Table 2.
Definition of domains and summary of findings
| Domain | Definition | Summary of findings |
|---|---|---|
| Dynamic BBF Committee | The composition of the country committee that implemented BBF toolbox. | A dynamic committee of experts from government and non‐government sectors with backgrounds in maternal and child health and nutrition program implementation and evaluation drove the implementation of BBF. Participation provided professional enrichment for CMs while also strengthening collegiality among members, which provided a platform for discussions, networking, and facilitated information sharing. |
| Implementation of BBF toolbox | The process implementing the BBF toolbox in Ghana, which included the five‐meeting process, application of the BBFI, and use of case studies. | CMs faced logistical and methodological challenges with implementing BBF, the BBF toolbox, including difficulty accessing or lack of data, the time and work commitment to complete the BBF process, and difficulties applying the BBFI, a standardized metric, in the country context of Ghana. Feeling the process was too academic. In‐country technical support was needed for adhering to all BBF implementation steps. However, some challenges enhanced CMs understanding of the current breastfeeding environment and bolstered discussions around strategies needed to strengthen the breastfeeding enabling environment. |
| BBF outputs | Outputs from implementing BBF, which included a country's readiness “score” and priority recommendations to scale‐up breastfeeding. | CMs felt the final BBF score was an accurate reflection of the enabling breastfeeding environment, but some felt it was a little lower due to data challenges. CMs called for additional stakeholders to be engaged early and throughout the BBF process, not only at the fifth meeting. CMs recommended the dissemination of recommendations needed to be a continual process to help encourage implementation at the country level. |
| Breastfeeding governance | The need for consistent and sustained executive (e.g., government) support in order to maintain momentum to implement BBF recommendations and strengthen enabling breastfeeding environment.a | Executive leadership from government actors will be needed to implement and sustain BBF recommendations. CMs identified that accountability will be essential to ensure recommendations were being translated properly, such as inclusion of action into work plans, having an independent, overseeing advisory group to guide scaling up and sustainability of breastfeeding programs and initiatives. Some CMs felt well positioned to facilitate the dissemination, take key leadership roles to implement and communicate progress of recommendations. |
| Enabling breastfeeding environment | Structural factors that create an enabling environment for women to breastfeed.b | CMs agreed that moving recommendations to action requires advocacy as the first step and identified BBF to facilitate this. Building country capacity will also be critical for scaling up the breastfeeding environment in Ghana. |