Dr. Ernest Konadu Asiedu

Dr. Ernest Konadu Asiedu
Public Health Physician Specialist (Healthcare Improvement Advisor/Field Epidemiologist), National Centre for Coordination of Early Warning and Response Mechanism, Ministry of Health, Ghana, Co-Creator of the Breastmilk for Life – Ghana project

What are your thoughts about the project and process of working with the Foundation?

Thank you very much. I would say generally it’s been quite an interesting experience working with the Foundation. This project also came in timely, because in the last holistic assessment, Ghana was really improving in the breastfeeding rate, and then suddenly in the last two years it hasn’t been as expected. So this coming in is also timely to address some of the challenges that we already developed as far as improving our breastfeeding rate is concerned.   

So for us, for me, I think it’s also timely for us to have a fair conversation around how we can improve breastfeeding rates in Ghana, and then also to plan together to address some of the barriers and then also the other opportunities for us to improve breastfeeding. Especially when we look at the personas to see various categories of women, whether they are educated, uneducated, whether they are in corporate organizations, whether they have time, or do not have time, whether they work for themselves or work for the public sector or private sector. Seeing the different personas and having a better understanding of why women may have challenges with breastfeeding, or what promotes breastfeeding, as well as even the contribution from their male partners to support the idea.

So I think it is quite timely for us, and it is a good opportunity for Ghana to work closely with the Foundation at this time.

How has this experience been unique from projects and collaborations with other international organizations, for example? Is there a difference or is it the same – how would you describe that? 

In some ways, yes, it is the same as other projects, in terms of the process. In other ways it may be different. 

But I think the good thing about the way we have taken this project is the way we had to co-design it together. We came up with a plan together, we are looking at the opportunities. If you look at the way we had to go back and forth as far as the contracting agreement was concerned and, for us to have a better understanding, bringing in various partners locally on board for us to look into how we can make it relevant for Ghana, and being an innovation within what we intend to scale up into the future, that has been very good.

The opportunity where the Foundation and also the Ministry have sat down to plan and to look into what is relevant for the Ghana context and to make it very relevant in our situation, is one of the things that I think has been very good. And moving forward with many other projects, for example, we are going to co-design with the intention of co-implementing into the future. Considering all the circumstances within the context that we operate, that is likely to be very, very good. 

So I like the way we have started the project, and how we have planned everything together, and how we have designed it together. We have done a few back and forth here and there to fine tune the ends, so I think that is quite good.

Why do you believe this project is important for Ghana? 

It’s very important for Ghana because this is going to help us achieve Universal Health Coverage by leaving no one behind – Sustainable Development Goal 3 – and then also ultimately improve on our various indicators as far as maternal and child health are concerned. 

One of our major challenges that we are facing now is having an exclusive breastfeeding rate of less than 50%. We do know that breastmilk is best for the baby, it contains all the various hemoglobins, antibiotics, all the food, the proteins, the water and everything. It’s also evidenced that children who get exclusively breastfed and receive breastmilk even in the complementary stage of life fare better in terms of their brain maturity, and everything, so there is a lot of positivity around exclusive breastfeeding. 

This project, as we have seen, is important for us in Ghana because it’s also going to create a little more awareness and to also understand the reasons and the barriers and the promoters of breastfeeding so that we can catalyze on those barriers – assuming we’re doing a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis – to know those challenges and how we can improve them or what we can use to address those challenges. Then for the things that promote exclusive breastfeeding, we can continuously push on those to happen.

Do you think the project will help you to execute a plan that gives you a better shot at really doing it at scale, and also with higher sustainability?

Yes, we do believe so. I think the way we are going and getting most of our service delivery agencies, and bringing together the various stakeholders who are relevant to the work we are doing will help. For example, the Code (WHO International Code of Marketing of Breast-milk Substitutes) is being harbored and managed by the Food and Drugs Authority. They are on board, they have brought various service and delivery agencies beyond Ghana Health Service and the other services agencies is because implementation is done across teaching hospitals, faith-based institutions, public institutions and then also the society.

So I think that yes, we are positioned in terms of implementation. Looking into the sustainability phase of this, I am hopeful, especially with leadership involvement at that top level: the Chief Director, the Director of Ghana Health Service, and technically, the Accra PPMED (Policy, Planning, Monitoring and Evaluation Division) and also the quality management unit at the level of the Ministry and also the Family Health Division and those responsible for nutrition being involved, and since all these stakeholders have a stake in improving breastfeeding rates, I am inclined to believe there is an opportunity for sustainability in terms of the implementation. 

The other side of course is also the financing component. We are also going to be able to engage the Minister of Finance to be able to allocate, to look at financing - whether the government will finance it, or if we will look for loans to finance it. I think engaging the Minister of Finance to understand that mobilization aspect of it is also very critical. And I think that is one of the steps we have already taken in moving toward implementation and then also sustainability.

From your point of view, how might this project be beneficial for other countries in West Africa or beyond?

If you take Ghana as a model country, most of the issues in West Africa and Africa may be similar. There may be specific challenges here and there, but by and large most of the issues may be a little bit similar. Of course in a particular country when we want to do implementation there may be an opportunity to understand a local context even as we do that implementation. 

But I think that with what we currently see, and then also toward the end of the first phase and into the implementation, that will also give us a lot more understanding of how the implementation is going to look. Since the Universal Health Coverage and the Sustainable Development Goals are global and each country is supposed to meet them, and that every country is expected and wants to increase their breastfeeding rate, so anything that is positive in that direction, I’m inclined to believe that all the other countries will embrace it. 

But we just have to be mindful of the context in which we work and then be able to focus on certain specific contextual issues that are pertaining to each country. But in terms of scalability, I’m inclined to believe that yes, there’s good opportunity to scale this up into other countries.

Is there also an opportunity for Ghana, once you’re through the process, to support other countries in that journey, within the context of the political alliances you have within the landscape? 

So if you look at ECOWAS (Economic Community of West African States) in itself, there is that leadership alliance and cooperation between the leaders of each of the countries. At some level the Ministers of Foreign Affairs across the countries have some relationship. The National Center for Coordination Early Warning Response Mechanism also has some relationship at that level. Then we have similar setups in other countries where we are supposed to provide early warning.

So if for example we have seen that breastfeeding rate going down in Ghana, this is a good opportunity to let our neighbors or other member countries know and ask: Is it the same thing in your country? And together, within the context of the national warning centers across the countries, this is something that we could issue within the ECOWAS subregion, for example, , and then to be able to share those best practices – as far as what would be good to do with the generation of let’s say a policy guideline, and then how Ghana is implementing it and how we can still scale this up in other countries. So I think that landscape is there, we have to just tap into the opportunity for learning and sharing. 

Beyond this we have the WHO collaborative, which Ubora has also been supported with, the WHO Quality, Equity, Dignity Network (to improve quality of care for maternal, newborn and child health) that involves about 10 countries in Africa, both English speaking and also French speaking. Sothis is also another opportunity for us to share this within that collaborative, for other countries within the African region to know that oh, this is something good. 

That opens up that door for us to do a lot of learning and sharing. So if Ghana has been able to improve our breastfeeding rates based on this engagement or because of this project, this is a good opportunity for us share with them. And then they can also increase the same things. 

So you would see yourself also as a vanguard country with respect to this more structured operationalization? 

Exactly.


Is there anything else you wish to share?

Yes, I would say that this experience has been good generally. Being part of this, being part of something which is very important for Ghana, to improve breastfeeding rates, and I’m very hopeful it will lead to some positive outcomes. 

Year on year we have our health summit, we had one in May this year, and then based on whatever we’ve been doing, and awareness creation and looking at the various personas and engaging them in the way that we have to, I’m hoping that in the next two, three, four, five years, we would see some good results based on work we’ve been doing as far as implementation is concerned. 

If there’s an opportunity for us to scale this up, we’re going to see this happening across West Africa and Africa. That we can improve breastfeeding as part of Universal Health Coverage, leaving no one behind, and also the Sustainability Goal 3, that is assuring the well-being of everybody at all ages, is going to be good. Thank you.