Helen Keller International, New York, New York, USA.
Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA.
Matern Child Nutr. 2019 Jun;15 Suppl 4(Suppl 4):e12795. doi: 10.1111/mcn.12795.
Globally, monitoring and enforcement mechanisms for the World Health Organization's International Code of Marketing of Breast-milk Substitutes are often lacking. The Cambodian government adopted the Code as the national standard in Sub-Decree 133 on Marketing of Products for Infant and Young Child Feeding. Following the formation of a multisectoral Oversight Board and development of detailed guidance documents for the implementation and enforcement of Sub-Decree 133, a 7-month pilot was conducted in 2017 to trial a monitoring system in four urban areas of Cambodia. The pilot included training of monitors from the Ministries of Health and Commerce, screening for violations at retail locations and health facilities, testing reporting mechanisms, and taking actions against violators. During the pilot, 85 national- and subnational-level monitors were trained, 392 site visits were made, 2,377 monitoring checklists were completed, and 11 warning letters were issued to violators. Half of the completed checklists (52.9%) indicated Code violations, yet monitors submitted zero violation reports. The pilot revealed modifications needed to the monitoring system: integrate monitor trainings into existing ministry training curricula for sustainability; enhance targeting of monitors for Sub-Decree training; delineate clear roles and responsibilities for the national and subnational levels; simplify monitoring checklists and violation reports; and improve integration of monitoring activities into routine ministry operations. Before the Sub-Decree 133 monitoring and enforcement system is implemented throughout Cambodia, revisions must be made to ensure the viability of this system. Challenges and lessons learned can also guide Code monitoring efforts being undertaken by other countries.
全球范围内，世界卫生组织国际母乳代用品销售守则的监测和执行机制往往缺乏。柬埔寨政府通过第 133 号政府令将该准则作为国家标准，纳入《婴幼儿食品营销产品子法令》。在成立多部门监督委员会并制定实施和执行第 133 号政府令的详细指导文件之后，2017 年进行了为期 7 个月的试点，在柬埔寨四个城市地区试行监测系统。试点包括对卫生部和商务部监测员进行培训，在零售点和卫生机构筛查违规行为，测试报告机制，并对违规者采取行动。在试点期间，培训了 85 名国家和国家以下各级监测员，进行了 392 次现场访问，完成了 2377 份监测检查表，并向违规者发出了 11 封警告信。完成的检查表中（52.9%）有一半表明存在违反守则的情况，但监测员没有提交任何违规报告。试点揭示了监测系统需要修改的地方：将监测员培训纳入现有部委培训课程，以确保可持续性；加强针对部委培训的监测员目标定位；明确国家和国家以下各级的明确角色和责任；简化监测检查表和违规报告；以及加强监测活动与部委日常运作的整合。在在整个柬埔寨实施第 133 号政府令的监测和执法系统之前，必须进行修订，以确保该系统的可行性。挑战和经验教训也可以为其他国家正在进行的守则监测工作提供指导。
