Conformity to the Baby Friendly Hospital Initiative Among Tier Two Health Care Facilities in Nairobi City County
Abstract
The Baby-Friendly Hospital Initiative (BFHI), founded on ten steps to successful breastfeeding, was introduced to promote exclusive breastfeeding globally. However, over time, factors such as limited commitment by health officials have hindered the achievement of its objectives. This study evaluated the extent of conformity to the BFHI’s ten steps, assessed the level of knowledge among health care workers (HCWs), and identified institutional factors influencing compliance within tier two health care facilities (HCFs) in Makadara and Embakasi East Sub-Counties, Nairobi City County. A cross-sectional, analytical, mixed-methods study was conducted between March and May 2021 across public, faith-based, and private HCFs. A total of 142 HCWs participated through semi-structured questionnaires, while 30 facility heads were interviewed in-depth. Additionally, six focus group discussions (FGDs) with mothers were held to validate HCWs’ responses. Quantitative data were analysed using SPSS version 23.0. Findings revealed that 80% of HCWs in public facilities could mention at least one step of the BFHI policy, compared to 74% in faith-based and 46% in private facilities. Only 26.3% of all HCWs reported having received formal training on the breastfeeding policy. The designation of HCWs significantly influenced conformity levels. Overall, tier two HCFs demonstrated partial adherence (70%) to BFHI standards. Inadequate and irregular training, coupled with limited access to educational materials, were identified as major barriers to full implementation. These findings underscore the need for continuous, structured BFHI training programs and equitable distribution of breastfeeding education resources across all facility types. Strengthening institutional capacity and staff engagement will be essential to achieving full compliance and sustaining the goals of the BFHI in Kenya.
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References
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Copyright (c) 2026 Judy Mwikali Matheka, Alloys Orago, PhD, Judy Mugo, PhD
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