40th Anniversary Celebration of the Adoption of the ...

40th Anniversary Celebration of the Adoption of the International Code of Marketing of Breastmilk

Substitutes

Implementing the Code and relevant World

Health Assembly resolutions

in West and Central Africa

Regional virtual event

Wednesday, May 26, 2021

About the event

▪ Simultaneous interpretation in French, English, and Portuguese.

▪ Chat box ▪ Introduction▪ to ask for help or to continue introducing yourselves.

▪ Q&A: Questions to speakers.

▪ Recording

Objectives

▪ Highlight the role of the Code and resolutions in

protecting breastfeeding

▪ Describe the state of implementation of the Code in

the region and highlight bottlenecks

▪ Introduce NetCode tools

▪ Provide country experiences in implementing

NetCode and other monitoring tools (Nigeria and

CIV).

▪ Encourage countries to develop a plan of action for

implementing the Code

About the event

Speakers and moderators

WelcomeAnne-Sophie Le DainUNICEF West & Central Africa

Opening & Closing remarks Dr Namoudou Keita West African Health Organization

Session 1: Setting the sceneManisha TharaneyAlive& Thrive

Session 2: Country experiences Cote d´Ivoire & Nigeria Hana BekeleWorld Health Organization

Q&A

Ellen SokolUNICEF West & Central Africa

Akoto OseiHellen Keller international

Edouard ZerboIBFAN

Dr. Namoudou Keita

West African Health Organization

Opening remarks

Speakers

Ellen SokolLegal consultantUNICEF West & Central Africa

Richmond Aryeetey,Associate Professor of Public HealthUniversity of Ghana

Hana BekeleSenior Nutrition SpecialistWorld Health Organization

Session 1: Setting the scene

1. The Code, related WHA resolutions,

implementation in West and Central Africa

2. Regional implementation of WHO

Guidance

3. NetCode tools for monitoring and

enforcement

The Code and implementation

in West and Central Africa

Ellen SOKOL, Legal Consultant,

UNICEF West and Central Africa

Regional Office

Outline

1. Summary of the Code and relevant

WHA resolutions

2. Legal status of the Code and WHA

resolutions

3. Implementation in West and Central

Africa

Media, billboards, special displays, free

samples, gifts, direct contact by

marketing personnel

Summary of the Code

No advertising or other form of promotion to general public

No promotion in the health care system

No posters, gadgets, gifts or incentives

to health workers, free supplies of

products or donations of equipment and

materials

Summary of the Code

Information on infant and young child feeding

Product labels

o Provide necessary information about

appropriate use

o designed so as not to discourage

breastfeeding

Product quality

Meet applicable standards recommended

by Codex Alimentarius Commission

Objective and consistent

Scope (products covered)

Companies introduce new products and

claim they are not “breastmilk substitutes”

Infant formula; other products marketed as breastmilk

substitutes; feeding bottles and teats

Scope of the Code (Article 2)

“from 6

months”

“12 months

to 3 years”

Legal status of the Code

Adopted by Resolution 34.22 of the World Health

Assembly (WHA) in 1981

A WHA resolution is an international

recommendation and NOT a binding treaty or

regulation

BUT it carries weight as a judgment on health from

the highest international body in field of health

WHA Resolution 34.22

Member States are urged to

Support implementation . . . of the provisions of the

International Code in its entirety and

Translate the International Code into national legislation,

regulations or other suitable measures.

Since 1981, WHA has adopted 18 resolutions with relevance

to the Code.

Subsequent WHA resolutions have the same status as the

Code

Relevant WHA resolutions

Six months optimal duration of exclusive breastfeeding and timely

complementary feeding

No donations of supplies of breastmilk substitutes in any part of the health

care system

Financial support for health professionals must not create conflicts of

interest

Implement WHO Guidance on ending inappropriate marketing of foods for

infants and young children

WHA Resolution 69.9 (2016)

WHA 69.9 welcomed the WHO

Guidance on Inappropriate Promotion of Foods for Infants

and Young Children

To address concern that the promotion of breastmilk substitutes and

some commercial foods for infants and young children continues to

undermine progress in optimal infant and young child feeding

Includes 7 recommendations for controlling the marketing of foods and

beverages targeted toward children under the age of 36 months

WHO Guidance: Recommendation 3

What is a breastmilk substitute

Any kind of milk specifically marketed for feeding infants and young children up to the age of 3 years (including follow-up formula and growing up milks). Recommendation 3, Guidance on ending the inappropriate promotion of foods for infants and young children, WHO 2016

Code implementation in West and Central Africa

Code implementation WCAR

www. breastmilkonly.com

Thank you!

Assessment of regional implementation of WHO guidance

on ending inappropriate promotion of foods for infants and young

children

West and Central Africa

Richmond Aryeetey,

University of Ghana School of Public Health

To assess awareness and extent to which ECOWAS and ECCAS countries have incorporated WHO Technical Guidance recommendations into national legislation, policies, strategies and plans

Objectives of analysis

• Online survey administered via email to 23 mid-level program managers

• Desk review of national legislation/regulations, policies, guidelines, and strategies/plans related to IYCF

• Using a checklist that was developed based on the 7 recommendations of the WHO Technical Guidance Document

Methods

• The Code and subsequent WHA resolutions prohibits promotion of breastmilk substitutes

• Breastmilk substitutes defined to include any milks (irrespective of form-powdered, liquid etc.) marketed for feeding infants and young children up to age of 3 years, • including follow-up formula and growing-

up milks

Recommendation 2: Breast milk Substitutes

Recommendation 2: How West and Central African countries are doing

West Africa Central Africa

Ben

in

Nig

eria

Gh

ana

Gam

bia

Co

te D

’ Ivo

ire

Cap

e V

erd

e

Sen

egal

Sier

ra L

eon

e

Togo

Bu

rkin

a Fa

so

Gu

inea

Gu

inea

B

issa

u

Lib

eria

Mal

i

Nig

er

Sao

To

me

and

Pri

nci

pe

Cam

ero

on

Ch

ad

Co

ngo

De

mo

crat

ic R

epu

blic

of

Co

ngo

Cen

tral

Afr

ican

Rep

ub

lic

Gab

on

Equ

ato

rial

Gu

inea

Part

ial

Part

ial

Part

ial

Part

ial

Litt

le

Litt

le

Litt

le

Litt

le

Litt

le

No

ne

No

ne

No

ne

No

ne

No

ne

No

ne

Part

ial

Part

ial

Part

ial

No

ne

No

ne

No

ne

No

ne

No

Info

rmat

ion

• Messages used to promote foods for infants and young children should support optimal feeding

• Inappropriate messages should not be used

• Messages should be easily understood, visible and legible to caregivers

• Messages should include:

• Importance of continued breastfeeding for up to 2 years and beyond

• Importance of not introducing complementary feeding before 6 months of age

Recommendation 4: Appropriate Messaging

• Messages SHOULD NOT :

• Include images, text or other representation that might suggest use of product for infants less than 6 months old

• Undermine or discourage breastfeeding

• Make a comparison to breastmilk

• Suggest the product is nearly equivalent or superior to breast-milk

• Recommend or promote bottle-feeding

• Convey endorsement by a professional body unless specifically approved by regulatory authorities

Recommendation 4: Appropriate Messaging

Recommendation 4: How West and Central African countries are doing

West Africa Central Africa

Cap

e V

erd

e

Gam

bia

Sen

egal

Cam

ero

on

Ben

in

Co

te D

’Ivo

ire

Gh

ana

Mal

i

Nig

eria

Sier

ra L

oen

e

Togo

Ch

ad

Gab

on

Sao

To

me

and

Pri

nci

pe

Mo

re t

han

a

littl

e

Mo

re t

han

a

littl

e

Mo

re t

han

a

littl

e

Mo

re t

han

a

littl

e

Litt

le

Litt

le

Litt

le

Litt

le

Litt

le

Litt

le

Litt

le

Litt

le

Litt

le

Litt

le

Occurs when similar packaging/labelling is used to link sale of different product lines

There should be no cross-promotion to promote breast-milk substitutes indirectly via promotion of foods for infants and young children.

Recommendation 5: Cross-promotion

Cross promotion regulation-Nigeria

CountryLegislation

mentions cross-promotion

Defines cross-promotion

Cross-promotion is prohibited

Labelling not permitted to

indicate cross-promotion

Tie-in-sales prohibited

Nigeria Yes Yes Yes No No

Senegal (Proposed in draft legislation)

Yes Yes Yes Yes No

Ghana No NoNot

indicatedNot

indicatedYes

• There is high awareness of the Code and WHO Technical guidance, albeit with limited understanding of the recommendations

• Only a few countries had included all Code provisions to effectively protect, promote and support breastfeeding.

• Relatively few countries, especially those in West Africa, had documents that had incorporated some of the seven WHO Guidance recommendations. Implementation of recommendation 5 is almost non-existent

• Survey identified opportunities for countries to build upon existing capacities

Conclusions

• Need to develop/update existing documents relevant to the WHO technical Guidance recommendations

• Advocacy, awareness creation, and capacity building regarding the WHO technical Guidance recommendations are needed.

• Technical and financial support needed for countries to develop or revise national IYCF policies, regulations, strategies, and plans

Needed Actions

Opeyemi Lasisi- University of Ghana

Akoto Osei, Marguette Beye, and Volkan Cakir - Helen Keller Intl.

Ellen Sokol- UNICEF

Acknowledgements

Monitoring and enforcement of the International Code of Marketing of

Breast-milk Substitutes

Use of the NetCode Toolkit

Hana Bekele

MO, WHO/AFRO, Zimbabwe

Outline

⚫ Why and who should monitor the Code?

⚫ NetCode toolkit – Types of monitoring

– Periodic assessment

– Ongoing monitoring system

⚫ Implementation status of the NetCode protocols

⚫ Summary

Why monitor the implementation of the Code?

⚫ Legislation to restrict marketing of breast-milk substitutes is necessary but not sufficient;

⚫ Equally important are the endorsement of implementing regulations, effective enforcement and monitoring of compliance

⚫ Monitoring compliance provides information essential for appropriate action and advocacy.

⚫ Monitoring also provides information on the quality of the legislation, including possible weaknesses and loopholes

⚫ A system of funding for regular monitoring of compliance with legislation should be explicitly developed and funded from the beginning

Who is responsible for monitoring and enforcement the implementation of the International Code ?

⚫ Primary responsibility lies with Governments according to the Article 11 of the Code

⚫ Monitoring mechanisms need to be transparent and independent

⚫ Free from commercial influence and should address labelling, all forms of advertising and commercial promotion across all media promotion and in health care, conflicts of interest, retail promotional devices, sales incentives

⚫ NGOs, institutions and individuals can draw the attention of manufacturers and distributors to activities which are incompatible with the Code, and inform the government to take action

⚫ The manufacturers and distributors of products, appropriate nongovernmental organizations, professional groups, and consumer organizations should collaborate with governments to this end

⚫ Responsible bodies should be able to impose appropriate sanctions according to existing legal systems

NetCode a monitoring framework since 2015

⚫ Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes and Subsequent Relevant World Health Assembly Resolutions

⚫ NetCode combines the efforts of civil society organizations, academics, and selected countries to establish standards for Code monitoring

The NetCode Protocols

⚫ NetCode protocols addresses both ongoing monitoring and periodic assessment of the Code

Protocol for periodic assessment

⚫ Assess quantitatively the level of compliance with the provisions of the Code and national measures

⚫ Assess trends and changes in compliance over time

⚫ Identify priority areas for Code implementation and enforcement work

⚫ Reveal gaps and limitations of national laws to be addressed through policy and legislative measures

Modules of periodic assessment protocol

Implementation status of periodic assessment protocol

⚫ Completed studies in:– Brazil (retail only)

– Chile

– Dominican Republic (mothers only)

– Ecuador

– Mexico

– Nigeria (ATNI)

– Sri Lanka

– Thailand (ATNI)

– Uruguay

– Philippines (ATNI)

– Cote d’Ivoire

⚫ Planning started in:– Panama

– Russian Federation

– Suriname

– Zimbabwe

Protocol for ongoing monitoring system

⚫ Detect violations of the national laws and/or the Code

⚫ Document and report such violations

⚫ Investigate and validate whether the reported activities are indeed violations

⚫ Activate an enforcement mechanism that would stop such violations and deter future violations

⚫ Hold manufacturers, distributors, retail outlets, the health-care system and health-care workers to account for their breeches of national laws and/or the Code

Implementation status of ongoing monitoring systems

⚫ Working with 12 countries on developing ongoing monitoring systems

⚫ Online reporting now operative in Oman & Sri Lanka

⚫ Violations being reported in Cambodia & Kenya

⚫ Planning activities underway in Armenia, Bangladesh, Brazil, Dominican Republic, Jordan, Mexico, Pakistan, Thailand

Summary

⚫ It’s not enough to simply translate the provisions of Code into national legislation

⚫ Monitoring of the Code legislation is necessary to ensure that its provisions are complied with to protect and promote the health of children

⚫ When a national law does not exist, monitoring compliance with the provisions of the Code is essential for future action and advocacy.

⚫ Efforts must be put in place to:

➢ strengthen community networks that protect, promote, and support breastfeeding;

➢ create monitoring systems that track the progress of policies, programmes, and funding

Links

NetCode monitoring toolkit

http://www.who.int/nutrition/netcode/toolkit/en/

Frequently Asked Questionshttp://www.who.int/nutrition/publications/infantfeeding/breastmilk-substitutes-FAQ2017/en/Online

Code training course

https://unitar.org/event/full-catalog/international-code-marketing-breast-milk-substitutes-open-access

Code status reporthttps://www.who.int/publications/i/item/9789240006010 2020 report

Implementation Manual for Guidance on Ending Inappropriate Marketing of Foods for Infants and Young Childrenhttp://www.who.int/nutrition/publications/infantfeeding/manual-ending-inappropriate-promotion-food/en/

OHCHR statement on breastfeeding and human rightshttps://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20871&LangID=E

Thank you

http://www.who.int/nutrition/netcode/toolkit/en

Oka René KouameCoordinatorProgramme National de Nutrition, Cote d’Ivoire

Eva EdwardsDeputy Director Food Safety and Applied Nutrition Directorate NAFDAC

Simeon NanamaRegional Nutrition AdvisorUNICEF West & Central Africa

Edouard ZerboRegional CoordinatorIBFAN Afrique

Session 2: Country experiences

1. Cote d’Ivoire experience with periodic

monitoring

2. Monitoring and enforcement in Nigeria

3. Wrap up

EVALUATION DES VIOLATIONS DU CODE DE COMMERCIALISATION DES

SUBSTITUTS DU LAIT MATERNEL DANS LES STRUCTURES DE SANTE A

ABIDJAN, CÔTE D’IVOIRE

Dr René Oka KOUAME,

Directeur Coordonnateur du PNN,

Côte d’Ivoire

Plan de présentation

• Introduction

• Objectifs et méthodologie de l’étude

• Etapes clé de l’étude

• Résultats clé de l’étude

• Utilisation des résultats de l’étude

Introduction

• Adoption en 2013 le décret n°2013-416 du 6 juin 2013 portant

règlementation de la commercialisation des substituts du lait

maternel (SLM), et 3 Projets d’arrêtés interministériels pas

encore d’adoptés

• Insuffisance de données factuelles pour caractériser l'étendue

et le type de violations du Code et du Décret SLM

• Nécessité de réaliser une évaluation quantitative

Objectifs de l’étude

Évaluer les violations du décret national réglementant la

commercialisation des SLM dans les établissements de santé et

auprès des mères d’enfants de moins de 24 mois.

- Estimer la prévalence de l’exposition à la commercialisation des

SLM chez les mères d’enfants de moins de 24 mois

- Mesurer la prévalence des interactions entre les professionnels de

santé et les représentants des entreprises et

- Evaluer la quantité et le contenu du matériel promotionnel trouvé

dans les établissements de santé

Méthodologie

Module « Mères et établissements de santé »

• Interviews structurés avec le personnel desanté

• Interviews structurés avec les mères desenfants de 0 à 23 mois

• Observations dans les centres de santé etdans les maternités

• Analyse de la conformité des matérielspromotionnels trouvés

Etapes clés de

l’étude

Préparation de l’étude

• Recrutement du cabinet pour conduire l’évaluation

• Passage en revue du module du protocole destiné aux établissements de santé et mères par le groupe de travail technique nutrition

• Adaptation nationale des outils de collecte

• Recrutement, formation des enquêteurs

• Pre-testing et révision des outils

Collecte des données et analyse des données

• Collecte en octobre 2019, à l’aide de

Smartphone, à travers des interviews avec

les cibles et des observations réalisées

dans l’établissement

• Analyse descriptive à l’aide de STATA . Des

tests du chi carré ont été utilisés pour

vérifier la signification statistique des

différences retrouvées entre les valeurs des

variables.

Restitution des résultats de l’étude

• Atelier de restitution en mars 2020

avec les parties prenantes clés de

l’allaitement en Côte d’Ivoire en

présence du Directeur Général de

la Santé

Résultats clés

Principales formes de violations

au niveau des agents de santé

Contacts avec les agents de santé

Exposition aux équipements ou

matériels d’éducation – information

Conformité des matériels

d’éducation – information

L'examen des 66 documents d’éducation -information retrouvés des 23 établissements de santé montre que seuls 4 d’entre eux sont conformes.

Exposition des mères aux

conseils sur les SLM

Exposition des mères aux messages

promotionnels sur les SLM en dehors des

établissements de santé

Connaissance des agents de santé sur

le Code ou le Décret National

Objets promotionnels retrouvés dans

les établissements de santé

Utilisation des résultats

Renforcement de la session sur le Code SLM dans le guide de formation des formateurs de l’Initiative Structures Sanitaires Amies des Bébés (ISSAB)

ISSAB

Les résultats ont été utilisés pour élaborer un guide d’opérationnalisation de l’ANJE

Opérationnalisation de l’ANJE:

Renforcement de la promotion de l’ANJE

- Amélioration de

la mise au sein

précoce;

- Augmentation

du taux

d’allaitement

exclusif;

- Meilleures

pratiques

l’alimentations

lemonde.fr/afrique/en-cote-d-ivoire-le-lait-maternel-concurrence-par-le-marketing-agroalimentaire_html

Video

MONITORING AND ENFORCEMENT IN NIGERIA

IMPLEMENTING THE CODE AND RELEVANT WORLD HEALTH ASSEMBLY RESOLUTIONS IN WEST AND

CENTRAL AFRICA

EVA EDWARDS

DEPUTY DIRECTOR

NATIONAL AGENCY FOR FOOD AND DRUG

ADMINISTRATION AND CONTROL (NAFDAC)

NIGERIA

26TH MAY 2021

• Background on Nigeria and the Code (evolution of the Code instruments)

• NAFDAC (mandate for the Code/National Regulations) • The system for monitoring compliance with the Regulations• Enforcement of the Regulations• Critical success factors in establishing the system for

monitoring and enforcing the Regulations• Challenges• Lessons learned • Way forward

OUTLINE

• Nigeria voted for Code adoption in 1981

• Is expected to implement its provisions in their entirety as aminimum requirement for Code implementation throughappropriate NATIONAL MEASURES.

BACKGROUND: NIGERIA AND THE CODE

THE JOURNEY SO FAR…..TIMELINES

1981

Voted for adoption of the Code

1986

Code of Ethics & Professional Standards for Marketing of Breastmilk Substitutes

1990

Decree No. 41 of 1990 -Marketing (Breast-milk Substitutes) Decree. Now an Act - Cap. M5 Laws of the Federation of Nigeria (LFN) 2004

1999

Decree No. 22 of 1999 -Marketing (Breastmilk Substitutes) Decree (Amendment) to Cap. M5

2005

NAFDAC – Marketing of Infant and Young Children Food and other Designated Products (Registration, Sales, etc.) Regulations 2005

2019

NAFDAC – Marketing of Infant and Young Children Food and other Designated Products (Registration, Sales, etc.) Regulations 2019

NAFDAC - designated as the regulatory agency to implement, monitor and enforce the Code (National Regulations) in Nigeria. (Decree No. 22 of 1999 - Amendment)

• Coordinates activities for implementing the national regulations

• Monitors compliance with the national regulations• Enforces compliance with the national regulations and

applies stipulated sanctions for violations (as contained in the national regulations).

NAFDAC – THE MANDATE

• National Technical Committee on the Code/Regulations – anchored by NAFDAC

• BMS desk officers designated in every NAFDAC State Office (36 States + FCT)

• State Code monitoring teams set up

• Training of State Code monitoring teams:

➢ the national regulations, BMS Code

➢ the monitoring tools (developed based on NetCode protocols)

• Compliance monitoring activities conducted using the monitoring forms/tools

• Independent Code watchers, Code experts, interest groups – report violations

• Strategic Plan (2021-2025) on the implementation of the National Regulations and

the BMS Code.

SYSTEM FOR MONITORING COMPLIANCE WITH REGULATIONS

Some activities that support the monitoring system:

• Training of health workers to identify violations & report

• Training of journalists/media practitioners to identify violations & report or prevent the occurrence of violations

• Training of NAFDAC technical staff for product registration/labelling requirements to ensure compliance

• Post-registration inspection activities

SYSTEM FOR MONITORING COMPLIANCE WITH REGULATIONS

Resources developed to support the system for monitoring compliance with the

national regulations:

• Monitoring tools based on NetCode protocols

• Training manuals (in modules)

• National regulations/Code advocacy briefs for legislators & policy-makers, the

media, religious & community leaders, health professionals, mothers & families

• Key messages on Breastfeeding, TV/radio campaigns

• Strategic Plan (2021-2025) on the implementation of the National Regulations and

the BMS Code

• mobile monitoring application for real time monitoring/reporting (awaiting

finalization and deployment)

SYSTEM FOR MONITORING COMPLIANCE WITH REGULATIONS

BREASTFEEDING LEAFLETS AT HEALTH FACILITY MONITORING (LAGOS 2019)

• Reported violations are investigated and verified by NAFDAC • Violator receives official communication from NAFDAC of the contravention• Enforcement Directorate of NAFDAC is activated; violator liable on conviction to

penalties/deterrent sanctions in line with the regulations:

➢warning letters for first offenders ➢seizure of offending articles for destruction ➢hold or detention of product to allow possible corrective action➢administrative fines ➢closure of business premises ➢invalidation of Marketing License ➢confiscation of assets ➢prosecution of recalcitrant offenders, leading to fines not less than

N150, 000 – N2, 000,000 and jail term not exceeding 6 months, as appropriate.

ENFORCEMENT OF COMPLIANCE WITH THEREGULATIONS

CRITICAL SUCCESS FACTORS IN ESTABLISHING THE SYSTEM FOR MONITORING AND ENFORCEMENT

• Competent Authority - designated by law to monitor and enforce the Regulations

• Sustained Political will/commitment - leadership of NAFDAC and partners

• National Technical Committee on the Code - comprising key stakeholders

• Training/re-training - core group of Code experts, master trainers

• Coordination and Collaboration - key ministries, departments & agencies; partners

• Existence of a strong governance structure at national and sub-national levels of

NAFDAC - all 36 States and the Federal Capital Territory

• Capacity for registration and routine inspection of BMS products by NAFDAC (post

registration)

• Sustained support from development partners - technical and financial

Inadequate budget/funding for Code activities, significant reliance on donor funding

➢ dedicated budget lines for sustainability

Inadequate numbers of trained personnel on the Code/national regulations

➢ increased training/capacity building activities

Lack of designated BMS desk officers in NAFDAC for focused coordination in the States

➢ designated BMS desk officers across the States, trained

Low/non-existent awareness of the Code/national regulations among health workers, media practitioners, mothers, the general public & infant food manufacturers/marketers

➢ training & re-training, sensitization/awareness, media campaigns, advocacy, WBW.

Ad hoc system of monitoring compliance

➢ establish monitoring system, the Strategic Plan

SOME CHALLENGES AND MITIGATION

HEALTH WORKERS SENSITIZATION ON THE CODE

BREASTFEEDING POSTER AT HEALTH FACILITY (ABUJA 2015)

We learned that we must ensure:

• Proper funding mechanisms for Code implementation

• Proper governance and coordination of the system

• Resilience of the system

• Sustainability of the system

• Collaboration with ALL stakeholders

• Adequacy of Code champions, Code watchers, Code experts, master trainers

• Sustained training and re-training, sensitization of stakeholders for effective implementation, monitoring and enforcement of the national regulations/Code

LESSONS LEARNED

2020 CODE STATUS REPORT:

• Nigeria: 1 of 11 countries that have “enacted new Code-related

legislation or amended existing legal measures” since the last Code

Status Report.

• National regulations: “substantially aligned with the Code”.

• Close identified gaps in legal measures, improve funding mechanisms,

encourage research, intensify action on monitoring and enforcing

compliance with the regulations.

WAY FORWARD

THANK YOU!

Simeon Nanama

UNICEF West and Central Africa

with

Edouard Zerbo

IBFAN Afrique

Wrap up

Dr. Namoudou Keita

West African Health Organization

Closing remarks

Thank you