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

From: Scaling up breastfeeding policy and programs in Samoa: application of the Becoming Breastfeeding Friendly initiative

GearGear ScoreGear StrengthGapsRecommendations
Advocacy1.5Moderate• 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 Will2.0Moderate• 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 & Policy1.8Moderate• 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 & Resources0.5Weak• 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 Delivery1.8Moderate• 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
Promotion2.0Moderate• 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 & Evaluation1.8Moderate• 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 & Monitoring1.7Moderate• 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.