However, the data said the average total score across the eight gears declined from 2.0 in 2017 to 1.6 out of 3.0, which is the maximum performance if all the gears are optimal.

The gears are advocacy, political will, legislation and policies, funding and resources, training and programme delivery, promotion, research and evaluation, and coordination, goals and monitoring – all these must be at work and in harmony for large-scale improvement in a country’s national programme.

BBF initiative is jointly implemented by University of Ghana School of Public Health and Yale School of Public Health, USA, using an evidence-based approach to assess country policy, programmes, and institutions to determine their readiness and capacity to scale-up breastfeeding promotion, protection, and support.

Dr Richmond Aryeetey, Country Principal Investigator of BBF Project and a Senior Lecturer at University of Ghana School of Public Health, said key reasons for the change in total score  were seen in the changes in the gears scores including limited evidence of coordination across programmes and institutions.

That, he said, accounted for the decline in the gear score for coordination, and decreases in advocacy, political will, and legislation and policy gear scores.

However, three gears, including promotion, training program delivery and funding and resources remained at the same score or increased slightly, he added.

 He said the BBF Committee identified several gaps in policy and implementation of programmes, which include inadequate advocacy and promotion about breastfeeding; insufficient allocation of funds to breastfeeding programmes and inadequate number and skill of trained personnel in breastfeeding.

The rests were weak system of coordination among key stakeholders in breastfeeding, and unanswered questions in breastfeeding requiring research evidence.

Dr Aryeetey said based on the identified gaps, the Committee suggested recommendation, which were prioritised based on feasibility, affordability, and effectiveness.

They included ensuring strong and sustained promotion environment for breastfeeding’ ensuring adequate funding and resources were allocated for breastfeeding promotion, protection and support in Ghana, ensuring strong institutional and individual capacity for service delivery and accountability.

Other recommendations were ensuring coordination and partnership across key holders and ensuring decisions on breastfeeding policies and programme were evidence-informed.

Dr Aryeetey said in Ghana, exclusive breastfeeding rate and early rates were not optimal, as the 2014 demographic and health Survey report showed that almost half of children were not put to breast within the first one hour of life, also, only about half of Ghanaian children were given breast milk exclusively during the first six months.

He said, for the situation to change, there needed to be a deliberate efforts to promote and priotise breastfeeding through various media, protect breastfeeding from threats such as unhealthy marketing of breastfeeding milk substitutes, as well as inappropriate cultural and commercial influences that limited appropriate breastfeeding practices. 

“There is also the need for policy and programmes that support breastfeeding at home, work and everywhere and by everyone. Continuous monitoring of breastfeeding programmes is necessary to ensure optimal breastfeeding programmes,” he added.

Mrs Esther Duah, Deputy Chief Nutrition Officer, Ghana Health Service, said already 634 maternity facilities have been declared ‘Becoming Breastfeeding Friendly’ and another 88 facilities also met the criteria and would soon be announced.

She said children that were put on exclusive breastfeeding turn to be healthier and grew better than those who did go through exclusive breastfeeding.

“Children with exclusive breastfeeding are less likely to fall sick as compared to the non-exclusive breastfeeding children,” she said and stressed on the need to scale up the campaign on exclusive breastfeeding to benefit the children, mothers and the country at large.

She said the situation where health facilities have children nurseries where mothers were not staying with their babies also serve as a barrier for BBF and  expressed her gratitude that the system had been abolished to give mothers adequate time to breastfeed their babies.

Joan Schubert, Chief of Party, BBF Project, said their target was no more promoting exclusive breastfeeding but also to teach mothers how to introduce their children to food after six months to ensure their survival, growth, and development.

Armber Hromi-Fiedler, Associate Research Scientist at Yale School of Public Health, USA, said Ghana and Mexico were the first countries to implement BBF and emphasised the need to empower countries to assess their current readiness to scale up.