Table 3 Gear strengths and gaps identified in the Becoming breastfeeding friendly pilot testing process in Ghana

Advocacy

• Strong capacity for breastfeeding advocacy and advocates exists at highest levels of government

• There is no network of advocates and thus advocacy is not coordinated

• Advocacy is not sustained

• Advocacy mainly limited to world breastfeeding week celebration

• Engage and Build capacity of media practitioners

• Promote breastfeeding through existing forums

• Actively engage and train breastfeeding champions

Political will

• Political will is demonstrated by existing government initiatives

• Key government staff are influencing breastfeeding policy development

• Actions by government staff has not translated into full action for breastfeeding

• Engage parliamentarians using policy briefs

• Advocate for adoption of ILO convention on maternity protection (No.183)

Legislation and policy

• Strong policy and legislative environment identified (BFHI, the Code, maternity protection, etc)

• Institutions exist to implement these policies/legislation

• Gaps identified in existing legislation with respect to current WHA resolutions

• Duration of maternity leave is less than ILO minimum standard

• Code not enforced nation-wide

• Revise LI 1667 to incorporate recent WHA resolutions

• Revise penalties for LI 1667 violations

• Strengthen implementation of the code

• Facilitate adoption of at least 14 weeks maternity leave

Funding and resources

• At least one fully funded position for breastfeeding coordination and monitoring at national level

• No earmarked funding for breastfeeding at national or sub-national levels for government and private sector breastfeeding services

• Provide adequate funding for breastfeeding programs

• Track expenditure on breastfeeding programming

Training and program Delivery

• Revised curricula for pre-service training in breastfeeding

• In-service training activities has been implemented throughout the country

• Breastfeeding is integrated into various existing programs at sub-national level

• BFHI designation and implementation exists

• Revised curricula not being utilized in many training institutions

• Coverage of in-service training remains sub-optimal and poorly tracked/coordinated

• No clear definition of competence level of trainers

• BFHI coverage is low and infrequently re-assessed

• Promote use of revised pre-service training curricula

• Harmonize and Track coverage of breastfeeding capacity strengthening

• Strengthen BFHI monitoring/re-assessment process

Promotion

• Several government initiatives (strategy documents) identified that aim to promote breastfeeding

• Identified initiatives are not adequately funded by government

• Impact of these initiatives on awareness is sub-optimal

• Engage retired health staff to promote breastfeeding

• Provide funding for promotion activities

• Promote breastfeeding using maternity promotion platforms

Research and evaluation

• Indicators exists for regular (surveys), and routine (institutional data) monitoring of breastfeeding

• BFHI/Ten Steps monitoring system exists

• Data exists for tracking progress in breastfeeding practice at national but not sub-national levels

• No data on vulnerable groups

• No tracking system for violations of maternity protection legislation

• No tracking of BCC

• Implement planned annual breastfeeding surveillance system

• Identify and track vulnerability to breastfeeding

• Decentralize monitoring of the code

• Track BCC activities

Coordination, goals, and monitoring

• Multi-sectoral BFHI Authority coordinates implementation of BFHI at national level; BFHI monitoring decentralized

• IYCF task team provides guidance on breastfeeding policy at national level

• Committees met infrequently and on a need-to-act basis

• Ensure regular meetings of coordination bodies

• Develop a workplan for action on breastfeeding