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Closser S, Neel AH, Gerber S, Alonge O. From legacy to integration in the Global Polio Eradication Initiative: looking back to look forward. BMJ Glob Health 2024; 9:e014758. [PMID: 38770815 PMCID: PMC11085807 DOI: 10.1136/bmjgh-2023-014758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION The Global Polio Eradication Initiative (GPEI) is a global single-disease programme with an extensive infrastructure in some of the world's most underserved areas. It provides a key example of the opportunities and challenges of transition efforts-the process of shifting from donor-funded, single-disease programmes to programmes with more integrated and sustainable programmatic and funding streams. Our goal is to closely analyse the social and political dynamics of the polio transition in the 2010s to provide insights into today, as well as lessons for other programmes. METHODS We conducted semistructured interviews with GPEI officials involved in transition planning across GPEI partner agencies (n=11). We also drew on document review and interviews with national and subnational actors in Nigeria, India, Ethiopia and the Democratic Republic of the Congo. We inductively analysed this material to capture emergent themes in the evolution of transition activities in the GPEI. RESULTS Since the mid-2010s, GPEI actors expressed concern that polio's assets should not be lost when polio was eradicated. Planning for polio's legacy, however, proved complicated. The GPEI's commitment to and focus on eradication had taken precedence over strong collaborations outside the polio programme, making building alliances for transition challenging. There were also complex questions around who should be responsible for the transition process, and which agencies would ultimately pay for and deliver polio-funded functions. Current efforts to achieve 'integration' both have great promise and must grapple with these same issues. DISCUSSION Within the GPEI, relinquishing control to other programmes and planning for significant, long-term funding for transition will be central to achieving successful integration and eventual transition. Beyond polio, other vertical programmes can benefit from going beyond transition 'planning' to integrate transition into the initial design of vertical programmes.
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Affiliation(s)
- Svea Closser
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abigail H Neel
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sue Gerber
- Independent Consultant, Truchas, New Mexico, USA
| | - Olakunle Alonge
- Sparkman Center for Global Health, The University of Alabama, Birmingham, Alabama, USA
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Tediosi F, Villa S, Levison D, Ekeman E, Politi C. Leveraging global investments for polio eradication to strengthen health systems' resilience through transition. Health Policy Plan 2024; 39:i93-i106. [PMID: 38253450 DOI: 10.1093/heapol/czad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/02/2023] [Accepted: 10/30/2023] [Indexed: 01/24/2024] Open
Abstract
Since the launch of the Global Polio Eradication Initiative in 1988, more than US$20 billion has been invested globally in polio eradication. The World Health Organization and its partners are currently supporting Member States to transition the functions used to eradicate polio to strengthen their health systems. This study analyses global polio activities through the lens of health systems and the Common Goods for Health (CGH). Polio activities include key health system functions such as surveillance and response systems and immunization, which are essential to maintaining resilient health systems. They also support essential functions such as policy development, planning, training and capacity building, which are often underfunded in many countries. To improve overall resilience, it is critical to continue to integrate these functions into local health systems so that the capacity built through the polio eradication programme can be used for broader public health purposes. It is vital that this integration process be tailored to each country's unique health system context, rather than using a one-size-fits-all approach. While integration of all polio activities into local health systems is ideal, the transition to domestic financing may be coordinated with other global health financing mechanisms. This would reduce funding fragmentation and transaction costs, and allow for a focus on health system functions as a whole rather than just disease-specific efforts. The transition to domestic financing of polio activities could be staggered, prioritizing the transition to domestic funding for activities with limited global externalities, while seeking longer-term external funding for those that are global CGH.
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Affiliation(s)
- Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil 4123, Switzerland
- University of Basel, Petersplatz 1, P. O. Box 4001, Basel, Switzerland
| | - Simone Villa
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Via Festa del Perdono, 7, Milano, 20122, Italy
| | - Darcy Levison
- Polio Transition Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Ebru Ekeman
- Polio Transition Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Claudio Politi
- Polio Transition Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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Sultan MA, Closser S, Majidulla A, Ahmed S, Naz F, Nayyab S, Zaman A, Shafique M, Sohail A. How to eradicate polio in Pakistan: Insights from community health workers. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002289. [PMID: 37643151 PMCID: PMC10464965 DOI: 10.1371/journal.pgph.0002289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
Pakistan, along with Afghanistan, is one of two countries where wild poliovirus is still endemic. Frontline workers (FLWs) are the staff most intimately familiar with both implementation challenges and community context. Harnessing their expertise may be a way to improve the community-polio program interface, which has been a persistent and shifting challenge in polio-endemic areas of both countries. From 2020-2022, we engaged frontline workers in 18 Super High-Risk Union Councils (SHRUCs) in Pakistan through a Human-Centered Design ideas competition. In that competition, teams of polio FLWs identified the most significant barriers they faced in conducting their work, and suggested solutions to those problems-a window into the issues the program faces by the people who know it best. The suggestions of FLWs on how to eradicate polio fell into four main categories. First, there were suggestions to tackle community fatigue by reducing touchpoints, particularly visits solely for data collection. Second, there were calls to improve Primary Health Care in SHRUCs, as a way of addressing community frustrations over an intense focus on just one disease in the context of numerous acute needs. Third, there were suggested ways to increase community engagement through locally relevant channels. Finally, many workers suggested improvements to Human Resources processes and workplace dynamics. Across these ideas, one repeated concept is the need for balance between the intensity of polio activities required for eradication and the provision of other government services, including health services. FLWs engaged the process deeply, providing well thought out problem statements and ideas for change. It is our view that there is no one more qualified to speak to the issues on the ground than FLWs. There are critical insights available if we listen to people who are instrumental to the success of health programs, but not commonly involved with creating policy.
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Affiliation(s)
- Marium A. Sultan
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Svea Closser
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Arman Majidulla
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Suhail MK, Moinuddin A. Evaluation of strategies against vaccine hesitancy in the COVID-19 and Indian context-A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:142. [PMID: 37397096 PMCID: PMC10312413 DOI: 10.4103/jehp.jehp_1376_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/27/2022] [Indexed: 07/04/2023]
Abstract
The world has been severely affected by the COVID-19 pandemic in terms of loss of lives, health, and its socioeconomic consequences; however, the true magnitude and extent of the damage from COVID-19 is still elusive till date. With the advent of many efficacious vaccines, one of the most effective ways to get to grips with the pandemic is mass vaccination. However, due to vaccine hesitancy (VH), it remains a colossal challenge globally thereby causing serious threat to the pandemic response efforts. This review intends to identify evaluated interventions and evidence to support recommendation of specific strategies to address VH from an Indian context. A systematic review was conducted to synthesize relevant literature around the evaluation of strategies to tackle VH for effectiveness or impact in India. Electronic databases were searched using specific keywords and predefined inclusion-exclusion criteria. A total of 133 articles were screened, 15 were assessed for eligibility, and two were included in the final review. There is a paucity of research on evaluation of vaccine hesitancy interventions in India. Evidence is not strong enough to recommend one specific strategy or intervention. Together, a permutation of multicomponent and tailored interventions has been found most effective in repressingVH in India.
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Affiliation(s)
- Mohammed K. Suhail
- Doctoral Researcher, School of Health and Life Sciences, Teesside University-Middlesbrough, United Kingdom
| | - Arsalan Moinuddin
- Vascular Health Researcher, School of Sport and Exercise, University of Gloucestershire-Gloucester, United Kingdom
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Hamani A, Hussein Jama I, Roland MAY, Wanjeri L, Oppon-Kusi AA, Karimi D, Kiconco P, Akpotu OE, Saka M. Mobile Money and the importance of timely, complete payments to frontline health campaign workers in the fight to eradicate polio: pilot experience from a World Health Organization digital payment platform in Africa. BMC Health Serv Res 2023; 23:16. [PMID: 36611190 PMCID: PMC9824973 DOI: 10.1186/s12913-022-08990-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In response to the increase in vaccine-derived poliovirus type 2 in Côte d'Ivoire, Mali, and many other African countries from 2017 to 2019, concentrated efforts are needed to improve the effectiveness of vaccination campaigns. Frontline polio health campaign worker engagement and job retention are critical to successful campaign implementation, as well as timely, in-full payment to these workers via an electronic system. METHODS The Global Polio Eradication Initiative and its partners designed a road map to implement the World Health Organization Mobile Money digital payment system for health campaign workers across designated African Region countries and country-specific areas. The road map included: (1) strategy communication about Mobile Money to key stakeholders; (2) prioritization of Mobile Money pilot countries; (3) establishment of a digital finance team to support Mobile Money rollout for polio campaigns; (4) implementation of Mobile Money in select pilot areas; and (5) documentation by the digital finance team of Mobile Money implementation across pilot areas. At the country-specific level, and as described in the first pilot campaign in Côte d'Ivoire, implementation of Mobile Money occurred in 3 phases: precampaign, campaign, and postcampaign. RESULTS Mobile Money was piloted in Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Mali, and Republic of the Congo. Although program reach varied by country, the percentages of payments successfully made via Mobile Money in pilot countries were high: In campaign round 1, 99% of campaign workers in 2 regions in Mali, and 99% of campaign workers in 5 districts in Ghana were paid successfully. In Cote d'Ivoire, Mobile Money was piloted in all 113 districts for campaign rounds 1, 2 and 3, and in 4 districts in Abidjan for campaign round 3. In rounds 1, 2 and 3, 99.6%, 99.6%, and 99.9% of payments to polio health campaign workers, respectively, were made successfully. CONCLUSION Implementation of the Mobile Money pilot program, particularly across Côte d'Ivoire, demonstrates the value of an electronic payment system in addressing frontline polio health campaign worker need for timely, in-full payment. The World Health Organization-led Mobile Money pilot program can serve as a model for agencies committed to delivering greater efficiencies and improved health campaigns in resource-challenged settings.
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Affiliation(s)
- Ahmed Hamani
- grid.463718.f0000 0004 0639 2906World Health Organization–Regional Office for Africa, Cité du Djoué, PO Box 06, Brazzaville, Republic of Congo
| | - Idil Hussein Jama
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa.
| | - Mian Amoakon Yves Roland
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa
| | - Leah Wanjeri
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa
| | - Abena Aboagyewaa Oppon-Kusi
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa
| | - Dorcas Karimi
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa
| | - Patsy Kiconco
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa
| | - Oromena Edwin Akpotu
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa
| | - Mahafous Saka
- World Health Organization, 351 Francis Baard St, Metropark Building, 7th Fl, PO Box 13113, Pretoria, South Africa
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Kalbarczyk A, Closser S, Hirpa S, Cintyamena U, Azizatunnisa L, Agrawal P, Rahimi AO, Akinyemi OO, Mafuta EM, Deressa W, Alonge OO. A light touch intervention with a heavy lift - gender, space and risk in a global vaccination programme. Glob Public Health 2022; 17:4087-4100. [PMID: 35849627 DOI: 10.1080/17441692.2022.2099930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Frontline workers (FLWs) in the Global Polio Eradication Initiative go door-to-door delivering polio vaccine to children. They have played a pivotal role in eliminating wild polio from most countries on earth; at the same time, they face significant bodily risk. STRIPE, an international consortium, conducted a mixed-methods study exploring the knowledge and experiences of polio staff in seven countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We surveyed 826 polio FLWs and conducted semi-structured interviews with 22 of them. We used a body work framework to guide analysis. Polio workers perform a different kind of body work than many other FLWs. Delivering a few drops of oral vaccine takes a light touch, but gendered spaces can make the work physically dangerous. Polio's FLWs must bend or break gendered space norms as they move from house-to-house. Navigating male spaces carries risk for women, including lethal risk, particularly in conflict settings. Workers manoeuvre between skeptical community members and the demands of supervisors which generates emotional labour. Providing FLWs with more power to make operational decisions and providing them with robust teams and remuneration would improve the likelihood that they could act to improve their working conditions.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Selamawit Hirpa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Utsamani Cintyamena
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lutfhi Azizatunnisa
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Priyanka Agrawal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Oluwaseun O Akinyemi
- Department of Health Policy and Management, University of Ibadan College of Medicine, Ibadan Nigeria
| | - Eric M Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, DRC
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Olakunle O Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Olateju A, Peters MA, Osaghae I, Alonge O. How service delivery implementation strategies can contribute to attaining universal health coverage: lessons from polio eradication using an implementation science approach. BMC Public Health 2022; 22:1271. [PMID: 35773671 PMCID: PMC9244363 DOI: 10.1186/s12889-022-13681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Improving service delivery is a key strategy for achieving service coverage, one of the two components of universal health coverage (UHC). As one of the largest global public health initiatives, individuals involved with the Global Polio Eradication Initiative (GPEI) have learned many important lessons about service delivery. We identified contributors and challenges to delivering health services at national and subnational levels using experiences from the GPEI. We described strategies used to strengthen service delivery and draw lessons that could be applicable to achieving UHC. Methods Online cross-sectional surveys based on the Consolidated Framework for Implementation Research (CFIR) domains and socioecological model were conducted from 2018–2019. Data were analyzed using an embedded mixed methods approach. Frequencies of the contributors and challenges to service delivery by levels of involvement were estimated. Chi-square tests of independence were used to assess unadjusted associations among categorical outcome variables. Logistic regressions were used to examine the association between respondent characteristics and contributors to successful implementation or implementation challenges. Horizontal analysis of free text responses by CFIR domain was done to contextualize the quantitative results. Results Three thousand nine hundred fifty-five people responded to the online survey which generated 3,659 valid responses. Among these, 887 (24.2%) reported involvement in service delivery at the global, national, or subnational level with more than 90% involved at subnational levels. The main internal contributor of strengthened service delivery was the process of conducting activities (48%); working in frontline role had higher odds of identifying the process of conducting activities as the main internal contributor (AOR: 1.22, p = 0.687). The main external contributor was the social environment (42.5%); having 10–14 years of polio program implementation was significantly associated with identifying the social environment as the main external contributor to strengthened service delivery (AOR: 1.61, p = 0.038). The most frequent implementation challenge was the external environment (56%); working in Eastern Mediterranean region was almost 4 times more likely to identify the external environment as the major challenge in service delivery strengthening (AOR:3.59, p < 0.001). Conclusion Priority actions to improve service delivery include: adopt strategies to systematically reach hard-to-reach populations, expand disease-focused programs to support broader primary healthcare priorities, maximize community outreach strategies to reach broader age groups, build community trust in health workers and develop multisectoral leadership for collaboration. Achieving UHC is contingent on strengthened subnational service delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13681-0.
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Affiliation(s)
- Adetoun Olateju
- Department of International Health, Bloomberg School of Public Health Johns Hopkins University, 615 N Wolfe Street, E8140, Baltimore, MD, 21205, USA
| | - Michael A Peters
- Department of International Health, Bloomberg School of Public Health Johns Hopkins University, 615 N Wolfe Street, E8140, Baltimore, MD, 21205, USA
| | - Ikponmwosa Osaghae
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Olakunle Alonge
- Department of International Health, Bloomberg School of Public Health Johns Hopkins University, 615 N Wolfe Street, E8140, Baltimore, MD, 21205, USA.
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Majumdar P, Gupta SD, Mangal DK, Sharma N, Kalbarczyk A. Understanding the role of power and its relationship to the implementation of the polio eradication initiative in india. FRONTIERS IN HEALTH SERVICES 2022; 2:896508. [PMID: 36925767 PMCID: PMC10012611 DOI: 10.3389/frhs.2022.896508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022]
Abstract
Background Power is exercised everywhere in global health, although its presence may be more apparent in some instances than others. Studying power is thus a core concern of researchers and practitioners working in health policy and systems research (HPSR), an interdisciplinary, problem-driven field focused on understanding and strengthening multilevel systems and policies. This paper aims to conduct a power analysis as mobilized by the actors involved in implementation of the polio program. It will also reflect how different power categories are exerted by actors and embedded in strategies to combat program implementation challenges while planning and executing the Global Polio Eradication Initiative. Methods We collected quantitative and qualitative data from stakeholders who were part of the Polio universe as a part of Synthesis and Translation of Research and Innovations from the Polio Eradication Project. Key informants were main actors of the polio eradication program, both at the national and sub-national levels. Research tools were designed to explore the challenges, strategies and unintended consequences in implementing the polio eradication program in India. We utilized Moon's expanded typology of power in global governance to analyze the implementation of the polio eradication programme in India. Results We collected 517 survey responses and conducted 25 key informant interviews. Understanding power is increasingly recognized as an essential parameter to understand global governance and health. Stakeholders involved during polio program implementation have exerted different kinds of power from structural to discursive, moral power wielded by religious leaders to institutional power, expert power used by professional doctors to commoners like female vaccinators, and network power exercised by community influencers. Hidden power was also demonstrated by powerless actors like children bringing mothers to polio booths. Conclusion Power is not a finite resource, and it can be used, shared, or created by stakeholders and networks in multiple ways. Those people who seem to be powerless possess invisible power that can influence decision making. Moreover, these power categories are not mutually exclusive and may be deeply interconnected with each other; one type of power can be transformed into another. Power and relations play an important role in influencing the decision-making of the community and individuals. Mid-range theories of core implementation science like PARIHAS and CFIR can also add an important variable of power in their construct necessary for implementation success of any health program.
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Affiliation(s)
- Piyusha Majumdar
- SD Gupta School of Public Health, IIHMR University, Jaipur, Rajasthan, India
| | - S D Gupta
- Indian Institute of Health Management Research, Jaipur, Rajasthan, India
| | - D K Mangal
- IIHMR University, Jaipur, Rajasthan, India
| | - Neeraj Sharma
- SD Gupta School of Public Health, IIHMR University, Jaipur, Rajasthan, India
| | - Anna Kalbarczyk
- International Health, Bloomberg School of Public Health, Baltimore, MD, United States
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