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Writing and Prioritizing Recommendations

Figure 1. Relationship between benchmark scores, gaps and recommendations
A critical aspect of BBF is identifying the gaps in your country’s breastfeeding environment and making robust, concrete recommendations to address these gaps. Experts in the country may already be aware of some gaps and these may be confirmed or modified by the evidence-based benchmark and gear scores. It is from the BBFI scores and corresponding gaps that recommendations will be developed. The relationship between the scores, gaps and recommendations is a dynamic and iterative one that should be considered throughout the 5-meeting process (Figure 1).
Figure 2: Steps of recommendation development and prioritization embedded in the 5-meeting process

Crafting meaningful recommendations that are understood by key stakeholders, such as policy and decision makers, media sources, funders, and other relevant organizations, is vital to translating these into actions. Well-designed recommendations can also be effectively monitored and evaluated, allowing a country to track its progress.

The BBF recommendation development and prioritization is summarized in 3 steps (Figure 2). The prioritization process has been adapted from The Child Health and Nutrition Research Initiative (CHNRI) research priority-setting methodology for BBF purposes. It is highly recommended that you use specific strategies to reach consensus during this process, similar to those utilized during benchmark scoring.

When to use this tool

In-country directors should begin reading the Writing and Prioritizing Recommendations guide before beginning the 5-meeting process. Writing the recommendations begins as gaps are being identified and prioritizing them is conducted after the third meeting.

The Appendices below provide the tools needed to writing and prioritize recommendations during the 5-meeting process.


1. Pérez-Escamilla R, Hromi-Fiedler AJ, Gubert MB, Doucet K, Meyers S & Buccini GS. Becoming Breastfeeding Friendly Index: Development and application for scaling-up breastfeeding programmes globally. Matern Child Nutr. doi: 10.1111/mcn.12596. [Epub ahead of print]

2. Rudan I, Gibson JL, Ameratunga S, Arifeen SE, Bhutta ZA, Black M, Black RE, Brown KH, Campbell H, Carneiro I, Chan KY. Setting priorities in global child health research investments: guidelines for implementation of CHNRI method. Croatian medical journal. 2008. 15; 49(6):720-33.

3. Okoli C. & Pawlowski S.D. (2004) The Delphi method as a research tool: an example, design considerations and applications. Information & Management.