The Organizational Barriers, Facilitators and Strategies related to the implementation of the Baby Friendly Hospital Initiative (BFHI): A study in selected Palestinian hospitals.

Background: The Baby-Friendly Hospital Initiative (BFHI) aims to promote and support breastfeeding. Globally, around 20,000 facilities have been designated BabyFriendly. In Palestine, only 6 hospitals have the ‘Baby Friendly’ designation since 2010. Despite the increasing evidence for the positive impact of BFHI on breastfeeding and health outcomes, few studies have explored the barriers and facilitating factors influencing to the implementation of Baby-Friendly practices that can be used to enhance the implementation of this initiative in different healthcare settings. Study aim and objectives: The aim of this study is to investigate the organizational factors that hindered or facilitated the implementation of the Baby-Friendly Hospital Initiative (BFHI) in two selected Palestinian governmental and private hospitals, to determine the strategies implemented by the participating hospitals to overcome these barriers and to identify points of convergence and divergence between the explored governmental and private hospitals. Methods: Using an interpretive qualitative approach, A purposive sampling technique was used to conduct in-depth, semi-structured interviews with 15 clinical and nonclinical staff members from different professional groups and managerial positions. Data were analyzed using content comparative analysis method. Results: One of the main organizational facilitators found in this study was the endorsement of a well-coordinated implementation strategy characterized by autocratic BFHI adoption and enforcement, strong administrative support, the presence of BFHIor quality coordinator as well as the financial and technical support by external partners. The designing of mandatory breastfeeding education for all levels of relevant professional groups was found to be also necessary to improve breastfeeding knowledge, attitudes, and practices among staff responsible for the implementation of BFHI tasks. The most frequently reported organizational barriers to implementing the initiative were inadequate staffing especially in the governmental hospital limiting the staff ability to implement BFHI related tasks and provide breastfeeding support. Another commonly reported challenge was hospital structures or routines that interfere with maternal-infant attachment and breastfeeding practices and lack of comprehensive auditing and monitoring tools in both hospitals. Conclusion: findings have indicated that the success of BFHI is achieved by addressing the integrated sociopolitical, organizational and individual factors. The organizational barriers and facilitating factors determined by this study provides a comprehensive model tailored to the Palestinian context which can be adopted to utilize the most effective strategies for a sustainable implementation of the BFHI in different health facilities and consequently the attainment of ‘Baby Friendly’ designation