Pilot testing of the Becoming Breastfeeding Friendly toolbox in Ghana

Abstract Background Ghana has achieved significant progress in breastfeeding practices in the past two decades. Further progress is, however, limited by insufficient government funding and declining donor support for breastfeeding programs. The current study pretested feasibility of the Becoming Breastfeeding Friendly (BBF) toolbox in Ghana, to assess the existing enabling environment and gaps for scaling-up effective actions. Methods Between June 2016 and April 2017, a 15-person expert country committee drawn from government and non-government agencies was established to implement the BBF toolbox. The committee used the BBF index (BBFI), comprising of 54 benchmarks and eight gears of the Breastfeeding Gear Model (advocacy; political will; legislation and policy; funding and resources; training and program delivery; promotion; research and evaluation; and coordination, goals and monitoring). Available evidence (document reviews, and key informant interviews) was used to arrive at consensus-scoring of benchmarks. Benchmark scores ranged between 0 (no progress) and 3 (major progress). Scores for each gear were averaged to estimate the Gear Total Score (GTS), ranging from 0 (least) to 3.0 (strong). GTS’s were aggregated as a weighted average to estimate the BBFI which ranged from 0 (weak) to 3.0 (outstanding). Gaps in policy and program implementation and recommendations were proposed for decision-making. Results The BBFI score was 2.0, indicating a moderate scaling-up environment for breastfeeding in Ghana. Four gears recorded strong gear strength: advocacy (2.3); political will (2.3); legislation and policy (2.3); and coordination, goals and monitoring (2.7). The remaining four gears had moderate gear strength: funding and resources (1.3); training and program delivery (1.9); promotion (2.0); and research and evaluation (1.3). Key policy and program gaps identified by the committee included sub-optimal coordination across partners, inadequate coverage and quality of services, insufficient government funding, sub-optimal enforcement of policies, and inadequate monitoring of existing initiatives. Prioritized recommendations from the process were: 1) strengthen advocacy and empower breastfeeding champions, 2) strengthen breastfeeding regulations, including maternity protection, 3) strengthen capacity for providing breastfeeding services, and 4) expand and sustain breastfeeding awareness initiatives. Conclusions The moderate environment for scaling-up breastfeeding in Ghana can be further strengthened by addressing identified gaps in policy and programs

Additional file 1: of Pilot testing of the Becoming Breastfeeding Friendly toolbox in Ghana

Appendix S1. Benchmark scores. This table presents the benchmark scores as well as gear total scores generated by the Becoming Breastfeeding Friendly Country committee in Ghana. (DOCX 18 kb

Additional file 3 of Pilot testing of the Becoming Breastfeeding Friendly toolbox in Ghana

Appendix S3. Policy Brief. This document is a policy brief developed and shared with high level decision makers across government and non-government stakeholders who participated in a high level decision makers consultation aimed at increasing awareness and uptake of the findings of the Becoming Breastfeeding Friendly Toolbox in Ghana. (PDF 1017 kb

Additional file 2: of Pilot testing of the Becoming Breastfeeding Friendly toolbox in Ghana

Appendix S2. Infographic. This document is an infographic which was developed and shared with key stakeholders in breastfeeding in Ghana who were invited to participate in the fifth committee meeting of the Becoming Breastfeeding Friendly Committee. (PDF 860 kb