The primary objective of Wellstart International's Lactation Management Education Program (LMEP) program was to develop an international cadre of skilled and knowledgeable leaders for medical, nursing and nutrition education programs as well as policy makers in lactation management and breastfeeding promotion. The ultimate outcome was anticipated to be a cascade of inservice/continuing education and training activities as well as changes in the preservice curriculums in the participant 's health care provider institutions A team approach was used throughout the LME program. At the completion of the formal course work designed to develop basic knowledge and skills, teams developed program plans of their own design to undertake the activities they considered most appropriate in their particular situation. The program was funded by primarily by USAID and ran for fifteen years (1983 - 1998)
At the request of UNICEF, a survey of long term outcomes of the LME program was carried out a to determine if participants (Wellstart Associates) were still involved in breastfeeding promotion and whether the LME program had effected their work. It was also of interest to evaluate the "cascade effect" of the training and education activities initiated by the Associates. A convenience sample of Associates reachable by e-mail and willing to respond to the questionnaire was used. Forty out of 60 questionnaires were returned and analyzed. All health care provider categories and all geographic regions were represented among the 40 respondents. Twenty-five percent of the respondents had entered the LME program between 1983 and 1989, 50% between 1990 and 1995 and 25% between 1995 and 1998.
Highlights of the findings include the following:
LME participation increased the knowledge and skills regarding how to support and promote breastfeeding by over 90% among the respondents.
Ninety-five percent of the respondents reported that they increased the level of activities after they began their LME activities and over 80% are still very involved.
Over 90% of the team plans of these respondents were activated. These plans included developing national promotion programs, establishing training centers, making changes in curricula, changing national policies, promoting Code of Marketing work and implementing the BFHI.
The 40 respondents reported that they had trained 141,059 other health care providers as well as over 4,000 trainers who in turn trained 167,622 other health care providers. Thus the 40 respondents had influenced the training of 312, 681 other health care trainers and providers.
Breastfeeding conferences, meetings and workshops were organized by 32 respondents, largely after they began participation in LME.
Over 80 articles were published by 26 of the respondents.
Forty percent of the respondents became Associates before the BFHI was launched in 1992, while 60% joined LME after 1992 and all became active in promoting BFHI as trainers, assessors and/or committee members.
Nearly 100% felt that LME was of significant help in their policy work.
Many respondents achieved leadership roles in their countries, their institutions and their professional societies and have also served as technical consultants at national, regional and international levels.
Thirteen national and/or regional training and resource centers have been established. Ten of these continue to function, 1 will reopen soon when funding for their next project begins and another has moved to a new location but continues to offer training.
Major obstacles to breastfeeding promotion identified by the respondents included inadequate Code enforcement, a need for increased breastfeeding content in preservice curricula, lack of political support, poor follow-up of mother-babies after discharge from maternity services, lack of financial support especially for BFHI and the challenge of HIV/AIDS.
Priorities for the future included:
- Continuing to offer LME training, particularly through regional centers.
- Providing back-up support and up-dates to Associates via consultant visits and refresher courses (internet based)
- Offering in-country curriculum development workshops
- Assisting Associates with research projects
- Providing educational materials including current references from the literature.
- Providing additional advanced fellowship opportunities.
It would appear that the LME program has indeed had a dramatic continuing and long term impact, at least among these 40 respondents. While it is not possible to speculate the extent to which these findings are representative of the activity level of all 655 Wellstart Associates, informal reports suggest that if they could be contacted, a significant number would respond similarly. to actively help in future training and other IYCF initiatives.