Becoming Breastfeeding Friendly Scotland: report

Appendix 02: BBF Scoring for Scotland

2.1 Scoring rationale for the BBF index

BBF Scoring Algorithm

The Becoming Breastfeeding Friendly Index (BBFI) score provides both gear scores and a total index score.

The eight gear scores show the strength of a country's current environment within each gear for scaling up breastfeeding protection, promotion and support programs and initiatives. The eight gear scores are required to calculate the final BBFI score, which shows the strength of the country's current national enabling environment as a whole to scale up breastfeeding programs and initiatives.

Three steps were taken to determine the final BBFI score:

1. Scoring the benchmarks

2. Calculating each of the eight gears scores using the benchmarks' scores

3. Calculating the total BBFI score using the gear scores

Step 1: Scoring the benchmarks

The first step to scoring the BBFI was to score each of the 54 benchmarks. In general, each benchmark was scored 0 (not progress), 1 (minimal progress), 2 (partial progress) or 3 (major progress) to describe the level of current progress for that benchmark. Each benchmark had to meet certain criteria to obtain a specific score from 0 to 3, with the BBF gear team reaching consensus on each score before it was recorded.

For example. Within the Advocacy Gear, the first benchmark is: There have been major events that have drawn media attention to breastfeeding issues. To determine the score for this benchmark, the gear team examined the available data and determined which criteria had been met in the preceding 12 month period:

• A score of 0 (no progress) was assigned to the benchmark if there had not been any major events that had drawn media attention to breastfeeding issues.
• A score of 1 (minimal progress) was assigned to the benchmark if one major event had drawn national media coverage to breastfeeding issues.
• A score of 2 (partial progress) was assigned to this benchmark if there had been two major events that had drawn national media coverage to breastfeeding issues at different times during the year.
• A score of 3 (major progress) was assigned to this benchmark if there had been three or more major event that had drawn national media coverage to breastfeeding issues at different times during the year.

Step 2: Scoring the gears: Calculating the Gear Total Score (GTS)

Each gear was measured by a different number of benchmarks:

1. Advocacy Gear: 4 benchmarks

2. Political Will Gear: 3 benchmarks

3. Legislation & Policies Gear: 10 benchmarks

4. Funding & Resources Gear: 4 benchmarks

5. Training & Program Delivery Gear: 17 benchmarks

6. Promotion Gear: 3 benchmarks

7. Research & Evaluation Gear: 10 benchmarks

8. Coordination, Goals & Monitoring Gear: 3 benchmarks

Once scores were assigned to all 54 benchmarks, the scores for each of the eight gears were determined. This score, called the Gear Total Score (GTS), was calculated for each of the gears using the benchmark scores within each gear. To account for the different number of benchmarks for each gear, the average score for each gear was calculated as follows:

• GTS Advocacy = Sum of all benchmark scores for that gear /4
• GTS Political Will = Sum of all benchmark scores for that gear /3
• GTS Legislation & Policies = Sum of all benchmark scores for that gear /10
• GTS Funding & Resources = Sum of all benchmark scores for that gear /4
• GTS Training & Program Delivery = Sum of all benchmark scores for that gear /17
• GTS Promotion = Sum of all benchmark scores for that gear /3
• GTS Research & Evaluation = Sum of all benchmark scores for that gear /10
• GTS Coordination, Goals & Monitoring = Sum of all benchmark scores for that gear /3

The table below illustrates the interpretation of the Gear Total score. The Gear Total Score identifies which gear(s) are working better than others within a country in order to prioritise and focus investment accordingly.

Gear Total Score	Interpretation
0	Gear not present
0.1 to 1.0	Weak Gear Strength
1.1 to 2.0	Moderate Gear Strength
2.1 to 3.0	Strong Gear Strength

2.2 BBF Scotland Scores

Advocacy

Overall AG Score: 2.0

Political Will

Overall PWG Score: 3.0

Legislation and Policies

Overall LPG Score: 1.6

Funding and Resources

Overall FRG Score: 3.0

Training and Programme Delivery: Benchmark Scores. Overall TPDG Score: 2.5

Trimmed wording in full:

TPDG1: A review of health provider schools and pre-service education programs for health care professionals that will care for mothers, infants and young children indicates that there are curricula that cover essential topics of breastfeeding

TPDG2: : Facility-based health care professionals who care for mothers, infants and young children are trained on the essential breastfeeding topics as well as their responsibilities under the Code implementation

TPDG4: Community-based health care professionals who care for mothers, infants and young children are trained on the essential breastfeeding topics as well as their responsibilities under the Code implementation

TPDG6: Community health workers and volunteers that work with mothers, infants and young children are trained on the essential breastfeeding topics as well as their responsibilities under the Code implementation

TPDG8: There exist national/subnational master trainers in breastfeeding (i.e. breastfeeding specialists or lactation consultants) who give support and training to facility-based and community-based health care professionals as well as community health workers

Promotion

Overall PG Score: 1.7

Research and Evaluation

Overall REG Score: 2.2

Coordination, goals and monitoring

Overall CGMG: 3.0