Program Delivery

Facility-Based Delivery Theme

Description : Breastfeeding promotion and support standards and guidelines need to be developed and disseminated to ensure delivery of high quality breastfeeding care within facilities providing maternity and newborn care. Breastfeeding standards and guidelines can be developed and disseminated as an individual guideline or can also be included in maternity and/or child health materials (for example, young child feeding guidelines, child health guidelines). This benchmark measures the availability and coverage of breastfeeding promotion and support standards and guidelines. 

Possible data sources : Interviews with government officials within the area of infant/young child feeding and health provide evidence of the availability and coverage of breastfeeding promotion and support standards and guidelines for program delivery.

How to score : The scoring reflects the:

a) Development of standards and guidelines for breastfeeding promotion and support; and
b) Level of dissemination to facilities and personnel.


☐ No progress: Standards and guidelines for breastfeeding promotion and support have not been developed.

☐ Minimal progress: Standards and guidelines have been developed but they have not been disseminated to any facilities and personnel providing maternity care. 

☐ Partial progress: Standards and guidelines have been developed and disseminated to some facilities and personnel providing maternity care. 

☐ Major progress: Standards and guidelines have been developed and disseminated to all facilities and personnel providing maternity care.

Description : This benchmark measures if assessment systems are in place for designating facilities as BFHI/Ten Steps which certifies that the steps required to become “Baby-Friendly”, have been completed.  Assessment systems must be based on the same criteria as the BFHI UNICEF/WHO global criteria and must be incorporated into the national plan to have maximum effectiveness.

Possible data sources : Interviews with government officials within the area of infant/young child feeding and health provide evidence of the existence of assessment systems for designating facilities as BFHI/Ten Steps.  A review of the assessment systems protocols and the National Breastfeeding Plan are needed to understand the quality and content of the assessment systems. 

How to score : The scoring of this benchmark reflects the:

a) Existence of assessment systems for designating BFHI/Ten Steps facilities;
b) Quality of the assessment system; and
c) Level of incorporation of the assessment systems into the National Breastfeeding Plan. 

☐ No progress: No assessment systems exist for designating BFHI/Ten Steps facilities. 

☐ Minimal progress: Assessment systems exist but they are not based on the BFHI UNICEF/WHO global criteria nor are they incorporated into the National Breastfeeding Plan. 

☐ Partial progress: Assessment systems exist and are based on the BFHI UNICEF/WHO global criteria but they are not incorporated into the National Breastfeeding Plan. 

☐ Major progress: Assessment systems exist and they are based on the BFHI UNICEF/WHO global criteria and they are incorporated into the National Breastfeeding Plan.

Description : This benchmark measures the existence of a Baby-Friendly/Ten Steps reassessment system designed to determine if facilities continue to adhere to the criteria is necessary to continue to support breastfeeding programs. 

Possible data sources : Interviews with government officials within the area of infant/young child feeding and health provide evidence of the existence of reassessment systems for reevaluating designated Baby-Friendly/Ten Steps facilities.  A review of the reassessment systems protocol and the National Breastfeeding Plan are needed to understand the quality and content of the reassessment systems. 

How to score : The scoring for this benchmark reflects the:

a) Existence of reassessment systems to reevaluate Baby-Friendly/Ten Steps facilities;
b) Incorporation into the National Breastfeeding Plan; and
c) Presence/absence of time bound implementation.


☐ No progress: No reassessment systems exist for reevaluating designated Baby-Friendly/Ten Steps facilities. 

☐ Minimal progress: Reassessment systems exist- not been incorporated in the National Breastfeeding Plan with a time bound implementation plan. 

☐ Partial progress: Reassessment systems exist - incorporated in the National Breastfeeding Plan but no time bound implementation plan. 

☐ Major progress: Reassessment systems exist - incorporated in the National Breastfeeding Plan and have a time bound implementation plan.

Description : This benchmark assesses the proportion of deliveries that take place within hospitals and maternity facilities that have been designated or recertified as baby-friendly over the past 5 years. The following questions from the WHO Global Nutrition Policy Review module on the Baby-friendly Hospital Initiative can be used to help assess how many healthcare facilities (pubic and private) have ever been designated Baby-Friendly:

  • How many of these have been designated or re-assessed as Baby-Friendly in the past 5 years?
  • What is the total number of births per year in the facilities that were designated or re-assessed as Baby-Friendly in the past 5 years?

Possible data sources : Reviews of reports on the status of the BFHI in the country including Ministry of Health (MOH) (including the National Breastfeeding/Infant and Young Child Feeding committee), UNICEF, etc.  Conduct interviews with government officials in the MOH and experts working in-country with UNICEF, Pan American Health Organization (PAHO) or WHO that are familiar with BFHI within the country.

How to score : Scoring reflects the coverage of BFHI in country. 

☐ No progress: No maternity facilities have been designated or reassessed as “Baby-Friendly” in the last 5 years.

☐ Minimal progress: Less than or equal to 33.3% of deliveries take place in hospitals and maternity facilities designated or reassessed as “Baby-Friendly” in the last 5 years. 

☐ Partial progress: Between 33.3% and 66.6% of deliveries take place in hospitals and maternity facilities designated or reassessed as “Baby-Friendly” in the last 5 years.

☐ Major progress: More than 66.6% of deliveries take place in hospitals and maternity facilities designated or reassessed as “Baby-Friendly” in the last 5 years.

Description : Healthcare facilities should be providing community outreach and support activities for breastfeeding: 
Promote breastfeeding:

  • Community health fairs
  • Disseminate educational materials in community settings or via media
  • Continuous activities - breastfeeding educational sessions for pregnant and postpartum women in community settings

 Breastfeeding support activities:

  • In-person (outpatient), on-line, or phone access to professional breastfeeding support
  • Provide individual and group breastfeeding counseling

This benchmark assesses if health facilities are implementing breastfeeding related community outreach and support activities and how well it links with existing community-based breastfeeding/nutrition programs.

Possible data sources : Interviews can be conducted with government officials within the MOH, the national and local breastfeeding coordinators, representatives of NGOs involved in health or breastfeeding; health facility officials, representatives of organizations involved with mother-to-mother support groups. If available, the National Breastfeeding Plan can be reviewed to understand the specific health-facility based community outreach and support activities and the coverage reached.   

How to score : The scoring reflects the:

a) Level and quality of implementation of health facility-based community outreach and support activities; and
b) Level and quality of linkages with community breastfeeding/nutrition programs. 

☐ No progress: No health facility-based community outreach and support activities related to breastfeeding are being implemented and linkages with community breastfeeding/nutrition programs are not in place. 

☐ Minimal progress: Health facility-based community outreach and support activities are minimally implemented -local level only- or limited linkages with community breastfeeding/nutrition programs are in place. 

☐ Partial progress: Health facility-based community outreach and support activities are effectively implemented -national, subnational, and local level- or effective linkages with community breastfeeding/nutrition programs are in place. 

☐ Major progress: Health facility-based community outreach and support activities are effectively implemented and effective linkages with community breastfeeding/nutrition programs are in place.

Community-Based (i.e. Non-Health Care Facilities Delivery) Theme

Description : This benchmark assesses if non-health care facilities, such as community organizations, have conducted breastfeeding outreach and support activities and, if so, have they achieved national coverage.
Community based outreach: Home visits, mother-to-mother support groups, providing hands-on assistance and breastfeeding guidance beyond the hospital walls.

Possible data sources :  Interviews can be conducted with government officials within the MOH, the national and local breastfeeding coordinators, representatives of NGOs involved in health or breastfeeding; health facility officials, representatives of organizations involved with mother-to-mother support groups. If available, the National Breastfeeding Plan can be reviewed to understand the specific community-based outreach and support activities and the coverage reached.   

How to score : The scoring for this benchmark reflects the availability and coverage of community-based breastfeeding outreach and support activities. Full national coverage refers to the fact that all activities are being implemented to cover all the specific target population. For example, if a community-based breastfeeding initiative is designed to reach an indigenous/ethnic population that only lives within a certain geographical area within the entire country, coverage would be considered national if the program activities reach the entire target population.

☐ No progress: No community-based breastfeeding outreach and support activities. 

☐ Minimal progress: Community-based breastfeeding outreach and support activities have minimal coverage - at the local level only. 

☐ Partial progress: Community-based breastfeeding outreach and support activities have partial coverage - local and subnational level only. 

☐ Major progress: Community-based breastfeeding outreach and support activities have full national coverage.

Supervision Theme

Description : Supportive supervision refers to a non-authoritarian method of monitoring and evaluating staff performance. 

Supervisors :

  • Serve as mentors
  • Encourage two-way communication
  • Facilitate team building
  • Encourage problem solving
  • Monitor performance towards goals
  • Maintain regular follow-ups with staff

Possible data sources : Interviews can be conducted with the national breastfeeding coordinator and representatives of NGOs involved in health or breastfeeding. If available, MOH documents specifying the parameters and registries reporting on coverage attained with supportive supervision should be reviewed to corroborate the key informants’ reports.

How to score : The scoring for this benchmark assesses the availability and coverage of trained and certified lactation management specialists available to provide supportive supervision for breastfeeding program delivery. 

☐ No progress: No trained and certified lactation management specialists available to provide supportive supervision for breastfeeding program delivery at either the facility or community level. 

☐ Minimal progress: Trained and certified lactation management specialists available at the facility and/or community level with sub-national/local coverage

☐ Partial progress: Trained and certified lactation management specialists available at the facility and community level reaching partial national coverage

☐ Major progress: Trained and certified lactation management specialists at the facility and community level reaching full national coverage.

Breastfeeding support, Raichur, India

A technology enhanced campaign uses laptops to support breastfeeding among women in a rural area in Raichur, India. © 2013 Dr Abhay Mane/ Smt. Kashibai Navale Medical College, Courtesy of Photoshare