D4: Designation Phase

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The D4: Designation Phase is the “assessing phase” of the 4-D Pathway.

Your facility will enter the Designation Phase after submitting a “Request to Move Letter” and the Dissemination Phase fee to Baby-Friendly USA (BFUSA).  At that time, BFUSA will provide your facility with a Dissemination Phase Certificate of Completion and provide access to the online Designation Phase Tool Kit.

The “Request to Move Letter” should be submitted when data from your quality improvement audits indicates your facility is meeting, or nearly meeting the standards outlined in the Guidelines and Evaluation Criteria.

Implementation of the International Code of Marketing of Breast-milk Substitutes

One of the final steps facilities must address is documenting and implementing payment of fair market value for all breast milk substitutes, bottles, nipples, pacifiers, and other infant feeding equipment.  Success in this area requires that you identify your fair market value for these products, document your process for determining fair market value, notify vendors of your intent to pay fair market value for these items, and maintain current invoices on file and proof that your facility is paying fair market value for these products. The online Designation Phase Tool Kit has resources to assist your facility in accomplishing this Baby-Friendly standard.

Telephone Readiness Assessment Interview – should be requested within 2 months of entering the Designation Phase

BFUSA provides facilities with a Telephone Readiness Assessment Interview. This 90-minute phone interview conducted by BFUSA staff will ask you a series of questions intended to assess your facility's readiness for the on-site assessment.  During the interview, we will discuss your quality improvement audits, infant feeding policy, and Attestation of Purchase of Breast-Milk Substitutes.  BFUSA will provide verbal and written feedback on areas in need of improvement.  Facilities find that the Readiness Assessment Interview helps them identify areas that require additional attention prior to the on-site assessment being scheduled.
It is strongly recommended that this interview take place shortly after your facility enters the Designation Phase because it will provide you with ample time to correct any areas that do not meet the requirements of the Guidelines and Evaluation Criteriaprior to scheduling your on-site assessment.

On-site Assessment - should be requested within 8 months of entering the Designation Phase

Once the areas identified during the Readiness Assessment Interview are corrected, the facility will send a letter to BFUSA requesting that the on-site assessment be scheduled.  In addition, BFUSA requires an updated Facility Data Sheet with 4 weeks of actual data, collected within 2 months of the on-site assessment, along with the most recent infant feeding policy and Attestation of Purchase of Breast-Milk Substitutes.  

The on-site assessment is a two-stage process. The first is the on-site assessment conducted by a BFUSA assessment team. Upon completion of their visit, the findings are compiled into a report, blinded and sent to the BFUSA External Review Board (ERB). The ERB determines whether or not the facility has fully implemented the Guidelines and Evaluation Criteria. Upon determination that the Guidelines and Evaluation Criteria have been met, the facility will officially be designated and granted a license to use the Baby-Friendly certification mark. If the facility does not pass the on-site assessment, there is a corrective action process that may require a re-assessment when identified problems have been corrected.

Additional Time in the Phase

Be aware that every facility faces different challenges.  Some find it necessary to take longer than the timelines outlined here to fully implement the tasks of the phase. If your facility is in this situation, you should not feel discouraged. The culture change you are making is enormous and sometimes requires additional time.  If this is your circumstance, contact BFUSA to learn about your options.

Link to: Maintaining Your Designation

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