CONCEPT NOTE—

Beta-Test: Training Course for Trainers on Lactation Management and Mother- and Baby-
Friendly Hospital Initiative (MBFHI) Implementation for Hospital-based Health Professionals
20 April to 07 May 2021

I. Rationale
Breastfeeding remains a global public health agenda beyond the 2015 UN Millennium
Development Goals. As part of the maternal and infant care component of primary
health under universal healthcare, it is an evidence-based lifesaving intervention
known to reduce under-five child deaths. Breastfeeding implementation from
initiation at birth, exclusive practice for six months, and its continuation with
complementary feeding from six months onward continue to be a challenge for health
professionals involved in maternal, newborn, infant and child care. The DOH, as the
lead agency in the implementation of RA 10028-Expanded Promotion of
Breastfeeding Act, under the Rule VI, Section 25 of its implementing rules and
regulations, states that it shall conduct training programs for midwives and nurses on
current and updated lactation management. This is in support of the AO 2007-0026
Revitalization of Mother-Baby Friendly Hospital Initiative (MBFHI) and the AO
2009-0025 Adopting Policies and Guidelines on Essential Newborn Care.

Lactation Management Training (LMT) has long been conducted by DOH and
hospitals to address the needs of health professionals practicing in non-hospital-based
birthing facilities. Cognizant of the importance of breastfeeding initiation taking place
in these areas, LMT for MBFHI implementation for facility-based, service delivery-
focused health professionals will strengthen their respective capacities and assist
DOH in implementing MBFHI and to improve the quality of care for birthing mothers
and their newborns. In light of the continuing pandemic that caused migration of in-
person training courses, the DOH is developing a low-cost, virtual platform for Essential
Maternal and Newborn Care, Lactation Management Training (EMNC-LMT) Training,
based on the updated Baby-Friendly Health Initiative (BFHI) 2018 Modules developed by
the World Health Organization (WHO).

II. Objective
A. General
The aim of the course is to train health facility trainers to provide their colleagues
with basic knowledge, skills, and competence to protect, promote and support
breastfeeding in the facilities where they work, and understand the importance of
the Ten Steps to Successful Breastfeeding and translate them into practice.
B. Specific
At the end of the course, participants will be able to:
1. Explain related policies/guidelines/laws relevant to MBFHI;
2. Discuss the anatomy and physiology of breastfeeding;
3. Demonstrate practices that assist breastfeeding and interventions to be done when
an infant fails to breastfeed;
4. Describe a mother- and baby- friendly hospital;
 5. Discuss indicators for monitoring and tracking of implementation of LMT and
MBFHI;
6. Demonstrate their learned facilitation skills; and
7. Prepare an action and implementation plan.
III. Contents
Session 1 - BFHI - A key component of quality maternal and newborn care
Session 2 - Benefits of breastfeeding
Session 3 - Counselling skills - Listening and learning
Session 4 - Counselling skills - Building confidence and giving support
Session 5 - How breastfeeding works
Session 6 - Impact of birth practices
Session 7 - Postnatal practices to support breastfeeding
Session 8 - Assessing a breastfeeding
Session 9 - Clinical practice - Positioning a baby at the breast
Session 10 - Clinical practice session 1 -
1) Listening and learning
2) Assessing a breastfeeding session
Session 11 - Breast and nipple conditions
Session 12 - Milk supply issues
Session 13 - Barriers to breastfeeding
Session 14 - Medical indications for supplementary feeding
Session 15 - Alternative feeding methods
Session 16 - Clinical Practice Session 2 -
1) Building confidence and giving support
2) Assisting breastfeeding session
Session 17 - Maternal health
Session 18 - Antenatal preparation for breastfeeding
Session 19 - Clinical Practice Session 3: Counseling a pregnant woman
Session 20 - Discharge care
Session 21 - The International code of marketing of breast-milk substitutes and
subsequent relevant World Health Assembly resolutions
Session 22 - Facility Practices - Implementing the Ten Steps

IV. Methodology
The EMNC-LMT mixed-method methodology adopts that of the National Nutrition
Council’s (NNC’s) initial implementation design of the Virtual Training on Nutrition
in Emergencies (NiE) for Local Government Units (National Nutrition Council,
2020).

Training
Component Content Method

Platform Virtual Modules 1. Pre-recorded video will be made for each

and Sessions topic so it can be re-uploaded by the 17
 regional offices. This will also allow
participants to finish the course on their
own pacing and for standardization of
content.
2. Platforms to be used in the online training
are (1) Google Classroom and (2) Google
Meet
a. Google classroom: for uploading pre-
recorded video, discussion forum,
submission of assignments, quizzes
etc.
b. Virtual Meeting Platforms: for live
forums which will be done every end
of Module to clarify questions of
participants

Additional feature of Google classroom and

virtual meeting platforms: Apps can be
downloaded in any android phone.
Participants can access the videos and
discussion forums via phone.

Facilitators Center for Health 1. CHD Coordinators shall be the main source
Development of training and materials for each region.
(CHD) 2. (What else is expected from them, in terms
Coordinators of coordination, monitoring of sessions,
determination of certificates that shall be
awarded)

Participants Health Facilities 1. In this beta-test, two (2) hospitals, one

public and one private, from each of the
four (4) provinces of CALABARZON shall be
invited.
2. Each facility that shall be undergoing the
training shall have five (5) representatives,
which will be invited by the CHD
Coordinator:
a. 1 Obstetric-Gynecologist
b. 1 Pediatrician
c. 1 Neonatal Intensive Care Unit (NICU)
Nurse OR Chief Nurse
d. 1 Registered Nutritionist Dietitian
e. (2) Midwives
 3. Group set-up will still be requested
considering the clinical practice sessions,
with each health facility having 3 sub-
teams of 2 personnel, each.

Beta Test Date and Time 1. The platform will be launched on 06 April
Frame 2021, with CHD CALABARZON and the
eight (8) teams from health facilities from
each province of the region.
2. A specific day and time will serve as the
main schedule for uploading of the
materials, but participants may finish the
session at their own convenient time and
pacing but must be completed within 48
hours. Attendance will be posted every
start of the meeting and will be closed
after 48 hours. Participants will receive an
e-mail reminding them of: (a) attendance
to sessions (b) assignments (c) other
activities.
3. Live forum will be conducted every after 1
module to answer additional questions
from participants.
Test Run NONE a. Pilot tests will happen in 1 region starting
20 April 2021.
b. Target Region: CALABARZON, given their
request for EMNC-LMT TOT.
c. With a maximum of 80 participants to allow
participants from health facilities and CHDs.
d. During the pilot run, 1-2 staff from the
regional office shall assist in:
- Identification of participants
- Ensuring completeness of materials of
pax prior to start of the classes
- Reviewing outputs of the participants.
ANNEX I. Program and Module Design

A. First Day of Engagement

1. Pre-test
2. Introduction
a. Opening Remarks
b. Introduction to the Program
c. Run-through of the Training Program
3. Opening of the First Module
B. Second Day of Engagement
1. Pre-Module Videos
a. Global Health Media: Early Initiation of Breastfeeding
2. Opening of the Second Module

No. of No. of
Module Ten Steps to Successful Breastfeeding Relative Sessions Resource Person Minutes Meetings
Module 1 Steps 1-2 Hospital Policy on Formula Session 1. BFHI - A key component of Jellie Anne C. Palencia 13 1 MEETING
Marketing, Infant Feeding Policy quality maternal and newborn care
for Parents and Caregivers, and Session 22. Facility Practices - Jo Ann O. Langaman 30
Staff Competency Implementing the Ten Steps

Session 21. The International Code of Ana Epefania Q. Escober 31

Module 2 Step 3 Discuss the importance and
management of breastfeeding
with pregnant women and their
families.
Step 4 Facilitate immediate and
uninterrupted skin-to-skin
Marketing of Breast-milk Substitutes and
Subsequent Relevant World Health
Assembly Resolutions
Session 3. Counselling Skills - Listening and Jomarie L. Tongol 43
Learning
Session 4. Counselling Skills - Building
Confidence and Giving Support
Session 2. Benefits of breastfeeding Luz B. Tagunicar 30 1 MEETING
Session 5. - How breastfeeding works Dr. Ma. Lourdes Salaveria-Imperial 32
 contact and support mothers to
initiate breastfeeding as soon as
possible after birth.
Step 7 Enable mothers and their infants
to remain together and to
practice rooming-in 24 hours a
day.
Steps 3 to Please refer to the descriptions
7 above for the corresponding
steps.
Module 3 Step 5 Support mothers to initiate and
maintain breastfeeding and
manage common difficulties.
Step 6 Do not provide breastfed
newborns any food or fluids other
than breast milk, unless medically
indicated.
Step 8 Support mothers to recognize
and respond to their infants’ cues
for feeding.
Step 9 Counsel mothers on the use and
risks of feeding bottles, teats and
pacifiers.
Step 10 Coordinate discharge so that
parents and their infants have
timely access to ongoing support
and care.
Module 4 Clinical Practice Sessions
Session 6. Impact of birth practices
Session 7. Postnatal practices to support
breastfeeding
Session 8. Assessing a breastfeeding Dr. Jamie Isip-Cumpas 33
Session 9. Clinical practice - Positioning a Dr. Teresa Maria Ribaño 25
baby at the breast
Special Module: Maternal and Newborn Dr. Maria Asuncion Silvestre 40
Care in COVID-19
Session 11. Breast and nipple conditions Dr. Aurora Gloria Inguillo-Libadia 44 + 1 MEETING
Session 12. Milk supply issues
Session 13. Barriers to breastfeeding Dr. Estrella Olonan-Jusi 20
Session 14. Medical indications for
supplementary feeding
Session 15. Alternative feeding methods
Session 17. Maternal health Dr. Cynthia Fernandez-Tan 20
Session 18. Antenatal preparation for
breastfeeding
Session 20. Discharge care
TEN STEPS EXERCISE: Making a Mother and Groupwork 60 Offline
Baby-Friendly Hospital Initiative (MBFHI)
Compliant Policy
Clinical Practice Session 1: Counseling a Groupwork 60
pregnant woman

Clinical Practice Session 2: Positioning a Groupwork 60

baby at the breast

Clinical Practice Session 3 - Groupwork 60

1) Listening and learning
2) Assessing a breastfeeding session

Clinical Practice Session 4 - Groupwork 60

1) Building confidence and giving
support
2) Assisting breastfeeding session
V. Operating Details
Venue : Online
Date : 20 April to 07 May 2021
Category of Participants: Key persons from hospitals in CALABARZON,
selected by Center for Health Development
(CHD) CALABARZON
Total Pax : ~
Facilitators : 4 facilitators
Resource Person/Trainers: 11 resource persons/trainers
Documentor/ : 1 documenter/support staff
Support Staff
Proposed Budget : PHP ~~
Meals, accommodation
Transportation for practicum
2 Resource persons/trainers
Supplies/materials : c/o Public Health Management Fund
Fund Source : GOP
VI. Evaluation
At the end of the TOT, a Level 2 Evaluation will be given to the participants. The
participants will have to answer a pre-test before the training and a post-test at the
end. Demonstration of the participants’ facilitation skills will also be done as part of
the evaluation. These evaluation activities will measure the gained knowledge, skills,
and attitude of the participants in relation to Lactation Management Training.
VII. Course Requirement/Expected Output
1. Completion of the Training of Trainers
2. Plan of Action
ANNEX. Additional Inputs to the Technical Advisories (to be issued prior to 18 April 2021)

1. The following are the names and e-mails of the members of the Training Group
NAME E-MAIL ADDRESS CONTACT NUMBER

2. Please take note of the schedule of the release of EMNC-LMT Pre-test and Post-test, and
Modules and dates of its related pre-tests, post-test, and submission of skills demonstrations and
practice.
a. aYour registration e-mail must be an INDIVIDUAL G-MAIL account. You may register at
https://mail.google.com. E-mail addresses that can be accessed by groups/more than one (1)
individual will not be allowed for registration.
b. Your registration to the training course signifies your agreement that the schedule and the terms
of this advisory is non-negotiable.
c. ALWAYS CHECK YOUR E-MAIL. Notifications about the activities and tests will be
sent to your-email.
d. The four (4) components of the training are (1) Learning Modules, (2) EMNC-LMT and
Module Pre-tests, (3) EMNC-LMT and Module Post-tests, and (4) Open Floor Discussions.
e. The schedule for the release and closing of each Learning Module, Pre-test, and Post-test is
plotted in Tables (a) and (b). PLEASE TAKE NOTE THAT LAUNCHES OCCUR ON
6:00 AM FOR EACH MATERIAL’S INTENDED SCHEDULE, AND MATERIALS
CLOSE ON ITS INTENDED DATES AT 11:59 PM.
f. You will receive e-mail notifications when Lecture Modules, Pre-tests, and Post-tests are
launched.
g. Please also regularly check the Google Classroom in which you will be enrolled, for live
updates in your own Stream page. After you have been enrolled by the Training Group, you
may access this link “https://classroom.google.com/c/Mjk0OTI2OTM3MjA0?cjc=j2czxl2’ or
access the Google classroom through “http://classroom.google.com” and refer to CLASS
CODE “j2czxl2” (please remove the quotation marks).
h. The EMNC-LMT TOT has a pre-test and post-test. This is taken at the beginning of the course,
and at the end of the course.
i. Participants will only be able to progress towards Module 1 when the EMNC-LMT TOT is
accomplished.
1) Each Module (except Module 4) has a pre-test and post-test. Both are important.
Module post-tests, however, entitles the participant to a Certificate of Module
Completion for the respective Module completed. A Certificate of Module
Completion is not equivalent to a Certificate of Course Completion/Trainer’s
Certificate.
2) Completion of a Module (for Modules 1, 2, and 3) is a requirement to complete the
remaining modules. Completion of Modules 1, 2, and 3 is required to access Module
4.
 3) Module 4 requires the submission of the Practice and Demonstration videos below.
Please note that items b) to e) should be done in pairs: one counsellor and one
“mother.” Feel free to find your practice/demonstration partner, observing infection
prevention control (IPC) measures). Note that when doing practice/demonstrations,
the counsellor should not touch the “mother.” As a counsellor, a breast model and a
model baby are important tools for practice and demonstration. Please refer to #2 for
guidance on breast models and model babies.
a) In MS Word format: TEN STEPS EXERCISE: Making a Mother and Baby-
Friendly Hospital Initiative (MBFHI) Compliant Policy
b) In .mp4/.mov format: Clinical Practice Session: Positioning a baby at the breast
c) In .mp4/.mov format: Clinical Practice Session: Counseling a pregnant woman
d) In .mp4/.mov format: Clinical practice session: (1) Listening and learning & (2)
Assessing a breastfeeding session
e) In .mp4/.mov format: Clinical Practice Session: (1) Building confidence and
giving support & (2) Assisting breastfeeding session
j. Each Learning Module has pre-tests and post-tests.
k. Each Learning Module has a section for comments. It is highly encouraged that, in the process
of completing the Learning Module, you place your questions or comments under the
Comments Section for the Learning Module you are trying to complete.
1) These Questions/Comments will be brought up during Open Floor Discussions. The
schedules of these discussions are plotted in Tables (a) and (b) as 2-3 hour live
sessions on a virtual meeting platform.

Table (a). Plot of TOT Activities

LEGEND
LAUNCH 6:00 AM 2 HOUR SESSION 9:00 AM
CLOSING 11:59 PM
LEARNING
DATE PRE-TEST POST-TEST OPEN FLOOR DISC.
MODULE
EMNC-LMT TOT
April 18
Module 1
EMNC-LMT TOT
April 19 Module 1

April 20 Module 1
April 21 Module 1
Module 2 Module 1
April 22 Module 2 Module 1
Module 2 Module 1
April 23
April 24
April 25 Module 2
Module 3 Module 2
April 26 Module 3 Module 2
Module 3 Module 2
April 27
April 28
April 29 Module 3
Module 4 Module 3
(Submission of
April 30 Module 3
Practice and Module 3
Demonstrations)
May 1
May 2
May 3
May 4
EMNC-LMT TOT
May 5
Module 4 (Submission of
 Practice and
Demonstrations)
May 6 EMNC-LMT TOT
Module 4
(Discussion of
May 7 Submissions)
Graduation

Table (b). Visualized Plot of TOT Activities

EMNC-LMT
APRIL 18 SUN Pretest MODULE 1: Pre-test
19 MON
MODULE 1:
20 TUES WELCOME WORK
21 WED

MODULE 1: MODULE 1: OPEN MODULE 2:

22 THU Post-test FLOOR MODULE 2: Pre-test WORK
23 FRI
24 SAT
25 SUN

MODULE 2: MODULE 2: OPEN MODULE 3:

26 MON Post-test FLOOR MODULE 3: Pre-test WORK
27 TUE
28 WED
29 THU
MODULE 3: MODULE 3: OPEN
30 FRI Post-test FLOOR MODULE 4: WORK
MAY 1 SAT
2 SUN
3 MON
4 TUE
EMNC-LMT
5 WED Post-test 11:59 PM: Deadline for Clinical Practice Submission
6 THU
7 FRI Regrouping & Discussion of Submissions; GRADUATION

3. Please find the guidance below on making breast models and model babies.
a. Making a Model Doll (if a baby doll is not available for your use)
1) Find any large fruit or vegetable, a towel or other strong thick cloth, and some rubber
bands or string.
2) Put the fruit or vegetable in the middle of the cloth and tie the cloth around it to form
the baby's “neck” and “head.”
3) Bunch the free part of the cloth together to form the baby's legs and arms and tie
them into shape.
4) If the cloth is rather thin, you may like to stuff some other cloth inside to give the
doll more of a “body.”
b. Making a Breast Model (if a breast model is not available for your use)
1) Use a pair of near skin-colored socks, or stockings, or an old sweater or T-shirt.
2) Make the cloth into a round bag shape, and stuff it with other cloth or foam rubber to
make it breast shaped.
3) Stitch a “purse string” around a circle in the middle of the breast to make a nipple.
4) Stuff the nipple with foam or cotton.
5) Color the areola with a felt pen. You can also push the nipple in to make an “inverted”
nipple.
6) If you wish to show the inside structure of the breast with the larger ducts, make the
breast with two layers, for example with two socks.
7) Sew the nipple in the outer layer and draw the large ducts and ducts on the inside
layer beneath the nipple.
8) You can remove the outer layer with the nipple to reveal the inside structure.