefits of breastfeeding to
child, mother, family.
2. Dangers of artificial/mixed
feeding.
3. Dangers of using bottles, teats,
and pacifiers.
Step 5: Support mothers to initiate breastfeeding within the first one hour of birth, establish and
maintain exclusive breastfeeding for first six months
Knowledge and skills Observations/gaps Mentorship conducted Action points
1. Importance of early initiation
of breastfeeding.
2. Supports early initiation of
breastfeeding.
3. Benefits of colostrum.
4. Benefits of exclusive
breastfeeding.

5. Dangers of pre-lacteal feeds
6. Identify hunger cues.
7. 4 key points of positioning and
attachment
8. Demonstrates on 4 key points
of positioning and attachment,
breast support.
9. Signs of effective suckling
10. Demonstrates and explains
breast milk expression, storage,
warming, and cup feeding
techniques.
11. Describes how to resolve
breastfeeding difficulties.
12. Identify common breast
conditions and refer/counsel
appropriately.
13. Feeding children 0- 6 months
in special circumstances
Step 6: Encourage sustained breastfeeding beyond six months to two years or more alongside
timely introduction of appropriate, adequate, and safe complementary foods
1. Benefits of continued
breastfeeding up to 2 years or
beyond.
2. Importance of timely
introduction of
complementary foods.
3. 7 recommended food groups
for children.
4. Complementary feeding
principals (FATVAH).
5. Age specific FATVAH.
6. Feeding children 6-23 months
in special circumstances
7. Health worker can conduct
and document GMP.
8. CHVs can interpret the growth
curve and take appropriate
action.
9. CHVs can establish GMP status.
10. CHVs can screen for
malnutrition and refer
appropriately.
Step 7: Provide a welcoming and conducive environment for breastfeeding families
1. Promotes male/family/
communities involvement.
2. Promotes community
involvement in baby friendly
fora.
3. Advocate for establishment of
breast-feeding spaces in the
facility and community.

Step 8: Promote collaboration between healthcare staff, maternal, infant, and young child nutrition
support groups and the local community.
1. Health workers/CHVs can
link mothers/caregivers to
community health services
and/or other sectors for
appropriate support.
2. Promotes and documents
complete referral process.
BFCI facilitation skills observation

Knowledge and skills Observations/gaps Mentorship Action points
conducted
MIYCN Counselling Skills
Can state and apply:
1. Listening and Learning skills
2. Building confidence and giving
support skills
Appropriate use of counselling cards and training aids.
Manage group sessions.
1. Participants sit in circle.
2. Facilitator conducts climate setting
3. Facilitator(s) clearly explain the day’s
agenda.
4. Facilitator(s) asks questions that
generate participation.
5. Facilitator(s) manages group
dynamics to enhance learning
Facilitate group discussions.
1. Encourage mothers/fathers/
caregivers to share their own
experiences.
2. Able to address all questions/issues
arising from members competently.
3. Able to facilitate sessions and answer
questions using the counselling cards
effectively
4. Able to conclude and give a clear way
forward.
Monitoring and reporting
1. Completeness and accuracy of Form
1a and b.
2. Target population of;
- Pregnant and lactating mothers
- Children 0-23 months
3. CHVs proportion of households
visited during the previous month
with;
- pregnant and lactating
mothers
- Children 0-23 months

SELF ASSESSMENT GUIDANCE AND TOOLS
What is self-assessment?
Self-assessment is evaluation of oneself or one’s actions or performance. It is the ability to examine yourself on
how much progress you have made in a given set of goals.
The purpose of self-assessment is to help an individual know the extent of their achievements according to the
goal set and to improve upon them without the need of a performance appraiser.
In BFCI,the purpose of self-assessment is quality improvement by monitoring and evaluating how the current
MIYCN practices in the community health unit measure up to the 8 steps of BFCI (see table 2 on BFCI steps).
Self-assessment identifies areas that need more support towards making communities comply with the 8 steps
of BFCI.
The self-assessment will measure MIYCN knowledge, skills and practices by the mother/caregiver. It also
measures the support provided to the mother/ caregiver by the community members and the health care system.
It measures more of what the mothers, health care workers and community members know and can do rather
than self-reporting of services provided.
Self-assessment is conducted:
• Baseline before commencing implementation,
• After first 6 months of implementation,
• Bi annually there after until the community unit has achieved a score 80% and above
Self assessment data is collected through interview, and observation of practices from the following
category of respondents.
1) Health Care Workers
2) Community Health Volunteers
3) Non-clinical Staff
4) Pregnant Women and Lactating Mothers
5) Household members
6) Link Health facility ( in charge)
BFCI self-assessment tools

The BFCI self-assessment tools are categorized into service provider, community and link health facility tools.
Both service provider and community tools have subsections and they have been assigned numbers for ease of
reference as shown in Table 1.
Tool Subsections Assigned reference number

Service provider tool Health Worker 1A
Community health volunteers 1B
Non-clinical staffs 1C
Community level tool Pregnant and lactating women 2A
Household members 2B
Health facility tool 3
The tools assess the skills, knowledge and practices related to the 8 steps of BFCI.

Table 2: BFCI steps
1) Have a written MIYCN policy summary statement that is strategically displayed and routinely
communicated to all health providers, community health volunteers and community
2) Train all healthcare providers and community health volunteers in the knowledge and skills
necessary to implement the MIYCN policy
3) Promote optimal maternal nutrition among women and their families
4) Inform all pregnant women and their families about the benefits of breastfeeding and Risks of
artificial feeding
5) Support mothers to initiate breastfeeding within the first one hour of birth, establish and maintain
exclusive breastfeeding for first six months
6) Encourage sustained breastfeeding beyond six months to two years or more alongside timely
introduction of appropriate, adequate and safe complementary foods
7) Provide a welcoming and conducive environment for breastfeeding families
8) Promote collaboration between healthcare staff, maternal, infant and young child nutrition support
groups and the local community.
Assessment Teams
The self-assessment team at sub county level will comprise of 5 persons including, but not limited to;
• Sub-county community health strategy focal person
• Sub-County Nutrition Officer
• Link health facility in-charge
• Nutrition Officer of link health facility
• CHEW/CHA of the implementing CU
• CHV/CMSG member
• The Sub-County Nutrition Officer will be the overall coordinator of the self-assessment.
At county level, self-assessment team will comprise of 5 persons including but not limited to;
• County nutrition officer
• County community health strategy focal person
• County medical officer of health
• county nursing officer
• County public health officer
Note: BFCI assessors should be very knowledgeable about BFCI and requirements for a baby-friendly community.
In addition, they should be oriented on the self- assessment data collection and summary tools.
Planning and coordination for BFCI self and external assessments

The self-assessment exercise will be led/coordinated by the Sub County health management team (SCNO
preferably) with the support of any other BFCI champion together with community unit staff (CHEW, nutritionist
or health care provider in the facility at the moment). The team also work closely with the CMSG members.
The Sub-County Health Management Team and the implementing Community Unit should agree upon the
timing of the assessment.
At county level, the self-assessment will be led/coordinated by the county nutrition coordinator(CNC) with
support from other CHMT members.
The CHMT will agree upon the timing of the assessment based on satisfactory results of 80% in all the steps by
SCHMT.
At the national level,the MIYCN manager will led/coordinate BFCI external assessment with support from MIYCN
TWG members. They will agree upon the timing of the assessment based on an invitation by CHMT who will
attach BFCI self-assessment report done by them with scores above 80% for each step.
The self-assessment exercise shall take at least 3-5 days to assess both the facility and a community unit (CU).
The team (CU, SCHMT, CHMT) should plan for assessment at least two weeks prior to ensure all tools are in place

The lead person will gather materials to be used during the exercise including adequate copies of the self-
assessment tools, pencils, pocket folders, any other materials deemed necessary.
At planning stage, the BFCI self-assessment team will:
a) Be up-to-date with MIYCN key messages

b) Orient themselves to all the assessment tools
c) Determine the sampling frame, sample size and the sampling method
d) Orient themselves on data collection procedures
e) Orient themselves on data analysis per questionnaire
f) Orient themselves on data triangulation from all the 6 different tools (questionnaires) to make a
scoring per question and per step
g) Orient themselves on how to interpret BFCI data and findings
h) Orient themselves on how to develop specific recommendations and actions based on findings
per question and per step
NB: The MIYCN manager will make prior communication to CHMT regarding the BFCI external assessment timings
and the external assessment team.
Upon arrival, the external assessment team will pay a courtesy call to the CHMT.

SAMPLING PROCEDURES FOR BFCI SELF-ASSESSMENT
Sampling Guideline for BFCI Self-Assessment

The sub county team and the link health facility team will work together to develop a tentative plan to determine
the sample size.
The self assessment will involve mixed methods of sampling; random and purposive sampling to ensure
representativeness and reduce bias. The recommended sample size for each cohort is provided in the table below;
Cohort Sampling Method

Health Care Workers Big Facility (County and Sub-County Referral Health
Consider all health care workers however facilities)
prioritize staff working in perinatal areas like Assess 10-20 Health Care workers
Maternity, CWC, paediatric ward,IMCI, OPD in
Small Facility (Health Centers and Dispensaries)
high volume health facilities
• Health Centres – 5-10 Health Care workers
• Dispensaries – 1-5 Health Care workers
In small health facilities consider all health
Note: If health facility has less than 5, do census (interview
workers
all)
Community Health Volunteers: Consider the number of CHVs in the CU
All CHVs are legible for sampling • If a CU has <10 CHV interview all of them
• If a CU has > 10 random sample of 10-20;
Non-clinical staff (cleaners, security, • 1-5 Non-clinical staff for Small Facility (Health Centres
clerical and catering) and Dispensaries)
• 5-10 Non-clinical staff for Big Facility (County and Sub-
county Referral Health facilities )
Pregnant and Lactating Mothers (0 to 23 Purposive sampling
months) Pregnant Women:
Consider the mapped list (obtained from • If <5 women in the CU assess all
form 1a and 1b) of this • If >5 women in the CU randomly sample to assess
Cohort by CHV/CHEW/CHA 5-10 women
Lactating Mothers:
• If <5 women in the CU assess all
• If >5 women in the CU randomly sample to assess
5-20 mothers
House hold members • Out of the sampled cohort(PLW) establish /list how
many have influencers and randomly select
• < 5 Pregnant or lactating randomly select 3
influencers per cohort
• > 5 PLW randomly select 5 influencers per cohort
Health Facilities: • Consider assessing the primary health facilities in the
CU with high work load
• If < 5 assess all
• If> than 5 sample 5 -
• Purposively assess the Link health facility.
(Reference BFCI Trainers Guide 2018)
Tools layout
The tools comprises of the 8 BFCI steps. Each step have questions ranging from 1-13. Three columns have been
provided to the right for recording responses as follows
1. Expected score
2. Correct responses given
3. Actual score

A space has been provided at the end of each question so that the assessors can record observations or verbal
responses which will form the narrative report
Questions in each BFCI self-assessment tool are coded for each step.
Questions responding to the same information have been given similar codes in all the tools
Questions in each tool are numbered in a sequential order and should not be altered.
Data analysis and scoring

After field assessment is completed, the assessors will come and sit together with the Link health facility team
members to analyze the results
Each questionnaire is analyzed against the sample size
For each step; analyze all the questions from all the questionnaires filled. Compare the correct responses against
the expected score (aggregate correct responses divided by aggregated expected score x 100%)
For each step, the assessment team is required to compute the performance score. To calculate performance
score for each step , check questions which have scored 80% and above against all the questions under the step
x 100%
NB: At times the correct responses mentioned by the interviewee may be more than the expected score. In such
a scenario award the maximum expected score ( see guidance notes).This process is repeated for each tool
For overall CU performance, compute all the performance score under each step that has a score of 80% and
above against all the 8 steps x 100%.
Example of sampling for a small health facility (Bukolwe dispensary).
Sampling guidance notes for CHU implementing BFCI

Bukolwe health facility and Sampling method Rationale
community health unit data
Bukolwe dispensary has 3 health care For Bukolwe dispensary Small facility (A CU attached to the
workers only 2 are on duty at the time of since the HCWs on health centre or dispensary
self –assessment duty are 2 purposively Dispensary 1-5 HCWs
interview both NB: if the health facility has <5HCW
interview all
Bukolwe dispensary is linked to Bukolwe Interview all If a CU has less than 10 CHVs
CHU which has 6 CHVs interview all of them
Non-clinical staff 3 only 2 are on duty at Interview all Sample 1-5 Non-clinical staff for
the time of self –assessment small facility ( Health centres and
dispensaries
Bukolwe dispensary community health Randomly select 5 If >5 women in a CU randomly
unit has 7 pregnant women sample 5-10
Bukolwe dispensary community health Interview all If >5 women in a CU randomly
unit has 9 lactating mothers sample 5-20
Since the CHU has more than 5 women Interview 5 per each Pregnant women (PW)
selected for each cohort (PLW),the cohort (PLW) If < 5 women selected randomly
household members to be selected will select 3 community household
be 5 for each cohort members(influencers) per cohort
Lactating woman (LW)
If >5 women selected randomly
select 5 community household
members (influencers) per cohort
Bukolwe dispensary will be assessed since Purposively assess the link health
it is the only health facility within the CHU facility

Example of analysis for Bukolwe dispensary for step 4
1A: Health workers questionnaires
Step 4: Inform pregnant and Q 4.1 Q 4.2 Q 4.3 Q 4.4 Q 4.5 Q 4.6
lactating women and their
families about benefits of
breastfeeding and the risks of
artificial feeding
HCW1 2 4 5 3 1 2
HCW2 3 4 5 2 1 2
Expected individual score 5 5 5 3 3 3
Total cumulative score for both 5 8 10 5 2 4
HCW
Total cumulative expected score 10 10 10 6 6 6
Average score (cumulative 5/10 x 100 8/10 x 100 10/10 x 100 5/6 x100 2/6 x 100 4/6 x 100
score for all respondents / total = 50% = 80% = 100% = 83% = 33% = 67%
cumulative expected score for total
respondents X 100)
Performance score for the step (all 3/6 x100 = 50%
questions scored above 80%/ by
the number of questions x 100)
1B: Community Health volunteer questionnaires

Step 4: Inform pregnant and lactating women and Q 4.1 Q 4.2 Q 4.3 Q 4.4 Q 4.5 Q 4.6
their families about benefits of breastfeeding and the
risks of artificial feeding
CHV1 2 4 5 3 1 2
CHV2 3 4 5 2 0 2
CHV3 2 2 3 3 2 1
CHV4 1 3 4 2 0 2
CHV5 4 2 3 3 1 1
CHV6 2 3 2 2 2 2
Total cumulative score for all CHV 18 22 27 18 9 13
Average score (cumulative score for all respondents / total 75.0 91.7 90.0 100.0 50.0 72.2
expected cumulative score for total respondents X 100)
Performace score for the step (all questions scored above 50
80%/ by the number of questions x 100)
1.C Non-clinical staff questionnaires

Non Clinical Staff 2 1 2 1 0 0
Non Clinical Staff 1 1 2 1 0 0
Total cumulative score for A all Non Clinical Staff 3 2 4 2 0 0
cumulative expected score for total respondents X 100)
Performance score for the step (all questions scored above 0

2A: Pregnant and lactating women questionnaires
Pregnant &Lactating Women 2 1 2 1 0 0
Total cumulative score for Pregnant &Lactating Women 8 7 9 6 3 6
Performance score for the step (all questions scored above 17
2B: Household member questionnaires

Step 4: Inform pregnant and lactating women and their families about Q 4.1 Q 4.3 Q 4.4
benefits of breastfeeding and the risks of artificial feeding
House hold members 1 2 2
Expected individual score 2 2 2
Total cumulative score for Household member 10 20 12
Total cumulative expected score 20 20 20
Average score (cumulative score for all respondents / total cumulative expected 50.0 100.0 60.0
score for total respondents X 100)
Performance score for the step (all questions scored above 80%/ by the number of 33
questions x 100)
3: Health facility questionnaire

Step 4: Inform pregnant and lactating women and their Q 4.1 Q 4.3 Q 4.5 Q 4.7 Q 4.8
families about benefits of breastfeeding and the risks of
artificial feeding
Health Facility I/c 0 0 1 0 1
Expected individual score 1 1 1 1 1
Total cumulative score for Health Facility I/C 0 0 1 1
Total cumulative expected score 1 1 1 1 1
Average score (cumulative score for all respondents / total 0.0 0.0 100.0 0.0 100.0
Performace score for the step (all questions scored above 80%/ by 40
the number of questions x 100)

All the results for that CU from different self-assessment tools will be summarized and a performace score awarded
for each step.
Step Health CHVs Non pregnant Household Health Performance
care clinical and member facility score per
workers lactating step (All
women questionnaires
scoring above
80 percent
divided by total
questionnaires
applicable x 100
Step 1
Step 2
Step 3
Step 4: Inform 50% 50% 0% 17% 33% 40% 0% (since in all the
pregnant questionnaires the
and lactating score was below
women 80%)
and their
families about
benefits of
breastfeeding
and the risks
of artificial
feeding
Step 5
Step 6
Step 7
Step 8
To calculate the overall CU performance score, use the performance score per step column and check all steps
scoring 80 percent and above, divided by 8 steps x 100
Example:
Step Health CHVs Non pregnant Household Health Performance
care clinical and member facility score per
workers lactating I/C step (All
women questionnaires
scoring above
80 percent
divided by total
questionnaires
applicable x 100
Step 1 87% 72% 15% 50% 40% 100% 2/6x100= 25%
(since two
Have a written
questionnaires
MIYCN policy
achieved 80% and
summary
above)
statement that
is routinely
communicated
to all health
providers,
community
health
volunteers and
community

Step 2 33% 50% 0% - - 80% Performance
score per step
Train all health-
(All questionnaires
care providers
scoring above
and community
80 percent
health
divided by total
volunteers in
questionnaires (4)
the knowledge
x 100
and skills
necessary to
1/3x100= 33.3%
implement the
MIYCN policy
Step 3 90% 80% 17% 60% 40% 66% 2/6x100= 25%
(since two
Promote
questionnaires
optimal
achieved 80% and
maternal
above)
nutrition among
women and
their families
Step 4 50% 50% 0% 17% 33% 40% 0% (since in all the
questionnaires the
Inform pregnant
score was below
and lactating
80%)
women and
their families
about benefits
of breastfeeding
and the risks of
artificial feeding
Step 5 62% 38% 78% 56% 90% 2/6x100= 25%
(since two
Support
questionnaires
mothers
achieved 80% and
to initiate
above)
breastfeeding
within one
hour of birth,
establish and
maintain
exclusive
breastfeeding
for the first six
months
Step 6 68% 62% 40% 59% 70% 80% Performance
score per step
Encourage
(All questionnaires
sustained
scoring above
breastfeeding
80 percent
beyond 6
divided by total
months to two
questionnaires 6
years or more
x 100
alongside timely
1/6x100= 17%
introduction
of appropriate
adequate
and safe
complementary
foods

Step 7 90% 87% 80% 83% 86% 85% Performance
score per step
Provide a
(All questionnaires
welcoming
scoring above
and conducive
80 percent
environment to
divided by total
breastfeeding
questionnaires 6
mothers and
x 100
their families
Step 8 25% 80% - 82% 0% 0% Performance
score per step
Promoting
(All questionnaires
collaboration
scoring above
between health
80 percent
care staff, MIYCN
divided by total
support groups,
questionnaires
and the local
applicable x 100
community
2/5x100= 40%
Findings
Step 1 2 3 4 5 6 7 8
Score 25% 33% 25% 0% 25% 17% 100 40%
P/F F F F F F F P F
Overall Performance score for CU (All steps scoring 80% and above divided by total steps x 100
performance 1/8x100= 12.5%
score for
Bukolwe unit
Interpretation
The overall community unit performance score was at 12.5%. (only step 7 scored above 80%) This is classified as
poor performance
Guide for scoring
Score Ranking
0-49% Poor
50-79% Satisfactory
80-100% Good
Guidance towards BFCI accreditation

Subsequent self-assessment should be conducted to ensure continuous quality improvement until
the CU has scored 80 percent and above
When the sub county is satisfied they have scored 80% overall in all steps, they invite the CHMT
If the CHMT score is less than 80% they give feedback on their findings
If the CHMT score is above 80% the CHMT invite the MIYCN TWG and attach self -assessment report
If the MIYCN TWG is less than 80%, they give feed back
If above 80% accreditation is awarded
Guide on how to provide recommendations after a self-assessment
• During self-assessment gaps are identified by the assessors per each question under each step
• The overall CU recommendations are generated from all the gaps identified during assessment
• When generating recommendations identify both individual and system problems and provide
recommendations appropriately

Feedback and results
A preliminary discussion on the results or feedback meeting will be held with the entire link health facility staff and
the community unit members.
The staff will be taken through the performance of each step.
They will be asked to provide solutions or actions for the areas that require improvement.
The CU together with the sub county team will use the results to identify areas needing improvement and then
develop plans of action to make needed changes.
Plans for making any improvements indicated will be discussed as well as any technical guidance or support
needed from all levels (sub county, county and national).
BFCI self-assessment results from CHU will be used as part and parcel of mentorship and supportive supervision
exercise.
Developing actions points based on BFCI CHU results

Both quantitative and narrative will inform the actions
The actions per each step will be specific to the findings and not general to enable accountability
BFCI steps Score Findings Action point By when Responsible

person
Developing actions based on BFCI CHU results

BFCI STEP SCORE FINDINGS ACTION BY WHEN RESPONSIBLE
PERSON
Step 4 0% (since Health care Have scheduled CMEs at the Continuous SCHMT and
in all the workers were health facility targeting all health facility in
Inform
questionnaires not able to health care providers and 22/5/2021- charge
pregnant
the scores offer correct Continue teaching mothers/ 22/11/2021
and lactating
were below responses to care givers through health
women
80%) Q 4.1,4.5 and talks and videos in antenatal
and their
4.6 clinic, postnatal ward,
families about
CCC, OPD ,during mother
benefits of
to mother support group
breastfeeding
meetings and home visits
and the risks
on the following topics;
of artificial
feeding 1. Benefits of early
initiation
2. Benefits of feeding the
baby on colostrum
3. Benefits of exclusive
breastfeeding
4. Risks of artificial
feeding
5. Dangers of using
bottles, teats or
dummies
6. Duration of exclusive
breastfeeding and the
duration of continued
breastfeeding for HIV
exposed infants-Infant
feeding in the context
of HIV

Community 7. Factors that facilitate CHEWs/CHAs
health mother to child
volunteers transmission of HIV
were not 8. Infant feeding in Drug
able to offer resistant (DR)TB
correct 9. Infant feeding for
responses to mothers undergoing
Q 4.1,4.5 and chemotherapy
4.6 10. Observe if there is
Non-clinical violation of Kenya Health facility in
staff were Breastmilk substitute charge
weak in (Regulation and Control)
all the Act,2012 (refer to the
questions guidance notes)
11. Document all scheduled
Pregnant CHEW/CHA
health talks and CMEs.
and lactating
mothers
were also
weak in
almost all the
questions
HH members CHVS
need to be SUPPORTED BY
supported CHEW/CHA
on Q 4.1 and
4.4
Health facility Health facility in
records-No charge
records on
4.1,4.3,4.7

Explain BFCI self assessment data analysis and scoring 45 Minutes
• Divide the participants into 2 groups

• Distribute copies of the Community Self-Assessment tools for all the 6 cohorts
• From the two groups formed with an average of 15 members, form sub groups as follows:
• Link health facility in-charge (1): to respond to questions in tool 3
• HCWs assign 2 people to respond to questions in tool 1A
• CHVs assign 2 people to respond to questions in tool 1B
• Non- clinical staff assign 2 people to respond to questions in tool 1C
• Pregnant mothers assign 2 people to respond to questions in tool 2A
• Lactating mothers assign 2 people to respond to questions in tool 2A
• Household member assign 4 people to respond to questions in tool 2B
• Ask participants to practice completing each of the questionnaires
• After completion of all the questionnaires, let the participants analyse, generate findings, recommendations
and action points for each step
Session summary 5 minutes
Ask participants if they have any questions or seek clarification

BFCI SELF-ASSESSMENT TOOLS
SERVICE PROVIDERS QUESTIONNAIRE
Instructions:
I. Give a mark for every correct response then write total correct answers in the column ‘correct responses’.
II. Award actual score in the last column considering the following.
a. If the total correct responses are less than expected score), record the same on actual score columns. If more
than expected score, record the expected scores on actual score column
b. Award all the correct responses each 1 mark and record on correct response column. Award zero If no
response is given
c. Each question has been provided with space for comments/observations. Write all the comments/
observations either verbal or non-verbal
1A: Health workers
Expected Correct Actual Remarks

Score responses Score
Step 1: Have a written MIYCN policy summary statement that is routinely communicated to all
health providers, community health volunteers and community
1.1 What are some of the steps in the 5
MIYCN policy-summary statement?
Total 5
Step 2: Train all healthcare providers and community health volunteers in the knowledge and
skills necessary to implement the MIYCN policy
2.1 Are you trained or sensitized on MIYCN
including the MIYCN policy?
2.2 If yes; Mention key MIYCN counselling 5
cards thematic areas
Total 5
3.1 What is the importance of IFAS? 3
3.2 What are the different components of 4
care for pregnant women
3.3 Name the 10 food groups required to 8
meet women’s dietary diversity for PLW
3.4 State the dietary recommendation for 1
pregnant women
3.5 State the dietary recommendation for a 1
lactating mother
Total 17
Step 4: Inform pregnant and lactating women and their families about the benefits of
breastfeeding and the risks of artificial feeding
4.1 What information do you give mothers 5
regarding the benefits of early initiation
of breastfeeding?
regarding the benefits of colostrum?
regarding the benefits of exclusive
breastfeeding?

regarding the dangers of artificial/mixed
feeding for infants 0-6 months?
regarding the dangers of using bottles
teats, pacifiers and cups with spout?
4.6 What information do you give parents 1
and caregivers regarding infant feeding
in context of HIV?
in Drug resistant (DR)TB
for mothers undergoing chemotherapy
Total 24
Step 5: Support mothers to initiate breastfeeding within one hour of birth, establish and maintain
exclusive breastfeeding for the first six months
5.1 Do you support mothers to initiate 3
breastfeeding within 1 hour of delivery?
Describe the steps of early initiation of
breastfeeding?
5.2 What are the benefits of un-interrupted 5
skin-to-skin contact of baby with their
mothers immediately after birth for at
least 1hour?
5.3 Mention signs/cues that shows a baby is 5
ready to breastfeed
5.4 Mention or demonstrate key points 4
on correct positioning during
breastfeeding.
5.5 Mention or demonstrate key points on 4
good attachment during breastfeeding.
5.6 Describe or demonstrate the process 5
of hand expression of breastmilk (able
to demonstrate or mention the correct
procedure)
Total 26
Step 6: Encourage sustained breastfeeding beyond 6 months to two years or more alongside timely
introduction of appropriate adequate and safe complementary foods
6.2 What are the benefits of continued 3
breastfeeding for 2 years or beyond?
6.3 What is the appropriate age to begin 1
complementary feeding?
6.4 What are the dangers of starting 3
complementary foods too late?
6.5 What is the age specific feeding 4
frequency for children aged:-
At 6 months (1)
7-8 months (1)
9-11 months (1)
12 – 23 months (1)

6.6 What is the specific amount of food to 4
be fed to babies aged:
At 6 months (1)
7-8 months (1)
9-11 months (1)
12 – 23 months (1)
6.7 Mention the recommended food 5
groups for children aged 6-23 months?
6.8 What is the minimum number of food 1
groups a child aged 6-23 months should
consume per day?
6.9 What are the critical times for hand 4
washing?
6.10 How can a mother encourage a child to 4
eat his/her food?
feed during and after illness
Total 32
Step 7: Provide a welcoming and conducive environment to breastfeeding mothers and their
families
7.1 (Ask) How do you encourage husband/ 4
spouse/partner to accompany the
mother to the health facility for
antenatal or postnatal care?
Total 4
Step 8: Promoting collaboration between health care staff, MIYCN support groups, and the local
community
8.1 (Ask) How many MtMSGs in the CU are 1
linked to this facility?
8.2 (Check records) How many MtMSGs 1
are functional?
8.4 (Ask and check records) Do you 1
refer mothers from the facility to the
community and receive from the
community? (if yes, award one mark)
Total 3

Instructions:
III. Give a mark for every correct response then write total correct answers in the column ‘correct responses’.
IV. Award actual score in the last column considering the following.
b. Award all the correct responses 1 mark each and record on correct response column. Award zero if no
response is given.
1B: CHVs

Score response Score
health care workers
1.1 What are some of the steps in the 3
MIYCN policy-summary statement?
Total 3
Step 2: Train all healthcare providers and community health volunteers in the knowledge and
2.1 Are you trained or sensitized on BFCI/
MIYCN?
2.2 If yes; Mention key MIYCN counselling 4
cards thematic areas.
Total 4
Step 3: Promote maternal nutrition amongst women and their children?
3.2 What are the different components of 3
care needed for pregnant women?
3.3 Ask CHVs to mention the 10 food 7
groups for pregnant and lactating
women for women’s dietary diversity
3.4 State the dietary recommendations for a 1
pregnant woman
3.5 State the dietary recommendations for a 1
lactating mother
Total 15
regarding the benefits of early initiation
of breastfeeding?
regarding the benefits of colostrum?
regarding the benefits of exclusive
breastfeeding?

regarding the dangers of artificial/mixed
feeding in the infant’s first 6 months of
life?
regarding the dangers of using bottles
in the context of HIV?
Total 22
maintain exclusive breastfeeding to six months
5.3 How do you recognize signs/cues that 4
shows a baby is ready to breastfeed?
5.4 Mention or demonstrate key points 8
on correct positioning during
breastfeeding.
5.5 Mention or demonstrate key points on 4
good attachment during breastfeeding
to demonstrate or mention the correct
procedure)
Total 21
introduction of appropriate adequate and safe complementary
6.5 What is the age specific feeding 4
frequency for children aged: -
At 6 months
7-8 months
9-11 months
12 – 23 months (1 mark each)
6.6 What is the specific amount of food to 4
be fed to babies aged: -
At 6 months
7-8 months
9-11 months
12 – 23 months (1mark each)
6.7 Mention the recommended 7 food 4
groups for children aged 6-23 months
groups a child aged 6-23 months should
consume per day?
6.9 What are the critical times for 4
handwashing?
eat his/her food?
Total 27

families
7.1 How do you encourage husband/ 3
spouse/partner to accompany the
wife/partner to the health facility for
antenatal or postnatal care?
Total 3
community
8.2 (Ask and check records) 1
Do you facilitate monthly MtMSG meetings?
8.4 (Ask and check records MOH 100) do 1
you refer mothers from the community
to the health facility for MIYCN support
when necessary?
8.5 (Ask and check records (form 1a and 1b) 1
) Do you conduct targeted home visits?
8.8 Do you conduct sensitization meetings 1
on MIYCN through community existing
forums
Total 4

Instructions:
V. Give a mark for every correct response then write total correct answers in the column ‘correct responses’.
VI. Award actual score in the last column considering the following.
response is given.
1C: Non-clinical staff

score answer Score
health care workers
1.1 What are some of the steps on MIYCN 2
policy summary statement?
Total 2
Step 2: Train all healthcare providers and community health volunteers in the knowledge and skills
2.1 Mention at least 2 MIYCN counselling 2
card thematic areas
Total 2
3.1 What is the importance of IFAS to 1

pregnant mothers
3.6 How can staff/family/community 3
support pregnant and breastfeeding
mothers?
Total 4
4.1 What are the benefits of early initiation 2
of breastfeeding?
4.2 What are the benefits of colostrum? 2
4.3 What are the benefits of exclusive 3
breastfeeding?
4.4 What are the dangers of artificial/mixed 2
feeding in the infants first 6 months of
life?
4.5 What are the dangers of using bottles 2
4.6 What do you know about infant feeding 3
in the context of HIV?
Total 14

5.3 What are some signs/cues that show a 2
baby is ready to breastfeed?
5.6 What type of support do you offer to a 1
breastfeeding mother?
5.7 Mention situations when it is necessary 2
for mothers to express breastmilk
Total 5
complementary feeding in addition to
breastmilk?
6.7 Mention the recommended food 2
groups for children 6-23 months?
6.8 What is the recommended minimum 1
number of food groups for a child aged
6-23 months per day?
6.9 What are the critical times for 4
handwashing?
eat his/her food?
Total 13
families
7.1 (Ask) What support do you provide to 2
pregnant or lactating mothers and their
families in the course of your duty?
Total 2

COMMUNITY LEVEL
Instructions:
VII. Give a mark for every correct response then write total correct answers in the column ‘correct responses’.
VIII. Award actual score in the last column considering the following.
response is given.
2A: Pregnant and lactating women (PLW)

Score Response Score
1.1 Have you received any information 3
regarding MIYCN? If yes; What
information did you receive?
Total 3
Step 2: Train all healthcare providers and community health volunteers in the knowledge and
3.2 What services did you receive from the 3
health facility during pregnancy
3.3 Mention food groups that a pregnant or 5
lactating woman consume to meet their
nutrient needs
Total 11
4.1 What are the benefits of early initiation 2
of breast feeding within 1 hour after
birth?
4.2 What are the benefits of feeding the 2
baby on colostrum?
breastfeeding?
4.4 What are the dangers of giving a baby 2
other foods/fluid in the first 6 months of
life?
4.5 What are the dangers of using bottles 2
4.6 What are the recommendations for 3
feeding infants born of a mother living
with HIV?
Total 14

5.2 What are the benefits of un-interrupted 2
skin-to-skin contact of babies with their
mothers immediately after birth for at
least 1hour?
5.3 How do you recognize when a baby is 3
ready to breastfeed?
5.4 (Observe) / Ask Mother to mention 4
or demonstrate key points on correct
positioning during breastfeeding
5.5 (Observe) / Ask Mother to mention 4
or demonstrate key points on good
attachment during breastfeeding.
to demonstrate or mention points
correctly)
Total 18
6.2 What are the benefits of continuing to 2
breastfeed your baby to 2 years and
beyond?
6.3 What is the appropriate age to introduce 1
complementary foods?
6.4 What are the dangers of beginning 1
6. 5 How many times should a baby aged: - 4
At 6 months
7-8 months
9-11 months
12-23months be fed in a day?
6.6 What is the amount of food should a 4
baby aged
At 6 months
7-8 months
9-11 months
12-23 months receive per meal every
day?
6.7 What are the recommended food 4
groups for children 6-23months
groups should a baby 6-23 months be
fed per day?
6.9 What are the critical times for hand 4
washing?
6.10 How should you encourage your child to 3
feed?
6.11 Have you participated in cooking 1
demonstrations in the health facility/
community on quarterly basis?
Total 25

Step7: Provide a welcoming and conducive environment to breastfeeding mothers and their
families
7.1 Mention the support you received when 3
pregnant or lactating.
7.5 Were you encouraged to have a 1
companion of choice to provide
constant or continuous physical and
or emotional support during labor and
birth?
7.6 Were you allowed to drink and eat light 1
foods during labor?
7.7 Were you encouraged to walk and move 1
about during labor when you desired
and assume positions of choice while
giving birth?
Total 6
community
8.2 Are you a member of a MtMSG? 1
8.3 What activities are conducted during the 1
MtMSG meetings?
Total 2

COMMUNITY LEVEL
Instructions:
IX. Give a mark for every correct response then write total correct answers in the column ‘correct responses’.
X. Award actual score in the last column considering the following.
response is given.
2 B: (household members)

Score Responses Score
1.1 What recommendations do you know 3
regarding feeding infants, young
children, pregnant and breastfeeding
mothers?
Total 3
3.1 What is the importance of IFAS to 1
pregnant mothers
3.2 Mention different food groups 3
recommended for pregnant and
breastfeeding mothers
3.3 How many meals in a day should a 1
pregnant mother eat?
3.4 How many meals in a day should a 1
lactating mother eat?
Total 6
4.1 When should a mother start 2
breastfeeding after delivery?
breastfeeding?
4.4 What are the dangers of artificial/mixed 2
feeding for infants 0-6 months?
Total 6
5.3 Mention ways that mothers recognize 2
their babies are ready to breastfeed?
5.7 Mention situations when it is necessary 2
for mothers to express breastmilk
Total 4

6.1 What is the minimum age in which a 1
child may stop breastfeeding?
6.2 What are the benefits of continuing to 1
breastfeed your baby to 2 years and
beyond?
complementary feeding in addition to
breastmilk?
6.9 Mention the critical times that a mother/ 3
caregiver should wash their hands?
Total 6
Step7: Provide a welcoming and conducive environment to breastfeeding mothers and their
families
7.1 In what ways do you support a pregnant 1
or breastfeeding woman?
Total 1
community
8.8 Do you attend community meetings/ 1
Baraza’s that discuss MIYCN?
Total 1

FACILITY TOOL
Instructions:
XI. Pay a courtesy call to the facility in-charge and orient them to the activity
Liaise with the facility I/C to populate sections A and B in this tool prior to assessment.
XII. Ask to see registers and summary tools, (ANC, MOH 333, 515, 711,100), minutes, and training records as required in
different steps for the last 3 months
XIII. Award marks as guided against every question
XIV. Award final score in the last column. For questions with more than 1 score, be sure not to exceed the maximum
score (in brackets)
Section A: Facility/ community unit demographics
IDENTIFICATION DETAILS
COUNTY: SUB-COUNTY:
LINK HEALTH FACILITY: LEVEL:
COMMUNITY UNIT:
NAME OF FACILITY I/C: TITLE:
DATE OF ASSESSMENT (DD/MM/YY):
START TIME (24 HRS): END TIME (24HRS):
NAME OF INTERVIEWER:
CODE NO.
STAFFING LEVELS (FACILITY OR PERINATAL AREAS IN LEVEL 4,5,6)

CADRE NUMBER
Health professionals
Nutritionist
Nurse
Clinical officers
Doctors
Paediatrician
CHEW/CHA
FACILITY BASED CHVs
Non-clinical
Cleaners
Security
Clerical
Catering

Section B: Facility/Community Unit data
From MOH 515 (CHEW summary)

Total no. of pregnant women: ……………………………………….………………………….……
Total no. of children 0-28 days: ………………………………….………………….………………...
Total children 29 days – 11 months: ………………………………………………………….………
Total no. of newborns visited within 48 hrs.: …………………………………………………........….
Number of mothers with newborns counselled on EBF: …………………………………………….
Total deliveries: ………………………………………………………………………………………
Number of deliveries by skilled birth attendants: …………………………………….………………
Total ANC attendance (previous month): ……………………………………………………..……..
Total no. of children 0-59mo participating in growth monitoring (previous month): ………………
BFCI INDICATORS (Refer to form 2)

BFCI indicators Performance
Proportion of infants who are initiated to breastfeeding within one hour of Month 1
delivery (0-11 months)
Proportion of infants exclusively breastfed in the first six months of life (0-6
months)
Proportion of infants receiving pre-lacteal feeds within the first three days of
life (0-11 months)
Proportion of children aged six to eight months who receive complementary
foods (semi-solid or solid) in addition to breast milk (6-11 months)
Proportion of children aged six months who ate any animal-source, iron-rich
foods in the last 24 hours (6-11 months)
Section C: Health facility self-assessment

Score answers Score
health care workers, CHEWs and CHVs
1.2 (Observe) The facility has an up-to- 1
date written National MIYCN policy -
summary statement present
1.3 (Observe) Is MIYCN policy statement 1
displayed in ALL strategic areas, (MCH,
maternity, Paediatric wards, notice
boards, critical care centre)?
1.4 (Observe) Is MIYCN policy illustrated 1
in a language, pictorial and/or any
other possible way of simplifying and
contextualizing that can be understood
by the local population?
1.5 (Ask the facility in-charge) The 1
written policy summary statement
is ROUTINELY communicated to all
Health workers (new, interns, attaches
and volunteers), CHVs
(Ask to see) Evidence of
documentation for routine
communication
Total 4

Step 2: Train all healthcare providers and community health volunteers in the knowledge and
Course Type of HCWs CHVs Non-tech
training staff
Guidance CME 8 0%> 80%> 80%> = 1

=1 =1
Full 80%> 80%> 80%> = 1
course =1 =1
Total number trained
CME
6- day
training
BFCI CME
6-day
training
c-BFCI CME
5-day
training
BFHI 3-day
training
CME
2.1 Are staff trained/sensitized on MIYCN / BFCI?
Summary of staff capacity to deliver MIYCN services
3.1 Ask and check: ANC register shows 1
accurate and complete documentation
for IFAS.
Total 1
4.1 From the health facility records (MoH 1
711), check the proportion of pregnant
women attending ANC counselled on
infant feeding (check from MoH 711)
(if ≥ 80%, award 1mark)
4.3 From the health facility records 1
(CHEW summary-MoH 515) check the
proportion of mothers with newborns
counselled on exclusive breastfeeding.
(if ≥ 80%, award 1mark)
4.5 (Observe). Do mothers seeking health 1
services at the health facility have
feeding bottles, cups with spouts and
pacifiers? If No, award 1 mark
4.7 (Ask, observe and check health talk 1
records) health facility conducts
health education (Orally, written form,
audio visual) on key topics related to
the importance and management of
breastfeeding? -If available and updated
award 1 mark

4.8 Observe if there is violation of Kenya 1
Breastmilk substitute (Regulation and
Control) Act,2012 (refer to the guidance
notes) If no violations award 1 mark
Total 5
5.1 From the health facility records (MoH 1
333), check the proportion of infants
(newborns) initiated on breast milk
within 1 hour after delivery.
If ≥80% award 1 mark
5.2 (Observe) Does the health facility 1
practice placement of babies on un-
interrupted skin-to-skin contact with
their mothers immediately after birth for
at least 1hour? If yes, award 1 mark (If no
delivery observed skip this question)
Total 2
6.9 (Ask and Observe) Does the facility 1
have hand washing facilities in points
accessible to mothers/caregivers?
6.11 (Ask and check records) Are cooking 1
demonstrations conducted in the
health facility/community on a quarterly
basis?
6.12 (Ask Check records) Does the facility 1
conduct health education, group
counselling or individual counselling on
6.13 (Ask and check records) Does 1
the facility conduct CMEs on
Total 4
families
7.2 (Ask and observe) Is there a 1
designated breastfeeding space with
clear signage reserved for mothers
to breastfeed within the community/
facility?
7.3 (Ask and observe) Are there MIYCN 1
IEC materials in the designated
breastfeeding space at the health
facility/community?
7.4 (Ask and observe) Are the designated 1
breastfeeding spaces conducive/
appropriate?
7.5 (Ask and observe) Does the health 1
facility encourage women to have
companions of their choice to provide
constant or continuous physical and
or emotional support during labor and
birth if desired?

facility allow women to drink and eat
light foods during labor if desired?
facility encourage women to walk and
move about during labor if desired
and assume positions of their choice
while giving birth unless a restriction is
specifically required for a complication
and the reason is explained to the
mother?
Total 6
community
8.2 (Ask and check records) Are there 1
functional MtMSG in the Community
Unit? If yes, award 1 mark
Type/status of MtMSG Number
Total MtMSG
Number functional
8.4 (Ask and check record) MOH 100 1
Is there an established referral system/
follow up mechanism from the facility to
community and back?
If yes, with evidence award 1 mark
8.6 (Ask and check record) Is there a 1
functional CMSG in every community
unit?
If yes, award 1 mark
8.7 (Ask and Check) are baby-friendly 1
gatherings conducted every two
months
8.9 (Ask and check records) Are the 5
MtMSG activities linked with other
nutrition sensitive sectors?
Agri- Food IGA Social WASH
nutrition security protection
If yes, award 1 mark for evidence of each

linkage
8.10 (Ask and check records) 1
Is there documentation of integrated
supportive supervision to the
community units/health facility?
If yes with evidence award 1 mark
8.11 (Ask and check records) Is MIYCN 1
integrated within the existing
community forums?
Chief’s CHC Dialogue
Baraza meetings days
Award (1 mark)

8.12 (Ask and check record) Is there 1
evidence of joint planning and
implementation (Sub County, facility,
CMSG, CHVs) in community level
activities?
If yes with evidence, award 1 mark
Total 12

GUIDANCE NOTES FOR BFCI SELF-ASSESSMENT
Tool FOCUS AREA GUIDANCE SCORING

3 Access availability Ask or Observe: Is the updated Award 1 mark if the updated MIYCN
of Policy MIYCN policy statement is available
policy statement available?
3 Strategic display of Observe if MIYCN policy is displayed Award 1 mark If the MIYCN policy
policy in all the listed strategic areas in statement is displayed in all the
locations where it can easily be strategic areas (as listed for the
seen for reference. ( Paediatric, specific health facility)-
ward, pediatric OPD, postnatal / FP
clinic, ,maternity, new born unit,
,PMTCT,ANC,CWC
3 Language and Observe: If the MIYCN policy is Award 1 mark if the MIYCN policy has
Presentation of the translated/ illustrated in a manner been translated/illustrated in a way
Policy that is culturally acceptable (pictorial, that easily understood by the local
videos, translation in local language, population.
posters and any other possible way
of simplifying and contextualizing) in
a way that can be understood by the
local population?
3 Policy is routinely Ask or check records: Is there Award 1 mark If there is evidence
communicated evidence of routine communication that MIYCN policy statement is
to all health care of MIYCN policy statement to health communicated routinely,
Workers and CHVs care workers (in terns, volunteers new
staff, attaché’) and community health
volunteers
1C Policy is routinely Ask or check records: Is there Award 1 mark If there is evidence
communicated evidence of routine communication that MIYCN policy statement is
to all non-clinical of MIYCN policy statement to non- communicated routinely
staffs clinical staff
1C Ask: non-clinical: What are some of If respondent answers correctly, award a
the steps on MIYCN policy summary maximum of 2 marks and I mark for each
statement(2) correct answer
2A Ask. PLW: Have you received any If there the mother answers correctly ,
information regarding MIYCN. If yes, award a maximum of 3 marks and I mark
what information did you receive (3) for each correct answer
2B Ask. Household member: The If there the household member answers
recommendation do you know correctly , award a maximum of 3 marks
regarding feeding infants young and I mark for each correct answer
children ,pregnant and breastfeeding
mothers (3)
Step 2: Train all health workers and community health volunteers in the knowledge and skills
1A Knowledge on Ask HCWs to mention MIYCN If the health worker mentions correctly at
MIYCN policy counseling cards thematic areas (at least 5 MIYCN policy statements, award
least 5) a maximum of 5 marks. If he or she
mentions< 5 statements, award 1 mark
for each of the correct statements.

1B Ask CHVs to mention at least 4 of If the CHV mentions correctly at least
MIYCN counseling cards thematic 34MIYCN counselling cards thematic
areas (at least 4) areas taught, award a maximum of
4 marks. If he or she mentions< 4
statements, award 1 mark for each of the
correct statements.
1C Ask non-clinical staff to mention If the non-clinical staffs mention
at least 2 MIYCN counseling cards correctly at least 2 MIYCN counselling
thematic areas (at least 2) cards thematic areas taught, award
a maximum of 2 marks. If he or she
mentions< 2 statements, award 1 mark
for each of the correct statements
3 All staff trained on Ask/see: If at least 80% of the health workers have
BFCI /BFHI/c-BFCI/ establish and list in table below: been trained or sensitized on either BFCI/
MIYCN • How many health providers have MIYCN/BFHI or CBFCI, award 1 mark each
attended the 6-day training?
• how many CHVs have attended If at least 80% of the CHV have been
the 5-day training? trained or sensitized on either BFCI/
• how many non –technical staff MIYCN or CBFCI, award 1 mark each
have attended the 5-day BFCI
If at least 80% of the non-clinical staffs
training?
have been trained or sensitized on either
BFCI/MIYCN or CBFCI, award 1 mark each
Total possible marks=3

Step 3: Promote maternal nutrition amongst women and their children
3 Iron Folic Acid Ask and check: ANC register for IFAS If there is accurate and correct
supplementation documentation. documentation, award 1 mark
(IFAS)
1A Ask: Health care workers to mention If the sampled health worker can
the importance of IFAS (3) correctly mention at least 3 correct
responses, award a maximum of 3
marks. If he or she mentions< 3 correct
responses, award 1 mark for each of the
correct response
1B Ask : CHVs to mention the If the sampled CHV can correctly
importance of IFAS (3) mention at least 3correct responses,
award a maximum of 3marks. If he or she
mentions< 3 correct responses, award 1
mark for each of the correct response
2A Ask: PLW to mention the importance If the sampled mother can correctly
of IFAS (3) mention at least 3 correct responses,
award a maximum of 3 marks. If he or
she mentions< 3 correct responses,
award 1 mark for each of the correct
response
2B Ask: Household members to If the sampled household members
mention the the services pregnant can correctly mention at least 2 correct
mothers should receive at the health responses, award a maximum of 2
facility (2) marks. If he or she mentions< 2 correct
correct response

1A Package of Care in Ask: Health care workers to mention If the sampled health worker can
Pregnancy the components of Care during correctly mention at least 4 correct
pregnancy (). responses, award a maximum of 4
correct response
1B Ask: CHVs to mention the If the sampled CHV can correctly
components of Care during mention at least 3 correct responses,
pregnancy (3). award a maximum of 3 marks. If he or
response
1C Ask Non-clinical staff; How can If the sampled health worker can
family/community support Pregnant correctly mention at least 3 correct
and breastfeeding mothers (At least responses, award a maximum of 3
3). marks. If he or she mentions< 3 correct
correct response
2A Ask: PLWs to mention the services If the sampled mother can correctly
received during pregnancy at ANC (3). mention at least 3 correct responses,
award a maximum of 3 marks. If he or
response
1A Dietary diversity Ask: Health workers to mention the If the sampled health worker can
10 food groups required to meet correctly mention at least 8 correct
dietary diversity for PLW(8). responses, award a maximum of 8
correct response
1B Ask: CHVs mention the 10 food If the sampled CHV can correctly
groups to meet dietary diversity for mention at least 7 correct responses,
PLW (7) award a maximum of 7 marks. If he or
response
2A Ask: The PLW to mention the If the sampled mother can mention the
number of food groups she should answer, award a maximum of 5 mark and
consume per day (5 ) I mark for each correct answer
2B Ask: Household member to mention If the sampled household member can
foods groups recommended for correctly answer award maximum of 3
PLW(3) and I marks for each correct answer
1A Frequency of ASK: Health care worker to state the If the sampled HCW can correctly state
feeding for dietary recommendation for pregnant the diet recommendation, award 1 mark
Pregnant mother women(1)
1B Ask: CHVs to mention the dietary If the sampled CHV can correctly state
recommendation for pregnant the diet recommendation, award 1 mark
woman (1)
2B Ask: Household member how many If the sampled household member can
meal in a day should a pregnant correctly state the diet recommendation,
mother consume.(1) award 1 mark

1A Frequency of ASK: Health care worker to state the If the sampled HCW can correctly state
feeding for dietary recommendation for lactating the diet recommendation, award 1 mark
lactating mother women(1)
1B Ask : CHV to state the dietary If the sampled CHV can correctly state
recommendation for lactating the diet recommendation, award 1 mark
women(1)
2B Ask: Household member how many If the sampled household member can
meal in a day should a lactating correctly state the diet recommendation,
mother consume.(1) award 1 mark
STEP 4: Inform all pregnant women and their families about the importance and management of
breastfeeding
3 Counseling Check from the health facility Award 1 mark if at least 80% pregnant
records (MoH 711), the proportion women attending ANC in the link health
of pregnant women attending ANC facility are counselled on infant feeding.
counselled on infant feeding.
Check from the health facility Award 1 mark if at least 80% mothers
records (MoH 515-CHEW summary), with new-borns are counselled on
the proportion of mothers with exclusive breastfeeding
newborns counselled on exclusive
breastfeeding.
1A Early Initiation of Ask: Health workers the benefits Health workers: Award a maximum of
breastfeeding of early initiation of breastfeeding (5 5 marks for at least 5 correct responses. If
benefits) he or she mentions< 5 correct responses,
response.
1B Ask: CHVs the benefits of early CHV: Award a maximum of 5 marks for
initiation of breastfeeding (4) at least 4 correct responses. If he or she
mark for each of the correct response.
1C Ask: non-clinical staff the benefits Non-clinical staff- Award a maximum
of early initiation of breastfeeding (2) of 2 marks for at least 2 correct
responses. If he or she mentions< 2
correct responses, award 1 mark for each
of the correct response.
2A Ask: Mothers the benefits of early Mothers- Award a maximum of 2 marks
initiation of breastfeeding (2) for at least 2 correct responses. If he
or she mentions< 2 correct responses,
response.
2B Ask: household member when Household member- Award a
should a mother start breastfeeding maximum of 2 marks for at least 2 correct
after delivery (2) responses. If he or she mentions< 2

1A Colostrum Ask: Health workers, what Health workers: Award a maximum of
information do you give mothers 4 marks for at least 4 correct responses. If
regarding the benefits of feeding a he or she mentions< 4 correct responses,
baby on colostrum (5 ) award 1 mark for each of the correct
response.
1B Ask: CHV the benefit of feeding a CHV: Award a maximum of 3 marks for
baby on colostrum (4) at least 3 correct responses. If he or she
mentions< 3 correct responses, award
1 mark for each of the correct response
and I mark for each.
1C Ask: Non-clinical the benefit of Non-clinical staff- Award a maximum
feeding a baby on colostrum (2) of 2 marks for at least 2 correct
of the correct response and I mark for
each
2A Ask: Mother the benefit of feeding a Mothers- Award a maximum of 2 marks
baby on colostrum (2 ) for at least 2 correct responses. If he
response and I mark for each.
1A Exclusive Ask: Health workers the benefits of Health workers: Award a maximum of
breastfeeding exclusive breastfeeding (5) 5 marks for at least 5 correct responses. If
he or she mentions< 5 correct responses,
response.
1B Ask: CHV the benefits of exclusive CHV: Award a maximum of 5 marks for
breastfeeding (5) at least 5 correct responses. If he or she
1C Ask: non-clinical the benefits of Non-clinical staff- Award a maximum
exclusive breastfeeding (3) of 3 marks for at least 3 correct
2A Ask: Mother the benefits of Mothers- Award a maximum of 2 marks
exclusive breastfeeding (3) for at least 3 correct responses. If he
response.
2B Ask: household member the Family members- Award a maximum of
benefits of exclusive breastfeeding (2) 2 marks for at least 1 correct response.
3 Check Health facility record: The Health facility record: If more than
proportion of mothers with new-born 80% award 1 mark
babies counseled on EBF

1A Mixed feeding Ask: Health workers: the risks of Health workers: Award a maximum of
mixed/artificial feeding (3) 3 marks for at least 3 correct responses. If
response.
1B Ask: CHVs: the risks of mixed/ CHV: Award a maximum of 3 marks for
artificial feeding (3) at least 3 correct responses. If he or she
1C Ask: Non-clinical: the risks of mixed/ Non-clinical staff- Award a maximum
artificial feeding (2) of 2 marks for at least 2 correct
2A Ask: mother: the risks of mixed/ Mothers- Award a maximum of 2 marks
artificial feeding (2) for at least 2 correct responses. If he
response.
2B Ask: household member: the risks Household members- Award a
of mixed/artificial feeding (2) maximum of 2 marks for at least 2 correct
1A Using feeding Ask: Health workers the dangers of Award scores for the correct response
bottles, teats, using feeding bottles, teats, pacifiers from the sampled target respondent
pacifiers and cups and cups with spouts (3)
with spouts Health workers: Award a maximum of
3 marks for at least 3 correct responses. If
response.
1B Ask: CHV the dangers of using CHV: Award a maximum of 3 marks for
feeding bottles, teats, pacifiers and at least 3 correct responses. If he or she
cups with spouts (3) mentions< 3 correct responses, award 1
1C Ask: Non-clinical the dangers of Non-clinical staff- Award a maximum
using feeding bottles, teats, pacifiers of 2 marks for at least 2 correct
and cups with spouts (2) responses. If he or she mentions< 2
2A Ask: mother the dangers of using Mothers- Award a maximum of 2 marks
feeding bottles, teats, pacifiers and for at least 2 correct responses. If he
cups with spouts (2) or she mentions< 2 correct responses,
response
3 Observe: Do mothers seeking health If no, award 1 mark
services at the health facility have
feeding bottles, cups with spouts and
pacifiers (1)
1A Infant feeding in Ask: Health Workers what Award scores for the correct response
the context of HIV information is given to parents/ from the sampled target respondent
caregivers regarding feeding in the
context of HIV (check the current Health workers: Award a maximum of
MIYCN policy) (1) 1 mark for at least 1 response. If he or she
is not able to mention at least 1 response
no score is awarded

1A Infant feeding in Ask Health care worker What Health workers: Award a maximum of 1
the context of DR information do you give parents and mark for at least 1 response. If he or she
TB caregivers regarding infant feeding in is not able to mention at least 1 response
Drug resistant (DR)TB no score is awarded
1A Infant feeding Ask Health care worker What Health workers: Award a maximum of 1
for patients information do you give parents mark for at least 1 response. If he or she
whose mothers and caregivers regarding infant is not able to mention at least 1 response
are receiving feeding for mothers undergoing no score is awarded
chemotherapy chemotherapy
1B Ask: CHVs what information is given CHV: Award a maximum of 3 marks for
to parents/caregivers regarding at least 3 correct responses. If he or she
feeding in the context of HIV (check mentions< 3 correct responses, award 1
the current MIYCN policy) (3) mark for each of the correct response.
1C Ask: Non-clinical staff what Non-clinical staff- Award a maximum
information is given to parents/ of 3 marks for at least 3 correct
caregivers regarding feeding in the responses. If he or she mentions< 3
context of HIV (check the current correct responses, award 1 mark for each
MIYCN policy) (3) of the correct response.
2A Ask: mother what information is Mothers- Award a maximum of 3 marks
given to parents/caregivers regarding for at least 3 correct responses. If he
feeding in the context of HIV (check or she mentions< 3 correct responses,
the current MIYCN policy) (3) award 1 mark for each of the correct
response.
1A Infant feeding in Ask Health care worker What Health workers: Award a maximum of
the context of DR information do you give parents 1 mark for at least 1 response. If he or she
TB and caregivers regarding infant is not able to mention at least 1 response
feeding for mothers undergoing no score is awarded
chemotherapy
3 Health education Ask/observe/check record: health If available and updated, award 1 mark
facility tool: health facility conducts
health education (orally, written form,
audio visual,)on key topics related to
the importance and management of
breastfeeding
3 BMS Act,2012 Observe: if there is violation of Kenya If no violation ,award 1 mark
breastmilk substitutes (regulation and
control ) Act, 2012 (Refer to guidance
notes)
STEP 5: Support mothers to initiate breastfeeding within the first one hour of birth, establish and
maintain exclusive breastfeeding for first six months
1A Initiation of Ask: Health workers: Describe Health workers: Award a maximum of
breastfeeding the steps to early initiation to 3 marks for at least 3 correct responses. If
within 1 hour after breastfeeding within one hour after he or she mentions< 3 correct responses,
delivery delivery(3) award 1 mark for each of the correct
response.
3 Check from the maternity records Award 1 mark if at least 80% of
(MoH 333), the proportion of infants babies born in the link health facility
initiated on breastmilk with 1 hour maternity*(where applicable) are
after birth initiated to breastfeeding within 1 hour
after birth.

1A Skin to Skin contact Ask: Health workers What are the Health workers: Award a maximum of
benefits of un-interrupted skin to skin 5 marks for at least 5 correct responses. If
contact immediately after birth for at he or she mentions< 5 correct responses,
least one hour (5) award 1 mark for each of the correct
response.
2A Ask: mothers What are the benefits Mothers- Award a maximum of 2 marks
of un-interrupted skin to skin contact for at least 2 correct responses. If he
immediately after birth for at least or she mentions< 2 correct responses,
one hour (2) award 1 mark for each of the correct
response.
3 Observe (where possible)-Does the Award 1 mark if there is evidence that
health facility practice placement of Skin to skin is observed in the health
babies on un-interrupted skin to skin If no delivery observed, skip this question
contact with their babies immediately and adjust the denominator when
after birth for at least 1 hour scoring
1A Feeding/hunger Ask Health workers: What are the Award scores for the correct response
cues signs that show that the baby is ready from the sampled target respondent
to breastfeed. (5)
Health workers: Award a maximum of
5 marks for at least 5 correct responses. If
response.
1B Ask CHV How do you recognize CHV: Award a maximum of 4 marks for
signs /cues that shows a baby is ready at least 4 correct responses. If he or she
to breastfeed (4) mentions< 4 correct responses, award 1
1C Ask Non-Clinical What are the signs/ Non-clinical staff- Award a maximum
cues that shows that a baby is ready of 2 marks for at least 2 correct
to breastfeed. (2) responses. If he or she mentions< 2
2A Ask mother how do you recognize Mothers- Award a maximum of 2 marks
when a baby is ready to breastfeed. for at least 2 correct responses. If he
(3) or she mentions< 2 correct responses,
response.
2B Ask household member Mention Family members- Award a maximum of
ways that mothers recognize their 2 marks for at least 2 correct responses. If
babies are ready to breastfeed (2) he or she mentions< 2 correct responses,
response.
1A Correct Positioning Ask the health workers: Mention Health workers: Award a maximum of
to the Breast or demonstrate key points on correct 4 marks for at least 4 correct responses. If
positioning (4). he or she mentions< 5 correct responses,
response.
1B Ask CHVs to demonstrate or describe CHV: Award a maximum of 4 marks for
correct breastfeeding positioning (4). at least 4 correct responses. If he or she
2A Ask mother to demonstrate or Mothers- Award a maximum of 4 marks
describe correct breastfeeding for at least 4 correct responses. If he
positioning and attachment (4). or she mentions< 4 correct responses,
response.

1A Good Attachment Ask the health workers: Mention Health workers: Award a maximum of
to the Breast or demonstrate key points on good 4 marks for at least 5 correct responses. If
attachment (4). he or she mentions< 5 correct responses,
response.
1B Ask CHV: Mention or demonstrate CHV: Award a maximum of 4 marks for
key points on good attachment (4). at least 4 correct responses. If he or she
2A Ask Mother: Mention or Mothers- Award a maximum of 4 marks
demonstrate key points on good for at least 4 correct responses. If he
attachment (4). or she mentions< 4 correct responses,
response.
1C Ask the non-clinical staffs: What If the answer is 1 of more, award 1mark
type of support do you offer to a
breastfeeding mother (1)
1A Expressing Ask the health workers to describe Health workers: Award a maximum of
breastmilk or demonstrate the process of hand 5 marks for at least 3 correct responses. If
expression of breastmilk (5) he or she mentions< 5 correct responses,
response.
1B Ask CHVs to describe or CHV: Award a maximum of 5 marks for
demonstrate the process of hand at least 3 correct responses. If he or she
expression of breastmilk (5) mentions< 5 correct responses, award 1
1C Ask Non-clinical to describe or Non-clinical staff- Award a maximum
demonstrate the process of hand of 2 marks for at least 2 correct
expression of breastmilk (2) responses. If he or she mentions< 2
2A Ask mother to describe or Mothers- Award a maximum of 5 marks
demonstrate the process of hand for at least 5 correct responses. If he
expression of breastmilk (5) or she mentions< 2 correct responses,
response.
2B Ask household member to Family members- Award a maximum of
describe or demonstrate the process 2 marks for at least 2 correct responses. If
of hand expression of breastmilk (2) he or she mentions< 2 correct responses,
response
STEP 6: Encourage sustained breastfeeding beyond six months to two years or beyond alongside
timely introduction of appropriate, adequate and safe complementary fools
2B Duration of Ask household member: What is Award 1 mark for correct response
breastfeeding the minimum age in which a child
may stop breastfeeding (1)
1A Benefits of Ask Health workers to mention the Health workers: Award a maximum of
continued Benefits of continued breastfeeding 3 marks for at least 3 correct responses. If
breastfeeding (3 ) he or she mentions< 2 correct responses,
response.
1B Ask CHV to mention the Benefits of CHV: Award a maximum of 3 marks for
continued breastfeeding (3) at least 2 correct responses. If he or she

1C Ask Non-clinical to mention the Non-clinical staff- Award a maximum
Benefits of continued breastfeeding of 1 mark for correct response.
(1)
2A Ask mother to mention the Benefits Mothers- Award a maximum of 2 marks
of continued breastfeeding (2) for correct response.
1A Introduction of Ask Health care worker : what Award 1 mark for correct response
complementary is the appropriate age is to start
foods complementary foods(1)
1B Ask CHVs : what is the appropriate Award 1 mark for correct response
age is to start complementary
foods(1)
1C Ask Non-clinical : what is Award 1 mark for correct response
the appropriate age is to start
complementary foods(1)
2A Ask Mother : what is the Award 1 mark for correct response
appropriate age is to start
2B Ask Household member : what Award 1 mark for correct response
is the appropriate age is to start
1A Dangers of late Ask Health workers: What are the Health workers: Award a maximum of
complementary dangers of starting complementary 6 marks for at least 6 correct responses. If
feeding foods too late? (3) he or she mentions< 6 correct responses,
response.
1B Ask CHV: What are the dangers of CHV: Award a maximum of 3 marks for
starting complementary foods too at least 6 correct responses. If he or she
late? (3) mentions< 3 correct responses, award 1
1C Ask Non-clinical staff: What are the Non-clinical staff- Award a maximum
dangers of starting complementary of 2 marks for at least 42correct
foods too late? (2) responses. If he or she mentions< 2
2A Ask mother: What are the dangers Mothers Award a maximum of 3 marks
of starting complementary foods too for at least 3correct responses. If he or
late? (3) she mentions< 3 correct responses,
response.
2B Ask household member: Mothers Award a maximum of 2 marks
What are the dangers of starting for at least 3 correct responses. If he
complementary foods too late? (2) or she mentions< 3 correct responses,
response.
1A Frequency of feeds Ask the health workers to mention Award scores for the correct response
the frequency of complementary from the sampled target respondent
feeding per age cohorts putting into
consideration the name and the age Health workers: Award a 1 mark for
of the child (I mark for each correct each of the correct response. Maximum
response) possible score is 4.
• at 6 months
• 7-8 months
• 9-11 months
• 12-23 months

1B Ask CHVs: Mention the frequency CHV: Award a 1 mark for each of the
of complementary feeding per age correct response. Maximum possible
cohorts putting into consideration score is 4.
the name and the age of the child (I
mark for each correct response)
• at 6 months
• 7-8 months
• 9-11 months
• 12-23 months
2A Ask Mother: Mention the frequency Mothers Award 1 mark for correct
of complementary feeding per age response based on her child’s age,
cohorts putting into consideration Maximum possible score is 4 marks.
the name and the age of the child (I
mark for each correct response)
• at 6 months
• 7-8 months
• 9-11 months
• 12-23 months)
1A Amount to offer Ask health workers: What is the Health workers: Award a 1 mark for
specific amount to be feed to a each of the correct response. Maximum
babies aged: - possible score is 4.
• at 6 months (1)
• 7-8 months (1)
• 9-11 months (1)
• 12-23 months(1)
1B Ask CHVs: What is the specific CHV: Award a 1 mark for each of the
amount to be feed to a babies aged: - correct response. Maximum possible
• At 6 months (1) score is 4.
• 7-8 months (1)
• 9-11 months (1)
• 12-23 months(1)
2A Ask Mothers: What is the specific Mothers Award 1 mark for correct
amount to be feed to a babies aged: - response based on her child’s age,
• At 6 months (1) Maximum possible score is 4 mark.
• 7-8 months (1)
• 9-11 months (1)
• 12-23 months (1)
1A Food groups Ask health care worker: What are Health workers: Award a maximum of
(Dietary diversity) the recommended food groups for 4 marks for at least 4 correct responses. If
children aged 6-23 months. (5) he or she mentions< 4 correct responses,
response.
1B Ask CHVs: What are the CHV: Award a maximum of 3 marks for
recommended food groups for at least 3 correct responses. If he or she
children aged 6-23 months. (3) mentions< 3 correct responses, award 1
1C Ask Non-Clinical What are the Non-clinical staff- Award a maximum
recommended food groups for of 2 marks for at least 2 correct
children aged 6-23 months (2) responses. If he or she mentions< 2
2A Ask mother What are the Mothers Award a maximum of 3 marks
recommended food groups for for at least 3 correct responses. If he
children aged 6-23 months (1) or she mentions< 3 correct responses,
response.

1A Food groups per Ask the health worker to state the Award 1 mark for correct response stated
day for children minimum number of food groups a by the health workers,
6-23 months child 6-23 months should consume
per day (1 )
1B Ask the CHV to state the minimum Award 1 mark for correct response stated
number of food groups a child 6-23 by the CHV.
months should consume per day (1)
1C Ask the Non-clinical staff to state Award 1 mark for correct response stated
the minimum number of food groups by the non-clinical staff
a child 6-23 months should consume
per day (1 )
2A Ask the PLW to state the minimum Award 1 mark for correct response stated
number of food groups a child 6-23 by the PLW.
months should consume per day(1)
1A Hand washing Ask the health worker to mention Award scores for the correct response
the four critical times to wash hands. from the sampled target respondent
Award 1 mark for each correct response

1B Ask the CHV to mention the four Award 1 mark for each correct response.
critical times to wash hands
1C Ask the non-clinical staff to Award 1 mark for each correct response.
mention the four critical times to
wash hands
2A Ask the PLW to mention the four Award 1 mark for each correct response.
critical times to wash hands
2B Ask the household member to Award 1 mark for each correct response.
mention the at least 3 critical times to
wash hands
3 Ask and observe: Health facility has Award 1 mark if there is a functional
at least one hand washing facility handwashing facility in the health facility
accessible to mothers/caregivers
1A Active/Responsive Ask the health worker: How can a Award a maximum of 4 marks for at
feeding mother encourage a child to eat his/ least 4 correct responses. If he or she
her food? (4) mentions< 4 correct responses, award 1
mark for each of the correct responses.
1A Ask Health care worker: What Health workers: Award a maximum of 3
information do you give parents and marks. For each correct response award 1
caregivers regarding feeding children mark. If he or she is not able to mention
during and after illness any no score is awarded
1B Ask the CHV: How can a mother Award a maximum of 3 marks for at
encourage a child to eat his/her food? least 3 correct responses. If he or she
(3) mentions< 3 correct responses, award 1
1C Ask the non-clinical staff: How can Award a maximum of 2 marks for at
a mother encourage a child to eat least 2 correct responses. If he or she
his/her food? (2) mentions< 2 correct responses, award 1
2A Mother: how should you encourage Award a maximum of 3 marks for at
your child to feed (3) least 3 correct responses. If he or she
2A Quarterly cooking Ask Mother if they have participated Award 1 mark if mother reports to
demonstrations in a cooking demonstration in the have participated in quarterly cooking
facility/community on quarterly basis demonstrations.
(1)

3 Ask and check records: Are cooking Award 1 mark if there is evidence of
demonstrations conducted in the quarterly cooking demonstrations.
health facility on a quarterly basis(1)
3 Health Education/ Ask and check records: Does the Award 1 mark if there is evidence of
CMEs on facility conduct health education, health education/individual/group
Complimentary group/individual counselling on counselling on complementary feeding.
feeding complementary feeding (1)
3 Ask and check records: Does Award 1 mark if there is evidence of CPD/
facility conduct CPD/CME on CME on complementary feeding.
complementary feeding (1)
families
1A Partner/family Ask health worker to describe how Award a maximum of 4 marks for 4
support they encourage Husbands/Spouses/ correct responses. If he or she mentions<
partner to accompany wife/partner 4 correct responses, award 1 mark for
for pre and post-natal care (ANC/PNC) each of the correct response.
(4)
1B Ask CHV to describe how they Award a maximum of 3 marks for 3
encourage Husbands/Spouses/ correct responses. If he or she mentions
partner to accompany wife/partner <3 correct responses, award 1 mark for
for pre and post-natal care (ANC/PNC) each of the correct response.
(4)
1C Ask non-clinical staff the support Award a maximum of 2 marks for 2
they provide to PLW and their families correct responses. If he or she mentions
in the course of their duty (2) <2 correct responses, award 1 mark for
each of the correct response.
2A Ask the mother to mention the Award a maximum of 3 marks for 3
support they received when pregnant correct responses. If she mentions <3
or lactating mother (3) correct responses, award 1 mark for each
2B Ask the household member to Award a maximum of 1 marks for 1
mention ways they support pregnant correct response.
or lactating mother (1)
3 Breastfeeding space Ask and Observe: Award 1 mark if the link health facility has
a designated breastfeeding space with
Does link health facility have a clear signage
designated breastfeeding space for
mothers with clear signage (1)
3 Ask and Observe: Award 1 mark if the designated
breastfeeding space with clear signage
Are there MIYCN IEC materials in the has MIYCN IEC materials
designated breastfeeding space in
the facility or community (1)
3 Ask and observe: Award 1 mark if the designated
breastfeeding space is conducive/
Are the designated breastfeeding appropriate.
spaces conducive/ appropriate
3 Ask and Observe: Award 1 mark if there is evidence that
mothers in labor are allowed to have a
Does the health facility encourage birth companion
women to have companions of
their choice to provide constant or
continuous physical and or emotional
support during labor and birth if
desired?

mothers in labor are allowed to drink or
Does the health facility allow women eat light foods during labour
to drink and eat light foods during
labor if desired
mothers are allowed to walk and move
Does the health facility encourage about during labor if desired and assume
women to walk and move about positions of their choice while giving
during labor if desired and assume birth
positions of their choice while giving
birth unless a restriction is specifically
required for a complication and the
reason is explained to the mother
community
1A Mother to Ask Health worker: Award 1 mark if MtMSGs groups are
Mother Support linked to this facility.
Groups(MtMSGs) How many MtMSGs are linked to this
facility (1)
1A Check records Award 1 mark if there is evidence of
functional MtMSGs.
How many MtMSGs are functional (1)
1B Ask CHV and check record: Award 1 mark if there is evidence of CHV
participation in MtMSG meetings.
Do you facilitate monthly MtMSG
meetings? (1)
2A Ask PLW Award 1 mark if mother reports
participating in MtMSG meetings
Are you a member of a MtMSG? (1)
2A Ask PLW: Award 1 mark if mother reports MIYCN
related activities take place during
What activities are conducted during MtMSG meetings
MtMSG meetings (1)
3 Ask and observe if there is Award 1 mark if there is evidence of
functional mother to mother support MtMSGs that are functional
group
2B Referral mechanism Ask and check records (MOH Award 1 mark if there is evidence of
100) if they refer mothers from the referral of mothers to the facility for
community to the facility for MIYCN MIYCN support when necessary
support when necessary (1)
3 Ask and check records (MOH Award 1 mark if there is evidence of an
100) if there is an established referral established referral mechanism
system/follow-up mechanism from
the community and back (1)
2B Targeted home Ask and check records (form 1) Award 1 mark if there is evidence of
visits targeted household visits
Do you conduct targeted home
visits? (1)

3 Community Ask and check records: Is there Award 1 mark if there is evidence that a
Mother Support a functional community mother CMSG exists and is functional
Groups(CMSG) support group (1)
2B Ask household member: Award 1 mark if household member
reports attending community meetings
Do you attend community meetings/ that discuss MIYCN
barazas that discuss MIYCN? (1)
3 Ask and check records: Are baby Award 1 mark if there is evidence baby
friendly gathering conducted bi- friendly gathering are conducted bi-
monthly? monthly.
Check evidence of scheduled

meetings, documentation –reports,
minutes
3 Linkages Ask and check if the Mother to Award 1 mark if MtMSGs are linked to
mother support groups are linked nutrition sensitive sectors
to nutrition sensitive interventions/
projects. (1)
3 Support Ask and check records: Is there Award 1 mark if there is evidence of
Supervision integrated supportive supervision to integrated supportive supervision
the community health units/health focusing on BFCI activities
facility on BFCI (1)
3 BFCI in community Ask and check records: Is MIYCN/ Award 1 mark if there is evidence of BFCI
forums BFCI agenda integrated in existing agenda in existing Community forums
community forums such as CHC
meetings, Community dialogue days,
Action days, Chief’s barazas (1)
3 Joint planning and Ask and check records: Award 1 mark if there is evidence of joint
implementation planning and implementation.
Is there evidence of joint planning
and implementation of community
BFCI activities? (SubCounty, facility,
CMSG, CHV) (1)

REPUBLIC OF KENYA
MINISTRY OF HEALTH

BFCI Mentorship and Self Assessment Tools

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REPUBLIC OF KENYA

BABY FRIENDLY COMMUNITY

THE BFCI MENTORSHIP PROCESS 6

SELF ASSESSMENT GUIDANCE AND TOOLS 18

SAMPLING PROCEDURES FOR BFCI SELF-ASSESSMENT 21

BFCI SELF-ASSESSMENT TOOLS 30

GUIDANCE NOTES FOR BFCI SELF-ASSESSMENT 49

When to conduct mentorship

4 MOH-DIVISION OF NUTRITION AND DIETETICS

Proposed mentorship Team

BFCI SELF-ASSESSMENT TOOLS 5

Step 2: Gap analysis

Step 3: Plan to conduct mentorship.

Step 4: Conducting a mentoring visit.

6 MOH-DIVISION OF NUTRITION AND DIETETICS

BFCI SELF-ASSESSMENT TOOLS 7

Name of Mentor: ________________________ Link facility _________________________________

Community Health unit: _________________ County _____________ Sub County: ___________

Staff Identified Activities Date & Venue Methodology Resource

8 MOH-DIVISION OF NUTRITION AND DIETETICS

BFCI SELF-ASSESSMENT TOOLS 9

Others (specify) [ ] ________________________

If yes, check minutes/reports

If yes, check minutes/reports

Number of PLWs & caregivers of children 0-23 months

If more than one MTMSG, provide membership for

10 MOH-DIVISION OF NUTRITION AND DIETETICS

If yes, Check records

Check minutes and reports

Indicate the number who attended in the box

Check CMSG meeting report

BFCI SELF-ASSESSMENT TOOLS 11

If yes, list the activities

Check training records

Check training records

Ask & Observe

12 MOH-DIVISION OF NUTRITION AND DIETETICS

If yes, Check supervision/monitoring report

Check supervision/monitoring report

Check CHV review meeting report

Labour and delivery area  Yes  No  N/A

BFCI SELF-ASSESSMENT TOOLS 13

Check ANC register and MCH handbook

If yes, check health talk schedule and CME records

14 MOH-DIVISION OF NUTRITION AND DIETETICS

Name of Mentee:_______________________________ Title of Mentee: __________________________________

BFCI Step 1: National MIYCN policy

BFCI SELF-ASSESSMENT TOOLS 15

16 MOH-DIVISION OF NUTRITION AND DIETETICS

BFCI facilitation skills observation

BFCI SELF-ASSESSMENT TOOLS 17

BFCI self-assessment tools

Tool Subsections Assigned reference number

18 MOH-DIVISION OF NUTRITION AND DIETETICS

Planning and coordination for BFCI self and external assessments

BFCI SELF-ASSESSMENT TOOLS 19

a) Be up-to-date with MIYCN key messages

20 MOH-DIVISION OF NUTRITION AND DIETETICS

Sampling Guideline for BFCI Self-Assessment

Cohort Sampling Method

BFCI SELF-ASSESSMENT TOOLS 21

Data analysis and scoring

Sampling guidance notes for CHU implementing BFCI

Name of Mentor: Link facility _________

Community Health unit: ___________ County _ Sub County: _____

Name of Mentee:_ Title of Mentee: ____