Implementing the Brazilian Strategy for Breastfeeding and Complementary Feeding Promotion: Barriers and Facilitators

The Brazilian Strategy for Breastfeeding and Complementary Feeding Promotion (Estratégia Amamenta e Alimenta Brasil—EAAB) is the main strategy from the Ministry of Health of Brazil to promote infant and young child feeding in primary health care. To improve the quality of breastfeeding and complementary feeding activities, the EAAB trains tutors and health workers. Although tutors provide numerous workshops, only a few primary health care units achieved certification in required activities, and many tutors left their positions. A previous study identified six critical quality control points that require monitoring to maximize the implementation quality and effectiveness. The objective of this study was to analyze the barriers and facilitators related to each critical quality control point. We first conducted an analysis of documents to diagram the program impact pathways. Next, we interviewed key EAAB informants at the Ministry of Health ( n = 3), in two states ( n = 2), and in two municipalities ( n = 3), and then conducted a thematic analysis of the transcripts. Through these analyses, we identified EAAB implementation barriers and facilitators along the Program Impact Pathways that modulate scaling up, especially the ones linked to the critical quality control point 1 (Definition/establishment and strengthening of state and municipal coordination) and critical quality control point 2 (Maintenance of tutors’ work) that influence the first steps to EAAB adoption and which will impact implementation results and sustainability. We now better understand critical quality control points and conclude with recommendations to strengthen EAAB implementation process.