Table 1 BBF gear score, gear strength, gaps and recommendations. Samoa, 2018

Advocacy

1.5

Moderate

• Lack of any high-level advocates or influential individuals who have taken on breastfeeding as a cause that they are promoting

• Lack of a formal National Breastfeeding Advocacy Strategy policy but some components are included in the National Nutrition Strategy (that was developed based on existing data and has indicators of effectiveness)

• There is a multisectoral breastfeeding committee that has national coverage but the strengths of the political commitment are not clear or documented

• Develop an evidence-based National Breastfeeding Advocacy Strategy

• Integrate breastfeeding into other health events during the year

• Seek a champion on breastfeeding to become a role model to advocate for breastfeeding

Political Will

2.0

Moderate

• Expressed political commitment is only showcased during annual events; Samoan culture/traditional beliefs and values as well as the political environment (e.g. Samoan political sphere is male dominate and older) may explain why there is little, consistent public official support

• Limited breastfeeding awareness at the political level

• Strengthen commitment to breastfeeding action at the political level

• Improve government’s efforts towards promoting an enabling environment for breastfeeding at a national level

• Government to be more proactive in creating awareness of legislations and policies affecting female employees

Legislation & Policy

1.8

Moderate

• Lack of a national breastfeeding policy, but breastfeeding is integrated into a National Health services policy

• No approval yet to pass the law to enforce penalties for breaching the Code

• Maternity protection laws are largely compliant with the Maternity Protection Convention 2000, but it has not been ratified

• Lack of legislation for workplace accommodations for breastfeeding

• Endorse and implement legislation on infant and young child feeding and the Code

• Ratify Maternity Protection Convention 2000

• Have legislation that promotes as upportive worksite for breastfeeding women

• Develop and endorse a National Breastfeeding Policy

• Have a formal mechanism for maternity entitlement for all working women

Funding & Resources

0.5

Weak

• Lack of a national budget line for breastfeeding

• Lack of adequate funding and human resources for breastfeeding;

• Lack of a national breastfeeding coordinator that is funded full time to primarily work on breastfeeding promotion

• Limited formal mechanism by which maternity entitlements are funded

• Create a national budget line for breastfeeding promotion activities.

• Have a national coordinator position for breastfeeding for lactation counselors/ master trainers and BFHI/Ten Steps

Training & Program Delivery

1.8

Moderate

• Lack of standard breastfeeding training in preservice medical, nursing, and midwife curricula

• Limited number of trainers - there are two “master trainers” with only 60% of staff trained in the National Health Service with the 20 h World Health Organization breastfeeding training program

• Need online breastfeeding courses/topics that are endorsed

• Need for continue education credit courses for nurses, doctors, and midwives

• BFHI audit reports are internal and not all reports are published online (such as on the MOH website)

• Lack of any lactation consult/specialist supervisors

• Certification of the breastfeeding counseling training program by the Samoa Qualification Attorney (SQA) and MOH

• Pre-service curriculum should include breastfeeding and be uniform for all preservice provider education including nursing and medicine

• Have an annual breastfeeding training and regular in-service training for new staff in the maternity services

Promotion

2.0

Moderate

• Lack of a national breastfeeding promotion strategy, but rely on the National Nutrition policy

• Limitations with consistent data collection and the coordination/awareness of various programs to support breastfeeding. Every organization is doing something for, breastfeeding but there is lack of coordination

• Review outdated National Infant and Young Child Feeding (IYCF) Strategy and incorporate apromotion strategy for breastfeeding

• National IYCF has a set annual plan for activities to be in place

Research & Evaluation

1.8

Moderate

• MOH data is collected yearly (including annual audited BFHI reports) but it is not publicly available

• Lactation counseling happens at individual basis but no monitoring system is in place

• Publish data on breastfeeding practices online via Ministry of Health website

• Establish an annual population-based surveillance or monitoring system to track breastfeeding /lactation counselling and support

• Strengthen implementation of routine data collection on breastfeeding during clinical visits

Coordination, Goals & Monitoring

1.7

Moderate

• Samoa has a National Multisectoral Committee on Breastfeeding with team members from MCIL, MNRE, MOH, NHS, PSC, MPE, SFH, and SRC but there is no workplan

• There is insufficient information online and data are disaggregated. No e-health system is available to evaluate the breastfeeding program progress

• Conduct an Annual National Symposium for Breastfeeding

• Create support network and service for breastfeeding free short message service (SMS) helpline.