Amplifying enablers, challenges and gaps in the implementation of Baby-Friendly Community Initiative (BFCI) at subnational level in Kenya: a cross-sectional qualitative study

Optimal maternal infant and young child nutrition is a cornerstone of child survival and development. Kenya adapted the Baby Friendly Hospital Initiative (BFHI), to strengthen maternal, infant, and young child nutrition through community level interventions, multisectoral engagement, and integration within the Community Health Strategy and Primary Health Care. Despite strong policy support, scale-up and sustainability remain uneven. This study examined enablers, barriers, and gaps influencing the implementation of Baby Friendly Community Initiative (BFCI) in Kenya. A qualitative, cross-sectional study was conducted between February 3 and 21, 2025, as part of a larger study of Baby Friendly Community Initiative. Forty-one key informant interviews and 37 focus group discussions were conducted with policymakers, development and implementing partners, county and sub-county health teams, community health actors, and beneficiaries. Nine counties were purposively selected to capture diverse geographic and health system contexts. Qualitative data was analyzed thematically using predefined matrices. Baby Friendly Community Initiative implementation was supported by policy integration and a strong community health strategy platform. Enablers included availability of guiding documents and integration into strategic frameworks, enhanced capacity through donor supported training, and community structures such as mother to mother and community mother support groups. However, barriers included inadequate domestic funding, delayed stipends for community health promoters, limited multisectoral integration, and a cumbersome manual reporting system. Context specific challenges, including food insecurity, gender dynamics, nomadic lifestyles, and geographic inaccessibility in arid and semi-arid lands, further constrained program reach and sustainability. BFCI has achieved policy alignment and community acceptance but faces systemic and contextual barriers that threaten long term sustainability and impact. Strengthened domestic financing, integration of digital reporting systems, simplified training, and enhanced multisectoral approaches to address food insecurity and gender inequities are essential for scaling and sustaining the initiative.