Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study

Abstract

Background Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. Method The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital’s Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. Results The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16–112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. Conclusions Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.

How midwives and nurses experience implementing ten steps to successful breastfeeding: a qualitative case study in an Indonesian maternity care facility

“…AUH is a teaching and referral hospital in Surabaya which is the second largest city in Indonesia and capital city of East Java Province with population of 2.9 million [ 40 ]. For the quantitative component, we measured the social return on investment (SROI) of the BFHI and Ten Steps implementation in these same Australian and Indonesian hospitals [ 26 , 27 ]. Integration of the two components will be conducted using the non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework [ 41 ].…”

“…There have been calls to invest more in breastfeeding policies and programs such as the BFHI for over two decades, including by UNICEF and WHO and the World Bank, and emerging research has focused on financing and economic aspects [ 22 – 25 ]. The positive social value of maintaining BFHI accreditation has been demonstrated in one hospital in Australia and in one hospital in Indonesia, which showed US$37 and US$49 benefit for every US$1 invested, respectively [ 26 , 27 ]. Two other breastfeeding supporting programs also demonstrated positive social benefits [ 28 , 29 ].…”

Interventions and policy approaches to promote equity in breastfeeding

“…Despite these potential benefits, the uptake of BFHI globally has been slow. In order to assess incentives for BFHI accreditation, Pramono et al [ 31 ] assess the social return of investment of maintaining the BFHI accreditation in a public maternity unit in Australia. Social return of investment is another novel methodology included in this collection, based on monetizing social impacts with inputs from diverse stakeholders.…”

“…Social return of investment is another novel methodology included in this collection, based on monetizing social impacts with inputs from diverse stakeholders. Pramono et al [ 31 ] estimate that the social return of investment ratio in the analyzed unit was approximately AU$ 55:1, which means that for every AU$1 invested in maintaining BFHI accreditation the facility generated approximately AU$55 of benefit. This suggest that scaling up BFHI accreditation can be an effective public health intervention and a sound investment from a societal perspective.…”

“We All Believe in Breastfeeding”: Australian Midwives’ Experience of Implementing the Baby Friendly Hospital Initiative

“…The positive social value of maintaining BFHI accreditation has been demonstrated in one hospital in Australia and showed a AU$55 (or US$37) benefit for every AU$1 invested (US$ 1 PPP = AU$ 1.48) (Pramono et al, 2021). Despite evidence demonstrating positive associations between breastfeeding duration and maternal and child health (Kivlighan et al, 2020; Spaeth et al, 2018), only 10% of births occur in BFHI accredited hospitals globally (WHO, 2017) and only 26% of Australian hospitals are BFHI accredited (BFHI Australia, 2020a).…”