USAID Advancing Nutrition, Arlington, Virginia, USA.
Save the Children USA, Washington, District of Columbia, USA.
Matern Child Nutr. 2023 Jan;19(1):e13422. doi: 10.1111/mcn.13422. Epub 2022 Sep 29.
The 2018 implementation guidance for the Baby-Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty-eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance-based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty-seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI.
2018 年《促进母乳喂养医院实施指南》（BFHI）实施指南建议通过 9 项国家普遍覆盖和可持续性责任，使 10 项步骤制度化。随着各国将 BFHI 项目调整为远离传统指定项目的这一范式转变，记录和分享政策和项目经验至关重要，但目前这方面的经验却很少。本定性案例研究包括对 BFHI 方案规划、国家计划和政策文件的文献综述，这些文件是针对普遍覆盖的选定国家责任和一系列行为者的关键信息提供者（KI）访谈而专门编写的。在吉尔吉斯斯坦，案例研究探讨了责任 5，激励和/或制裁的制定和实施，以及马拉维的责任 6，提供技术援助（TA）。在这两个国家，还探讨了与目标责任普遍覆盖相关的三个可持续性责任（国家监测[7]沟通和宣传[8]以及融资[9]）。在吉尔吉斯斯坦，38 名受访者描述了在卫生系统中使用的方法，包括 BFHI 指定牌匾、基于绩效的融资和财务制裁。然而，目前还没有正式的激励和制裁。在马拉维，TA 被用于国家规划和引入质量改进流程。47 名受访者主要描述了 TA 在提供者能力建设和加强方面的规定。需要更多的项目证据来证明哪些类型的激励或制裁可以有效和持续，以及更多的文件记录 TA 是如何在实施的多个方面提供的，因为各国正在将 BFHI 制度化。
