Analysis of stakeholder networks for breastfeeding policies and programs in Ghana

Amber Hromi-Fiedler,Rafael Pérez-Escamilla,Richmond Aryeetey,Kassandra Harding

doi:10.1186/s13006-020-00311-x

Amber Hromi-Fiedler, Rafael Pérez-Escamilla + Show 2 more

Open Access

https://doi.org/10.1186/s13006-020-00311-x

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Abstract

BackgroundSuboptimal breastfeeding practices are driven by multiple factors. Thus, a multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding.MethodsThis study used Net-Map, an interactive social network interviewing and mapping technique, to: a) identify key institutional actors involved in breastfeeding policy/programs in Ghana, b) identify and describe links between actors (i.e., command, dissemination, funding, and technical assistance (TA)), and c) document actors influence to initiate or modify breastfeeding policy/programs. Ten experts were purposively selected from relevant institutions and were individually interviewed. Interview data was analysed using social networking mapping software, Gephi (version 0.9.2).ResultsForty-six unique actors were identified across six actor categories (government, United Nations agencies, civil society, academia, media, others), with one-third being from government agencies. Dissemination and TA links accounted for two-thirds of the identified links between actors (85/261 links for dissemination; 85/261 for TA). Command links were mainly limited to government agencies, while other link types were observed across all actor groups. Ghana Health Service (GHS) had the greatest in-degree centrality for TA and funding links, primarily from United Nations Children’s Fund (UNICEF) and development partners. The World Health Organization, UNICEF, Ministry of Health, and GHS had the highest weighted average relative influence scores.ConclusionsAlthough diverse actors are involved in breastfeeding policy and programming in Ghana, GHS plays a central role. United Nations and donor agencies are crucial supporters of GHS providing breastfeeding technical and financial assistance in Ghana.

Highlights

IntroductionA multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding
Suboptimal breastfeeding practices are driven by multiple factors
Across the 10 interviews, 46 unique actors who engaged with breastfeeding promotion, protection, and support, were identified into six actor groups including government agencies (41.3%), non-governmental/civil society organizations (26.1%) and United Nations agencies (10.9%) (Table 2)

Summary

Introduction

A multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding. Policies and programs that protect, promote, and support breastfeeding represent an important, cost-effective pathway to improve human health and development outcomes [1, 2]. The adoption of national policies contributed to the improvement of breastfeeding outcomes in Ghana, beginning in 1992, with the adoption of the International Code of Marketing of Breastmilk Substitutes [9]. Between 1993 and 2003, Ghana adopted additional supportive breastfeeding policies (i.e. Baby-Friendly Hospital Initiative, National Breastfeeding Policy, Breastfeeding Promotion Regulation, maternity protection provisions in the National Labour Law) [9], which translated into stronger breastfeeding outcomes over the decade. The national Labour law [10] incorporates maternity protection provisions of the International Labour Organization (ILO)

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Discussion

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