Nine key responsibilities of a national BFHI programme
National leadership and coordination are critical to achieving the goal of scaling up the Baby-Friendly Hospital Initiative to 100% coverage. Every mother and baby throughout the world deserve to receive the care embodied in the Ten Steps to Successful Breastfeeding. The 2018 BFHI Implementation Guidance outlines nine key responsibilities of national leadership. As the WHO/UNICEF illustrate in the diagram below, national leadership and coordination is the first priority and at the center of all other activities.
A national breastfeeding coordination body can help promote policies that protect, promote and support breastfeeding as well as encourage implementation of the BFHI. WHO and UNICEF recommend that the national breastfeeding coordination body be multi-disciplinary and consist of a wide array of individuals working in the maternal and child health field including academia, breastfeeding support organizations, community-based organizations, government, mother support organizations and non-governmental professional organizations.
Those with a conflict of interest, particularly who work for and/or receive funding from companies who produce and/or market foods for infants and young children or feeding bottles and/or teats may not be members of this body. Other conflicts of interest include individuals/organizations whose activities and/or affiliations may be perceived to impact the integrity, credibility and/or impartiality of the BFHI. To address some potential conflicts of interests, some countries have found it to be beneficial to have two separate bodies: a breastfeeding coordination body and a BFHI coordination body. The BFHI coordination body should be multidisciplinary and is primarily responsible for overseeing all aspects of the national BFHI programme. It is essential that the national BFHI coordination body be seen as objective and free from conflicts of interest.
For more information on establishing or strengthening a national breastfeeding coordination body, see BFHI Implementation Guidance page 31.
All mothers and infants should benefit from the evidenced based practices embodied in the Ten Steps to Successful Breastfeeding (Ten Steps). As such, inclusion of the Tens Steps in as many national policy documents as possible will result in their widespread knowledge. In addition, governmental policies can have a powerful influence on health care practices. They inspire professional organizations to address the recommended practices in their relevant standards of care documents. They also provide vital tools for breastfeeding advocates to encourage changes to current practice at the hospital level.
For more information on integrating the Ten Steps into relevant national policy documents and professional standards of care, see BFHI Implementation Guidance page 31-32.
All health professionals working with pregnant women, mothers and infants must demonstrate competence in delivering safe, compassionate and appropriate care. Ideally, this should be addressed in pre-service education. However, since breastfeeding management competencies are not currently included in the curriculum for most professions, this must be carried out at the facility level for those currently in practice. To assist countries with this requirement, the WHO/UNICEF developed the BFHI Competency Verification Toolkit. Please note, the list of competencies included in this document replace those listed on page 15 of the 2018 BFHI Implementation Guidance.
For more information on ensuring the competency of health professionals and managers in implementation of the Ten Steps, see the BFHI Implementation Guidance page 32-33.
An objective external assessment by an independent body is the most effective means for verifying that a facility has properly implemented the Ten Steps to Successful Breastfeeding in accordance with the global BFHI guidelines and national evidence-based quality standards. External assessments should be conducted at least every 5 years and include a review of key documents (infant feeding policy, monitoring systems, clinical practice data related to the sentinel indicators, etc.) as well as interviews with hospital staff, pregnant women and new mothers.
For more information on utilizing external assessment systems to regularly evaluate adherence to the Ten Steps, see the BFHI Implementation Guidance page 33-34.
There are a variety of factors taken into consideration as health care facilities develop and revise policies and procedures. Many are motivated by scientific evidence, accreditation and recognition programs. Some are motivated by public reporting of health outcomes and/or performance-based financing. Countries should consider the best approach for their circumstances to achieve sustainable improvements in perinatal care.
For more information on developing and implementing incentives for compliance and/or sanctions for non-compliance with the Ten Steps, see the BFHI Implementation Guidance page 34-36
Policy and practice change can be very difficult and facilities may require trained experts to guide them through the process of adopting the Ten Steps. It is important to note that, in order to protect the integrity of the BFHI, the technical assistance providers should not be the same individuals who conduct an internal assessment of a facility. It is essential that the external assessment process be seen as objective and free from conflicts of interest.
For more information on providing technical assistance to facilities that are making changes to adopt the Ten Steps, see the BFHI Implementation Guidance page 36-37.
Collecting and evaluating key data on BFHI implementation, breastfeeding outcomes, and clinical practices is essential for guiding decision making at the national level. Countries should consider the most feasible and effective means for gathering this information.
For more information on monitoring implementation of the initiative, see the BFHI Implementation Guidance page 37.
Ongoing information sharing and communication to hospitals, health professionals and key community organizations are an essential means for encouraging more hospitals to implement the Ten Steps to Successful Breastfeeding and attain BFHI designation. This can be achieved through presentations/exhibits at meetings/conferences/webinars, publication of articles in journals and/or creation of a BFHI newsletter/social media page/website. The WHO and UNICEF recommends a 4-point communication plan that addresses:
- Identification of key audiences
- Identification of existing knowledge and attitudes
- Development of key messages
- Identification of key communication channels
For more information on advocating for the BFHI to relevant audiences, see the BFHI Implementation Guidance page 38.
Countries should examine the best source of funding to ensure the sustainability of the BFHI. Some models include fees paid by hospitals, others include grant funding by private foundations and/or government. Most importantly, it is essential that the source of funding does not generate any conflicts of interest.
For more information on identifying and allocating sufficient resources to ensure the ongoing funding of the initiative, see the BFHI Implementation Guidance page 39.
The goal of this tool is to assist countries who are working on implementing the Baby-Friendly Hospital Initiative (BFHI) with the development of both long- and short-term plans that will lead to important policy and practice changes over time. It offers a series of thought-provoking questions that relate to the nine key responsibilities of a national BFHI programme and offers tips to address specific challenges. There are many tasks that will be identified through the use of this tool. It is not expected or necessary for everything to be carried out at one time.
