Türkiye'de Emzirmenin Teşviki ve Bebek Dostu Sağlık Kuruluşları: Programı Geliştirmek İçin Sistematik Bir Yaklaşım

Öz

Amaç: Türkiye’de Emzirmenin Teşviki ve Bebek Dostu Sağlık Kuruluşları Programı (BDSK), 1991 yılında Sağlık Bakanlığı ve Birleşmiş Milletler Çocuklara Yardım Fonu (UNICEF) işbirliği ile başlatılmıştır. 2002’den beri Program hastanelerden birinci basamak sağlık hizmetlerine ve toplum düzeyine ilerlemiştir. Bu yazıda, mevcut durumu değerlendirmek ve Programı canlandırmak için geliştirilen yeni stratejileri sunmak ve böylece Programın ilerlemesine katkı sağlamak hedeflenmektedir.
Materyal ve Metot: Sağlık kuruluşları ve illere ait tüm veriler, Çocuk ve Ergen Sağlığı Daire Başkanlığı’nın veri tabanından alınmıştır. Paydaş kurumlarla ve tüm bebek dostu savunucuları ile Ulusal Emzirme Komitesi Toplantısında ve Ulusal Emzirme Sempozyumunda Program hakkında tartışmalar gerçekleştirilmiş ve ardından çalışma grubu tarafından Programın SWOT (güçlü yönler, zayıf yönler, fırsatlar, tehditler) analizi yapılmıştır. Sonrasında bu analiz sonuçları kullanılarak yeni stratejiler ve yol haritası belirlenmiştir.

Bulgular: Bebek dostu hastanelerin güncel sayısı 2017 yılı sonu itibariyle 1051’e (tüm hastanelerin %69,42’si) ulaşmıştır. Bu hastanelerin 46’sı kadın doğum hastanesi statüsündedir ve %93,50’si 2017 yılı sonu itibariyle bebek dostu olarak onaylanmıştır. 2008 ve 2017 yılları arasında önceden bebek dostu unvanı almış olan hastanelerin 120’si (%11,42) yeniden değerlendirilmiştir. 2002 ve 2013 yılları arasında 81 ilin tamamı bebek dostu unvanı almıştır. 2008 yılından itibaren 81 ilin 61’i Bebek Dostu İl unvanını Altın Bebek Dostu İl olarak geliştirmiş ve Aile Hekimliği Birimlerinin %95’i bebek dostu unvanı almıştır. SWOT analizi sonuçlarına göre programın en güçlü yönü BDSK’nın devlet tarafından güçlü bir şekilde tanınması ve desteklenmesi olarak belirlenmiştir. Sağlık kuruluşlarında bebek dostu standartların sürdürülmesinde yaşanan güçlükler ve bebek dostu unvanı alan hastanelerin yeterince yeniden değerlendirilememesi çalışma grubu tarafından programın en zayıf yönleri olarak değerlendirilmiştir.

Sonuç: Emzirmeyi etkili bir şekilde korumak, teşvik etmek ve desteklemek, ulusal ve küresel emzirme hedeflerine erişmek için girişimlerin sağlık politikaları, sağlık sistemleri, ev, aile, toplum gibi bir dizi ortamın kombinasyonunu kapsayacak şekilde planlanması gereklidir.

Anahtar Kelimeler

• Bebek Dostu Hastaneler Girişimi,Bebek Dostu Sağlık Kuruluşları,emzirmenin teşviki,emzirme oranları,tamamlayıcı beslenme,Anne Sütü Muadillerinin Pazarlanması ile İlgili Uluslararası Yasa

Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program

Abstract

Objectives: In Turkey, Breastfeeding Promotion and Baby-Friendly Health Facilities Program (BFHF) was launched in 1991 with the collaboration of the Ministry of Health (MoH) and United Nations International Children’s Emergency Fund (UNICEF). Since 2002, the program has been extended from hospitals to the primary health care services and the community level. This paper aims to present the current status of BFHF and development of new strategies to revitalize the program and thus, to contribute to the progress.
Materials and Methods: All information about health facilities and provinces was collected from the database of the Child and Adolescent Health Department. Discussions about Initiative with stakeholder institutions and baby-friendly advocates took place in the National Breastfeeding Committee Meeting and in Annual Breastfeeding Symposium. Then a SWOT (strengths, weaknesses, opportunities, threats) analysis of the Program was performed by the working group. Using this analysis results, new strategies and course of action were identified.
Results: The current number of baby-friendly hospitals has reached a total of 1051(69.42% of all hospitals). Of those, 46 were maternity hospitals, which were 93.50% approved as baby-friendly at the end of 2017. Between 2008 and 2017, 120 (%11.42) of those pre-certified hospitals were reassessed. Between 2002 and 2013, all 81 provinces have been designated Baby-Friendly Provinces. Since 2008, 61 of the 81 provinces have been designated Golden Baby-Friendly Provinces and 95% of Family Medicine Units have been certified as baby-friendly. According to the SWOT analysis result, the main strength of the program was strong recognition and support of the BFHF by the government. The difficulties in maintaining of baby-friendly standards in health facilities and inadequate reassessment of pre-certified facilities were determined as the main weaknesses of the BFHF by the working group.
Conclusion: To protect, promote and support breastfeeding effectively and to reach the national and global breastfeeding goals, interventions should be planned in a combination of settings by concurrently involving health policies, health systems, home, family and the community. 

Keywords

• Baby-Friendly Hospital Initiative,Baby-Friendly Health Facilities,breastfeeding promotion,breastfeeding rates,complementary feeding,International Code of Marketing of Breastmilk Substitutes

Kaynakça

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