Table 3.

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

Gear	Strengths	Gaps	Recommended actions
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