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Anwar HB, Mazumder Y, Nujhat S, Islam BZ, Kalbarczyk A, Alonge O, Sarker M. The evolution, facilitators, barriers, and additional activities of acute flaccid paralysis surveillance platform in polio eradication programme Bangladesh: a mixed-method study. Glob Health Action 2024; 17:2370096. [PMID: 38932666 PMCID: PMC11212555 DOI: 10.1080/16549716.2024.2370096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The Global Polio Eradication Initiative (GPEI) helped develop the standard acute flaccid paralysis surveillance (AFP) system worldwide, including, knowledge, expertise, technical assistance, and trained personnel. AFP surveillance can complement any disease surveillance system. OBJECTIVE This study outlines AFP surveillance evolution in Bangladesh, its success and challenging factors, and its potential to facilitate other health goals. METHODS This mixed-method study includes a grey literature review, survey, and key informant interviews (KIIs). We collected grey literature from online websites and paper documentation from GPEI stakeholders. Online and in-person surveys were conducted in six divisions of Bangladesh, including Dhaka, Rajshahi, Rangpur, Chittagong, Sylhet, and Khulna, to map tacit knowledge ideas, approaches, and experiences. We also conducted KIIs, and Data were then combined on focused emerging themes, including the history, challenges, and successes of AFP surveillance programme. RESULTS According to the grey literature review, survey, and KII, AFP surveillance successfully contributed to decreasing polio in Bangladesh. The major facilitating factors were multi-sectoral collaboration, Surveillance Immunization Medical Officer (SIMO) network activities, social environment, community-based surveillance, and promising political commitment. On the other hand, high population growth, hard-to-reach areas, people residing in risky zones, and polio transition planning were significant challenges. Bangladesh is also utilizing these polio surveillance assets for other vaccine-preventable diseases. CONCLUSION As the world is so close to eradicating polio, the knowledge, and other assets of the AFP surveillance, could be used for other health programmes. In addition, its strengths can be leveraged for combating new and emerging diseases.
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Affiliation(s)
- Humayra Binte Anwar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Yameen Mazumder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sanjana Nujhat
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bushra Zarin Islam
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Olakunle Alonge
- Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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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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Oladayo AM, Odukoya O, Sule V, Molobe I, Busch T, Akodu B, Adeyemo WL, Gowans LJJ, Eshete M, Alade A, Awotoye W, Adeyemo AA, Mossey PA, Prince AER, Murray JC, Butali A. Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research. BMC Public Health 2024; 24:507. [PMID: 38365612 PMCID: PMC10873930 DOI: 10.1186/s12889-024-17987-z] [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: 10/02/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort. METHODS Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis. RESULTS Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI. CONCLUSIONS Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.
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Affiliation(s)
- Abimbola M Oladayo
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
| | - Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Veronica Sule
- Department of Operative Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Ikenna Molobe
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tamara Busch
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Babatunde Akodu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Wasiu L Adeyemo
- Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - Lord J J Gowans
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mekonen Eshete
- School of Medicine, Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Azeez Alade
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - Waheed Awotoye
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | | | - Peter A Mossey
- Department of Orthodontics, University of Dundee, Dundee, UK
| | | | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.
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Kalbarczyk A, Rao A, Alonge OO. Determinants of factors affecting readiness of academic institutions to conduct knowledge translation in low- and middle-income countries. Front Public Health 2024; 11:1302756. [PMID: 38259768 PMCID: PMC10800438 DOI: 10.3389/fpubh.2023.1302756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Capacity building strategies have been used to improve uptake of knowledge translation (KT) activities among academic institutions, but little is known about their effectiveness, contextual responsiveness, and adaptability. Many of these strategies target individuals while few address institutional gaps. This research describes the determinants for conducting KT (or readiness to conduct such activities) at the institutional level across diverse LMIC contexts to inform the development of capacity building strategies. Methods We conducted a survey to assess organizational readiness to conduct KT to public health researchers and practitioners from six academic institutions in Bangladesh, Ethiopia, DRC, India, Indonesia and Nigeria and members of a global knowledge-to-action working group. We assessed the frequency of barriers and facilitators to KT and their relationship to age, gender, country, and KT experience. We then performed logistic regression to identify determinants of five underlying factors demonstrated to influence KT readiness in LMICs (Institutional Climate, Organization Change Efficacy, Prioritization and Cosmopolitanism, Self-Efficacy and Financial Resource) along with their composite score, which represented an overall readiness score to conduct KT. Results A total of 111 responses were included in the final analysis. Participants represented 10 LMICs; a majority were 30-49 years old (57%) and most were male (53%). Most participants had professional foci in research (84%), teaching (62%), and project coordination (36%) and 59% indicated they had experience with KT. Common facilitators included motivated faculty (57%) and dedicated personnel (40%). Funding (60%), training (37%), and time (37%) were the most frequently reported barriers. In the adjusted model, age, gender, country, and professional focus were significantly associated with at least one factor. Prior experience with KT was significantly and positively (OR = 9.07; CI: 1.60-51.58; p < 0.05) associated with the overall KT readiness to conduct KT. Discussion Different KT readiness factors are relevant for younger (institutional climate) vs. older (self-efficacy) academic professionals, suggesting value in cross-generational collaborations. Leadership and gender were both relevant for organizational change efficacy indicating a need to engage leaders and promote women to influence organizational change. Institutions in different countries may be at different stages of change; readiness assessments can be used to systematically identify needs and develop targeted strategies.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Lohiniva AL, Nurzhynska A, Alhassan H, Shetye M, Ayiku P. Understanding Factors Influencing Polio Vaccine Uptake in Ghana-Developing Meaningful Community Mobilization and Engagement Strategies in Collaboration with Religious Leaders. Am J Trop Med Hyg 2022; 107:1345-1350. [PMID: 36315999 PMCID: PMC9768250 DOI: 10.4269/ajtmh.22-0271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/05/2022] [Indexed: 12/30/2022] Open
Abstract
This qualitative study explores how religious leaders in Ghana view polio and polio vaccine-related knowledge and perceptions of the community members. It also examines the personal characteristics of those who are most likely to accept or reject the vaccine. On the basis of the findings, this study provides a set of evidence-based recommendations to support religious leaders' efforts to create polio vaccine demand in their communities. The study is based on focus group discussions conducted with religious leaders from various geographic locations across Ghana. The discussions were transcribed verbatim and analyzed thematically. Twenty religious leaders, including Christian, Muslim, and leaders of traditional African religions, participated in the study. The findings show that both religious leaders and community members lack knowledge and have multiple culturally and religiously influenced explanations for polio. In addition, the findings reveal that vaccine safety and efficacy are linked to emotional narratives, and receiving the polio vaccine is not a social norm in all communities. Educated mothers in urban settings were identified as those most receptive to the polio vaccine. To create polio vaccine demand, religious leaders need to combat misinformation and the negative perceptions about the vaccine. Recommendations include conveying high-quality information to community members, developing tactics to address culturally and religiously sensitive matters, using emotionally inspired personal accounts to enhance positive attitudes toward polio vaccines and act as catalysts for positive social norms towards the polio vaccine. Educated mothers from urban areas can be engaged as champions in vaccine demand creation.
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Affiliation(s)
- Anna-Leena Lohiniva
- UNICEF Ghana, Accra, Ghana;,Address correspondence to Anna-Leena Lohiniva, UNICEF Country Office, P.O. Box 5051, 4-8 Rangoon Close, Accra-North, Ghana. E-mail:
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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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Akinyemi O, Adebayo A, Bassey C, Nwaiwu C, Kalbarczyk A, Nomhwange T, Alonge OO, Owoaje ET. A qualitative exploration of the contributions of Polio Eradication Initiative to the Nigerian health system: policy implications for polio transition planning. Trop Med Health 2022; 50:38. [PMID: 35668515 PMCID: PMC9169377 DOI: 10.1186/s41182-022-00429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nigerian health care system is weak due to lack of coordination, fragmentation of services by donor funding of vertical services, dearth and poor distribution of resources, and inadequate infrastructures. The Global Polio Eradication Initiative has supported the country's health system and provided strategies and skills which need to be documented for use by other health programs attempting disease control or eradication. This study, therefore, explored the contributions of the Polio Eradication Initiative (PEI) activities to the operations of other health programs within the Nigerian health system from the perspectives of frontline workers and managers. METHODS This cross-sectional qualitative study used key informant interviews (KIIs) and inductive thematic analysis. Twenty-nine KIIs were conducted with individuals who have been involved continuously in PEI activities for at least 12 months since the program's inception. This research was part of a more extensive study, the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE), conducted in 2018. The KII tool focused on four major themes: work experience in other health programs, similarities and differences between polio programs and other health programs, contributions of polio programs, and missed opportunities for implementing polio lessons. All interviews were transcribed verbatim and analyzed using a thematic framework. RESULTS The implementation of the PEI has increased health promotion activities and coverage of maternal and child health interventions through the development of tangible and intangible resources, building the capacities of health workers and discovering innovations. The presence of a robust PEI program within a weakened health system of similar programs lacking such extensive support led to a shift in health workers' primary roles. This was perceived to reduce human resources efforts in rural areas with a limited workforce, and to affect other programs' service delivery. CONCLUSION The PEI has made a notable impact on the Nigerian health system. There should be hastened efforts to transition these resources from the PEI into other programs where there are missed opportunities and future control programs. The primary health care managers should continue integration efforts to ensure that programs leverage opportunities within successful programs to improve the health of the community members.
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Affiliation(s)
- Oluwaseun Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Adedamola Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christopher Bassey
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chioma Nwaiwu
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Terna Nomhwange
- Accelerated Disease Control, Immunization, World Health Organization, Abuja, Nigeria
| | | | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Njoh AA, Saidu Y, Bachir HB, Ndoula ST, Mboke E, Nembot R, Tambasho AC, Abizou MB, Seungue J, Mbanga C, Mbome VN. Impact of periodic intensification of routine immunization within an armed conflict setting and COVID-19 outbreak in Cameroon in 2020. Confl Health 2022; 16:29. [PMID: 35655226 PMCID: PMC9161648 DOI: 10.1186/s13031-022-00461-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Cameroon’s Southwest Region (SW) has been hit by an armed conflict for over half a decade now, negatively affecting the region’s routine immunization and disease surveillance activities. This negative effect was further acerbated by the COVID-19 pandemic, which alongside the conflict, caused thousands of children to miss out on life-saving vaccinations. Herein, we present the contribution of periodic intensification of routine immunization in improving immunization and surveillance activities amid crises.
Method
Periodic intensification of routine immunization (PIRI) and disease surveillance were carried out in three rounds per health district. Before the intervention, the security profile of each district involved was reviewed. Data for this study was extracted on vaccination and surveillance activities from the District Health Information Software and monthly regional reports for 2019 and 2020 from the SW delegation of health.
Results
54,242 persons were vaccinated in the SW following these interventions. An increase in performance was observed in all 18 health districts in 2020 compared to 2019. Both DPT-HebB-Heb-3 vaccine and OPV-3 coverage rose by 28% points. Similarly, the proportion of health districts that investigated at least a case of acute flaccid paralysis increased by 83%, rising from just three districts in 2019 to all 18 in 2020.
Conclusion
PIRI was a practical approach to improving vaccination coverage and surveillance indicators in this region amidst the ongoing armed conflict and COVID-19 pandemic.
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Osaghae I, Agrawal P, Olateju A, Alonge O. Facilitators and barriers of infectious diseases surveillance activities: lessons from the Global Polio Eradication Initiative - a mixed-methods study. BMJ Open 2022; 12:e060885. [PMID: 35551082 PMCID: PMC9109099 DOI: 10.1136/bmjopen-2022-060885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To document lessons from the Global Polio Eradication Initiative (GPEI) by determining factors associated with successful surveillance programme globally as well as at national and subnational levels. The process of conducting surveillance has been previously recognised in the literature as important for the success of polio surveillance activities. DESIGN A cross-sectional survey with closed and open-ended questions. SETTINGS Survey of persons involved in the implementation of surveillance activities under the GPEI at the global level and in seven low-income and middle-income countries. PARTICIPANTS Individuals (n=802) with ≥12 months of experience implementing surveillance objective of the GPEI between 1988 and 2019. MAIN OUTCOME MEASURES AND METHODS Quantitative and qualitative analyses were conducted. Logistic regression analyses were used to assess factors associated with implementation process as a factor for successful surveillance programme. Horizontal analysis was used to analyse qualitative free-text responses on facilitators and barriers identified for conducting surveillance activities successfully. RESULTS Overall, participants who reported challenges relating to GPEI programme characteristics had 50% lower odds of reporting implementation process as a factor for successful surveillance (adjusted OR (AOR): 0.50, 95% CI: 0.29 to 0.85). Challenges were mainly perceptions of external intervention source (ie, surveillance perceived as 'foreign' to local communities) and the complexity of surveillance processes (ie, surveillance required several intricate steps). Those who reported organisational challenges were almost two times more likely to report implementation process as a factor for successful surveillance (AOR: 1.89, 95% CI: 1.07 to 3.31) overall, and over threefolds (AOR: 3.32, 95% CI: 1.14 to 9.66) at the national level. CONCLUSIONS Programme characteristics may have impeded the process of conducting surveillance under the GPEI, while organisational characteristics may have facilitated the process. Future surveillance programmes should be designed with inputs from local communities and frontline implementers.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Priyanka Agrawal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adetoun Olateju
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ezezika O, Mengistu M, Opoku E, Farheen A, Chauhan A, Barrett K. What are the barriers and facilitators to polio vaccination and eradication programs? A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001283. [PMID: 36962654 PMCID: PMC10022167 DOI: 10.1371/journal.pgph.0001283] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Global efforts to eradicate polio by the Global Polio Eradication Initiative agency partners and country-level stakeholders have led to the implementation of global polio vaccination programs. This study presents the findings of existing studies regarding the barriers and facilitators that countries face when implementing polio interventions. A comprehensive search was conducted in OVID Medline, OVID Embase, EBSCO CINAHL Plus, and Web of Science. Eligible studies underwent quality assessment. A qualitative evidence synthesis approach was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR). The search identified 4147 citations, and following the removal of duplicates and screening according to our inclusion/exclusion criteria, 20 articles were eligible for inclusion in the review. Twelve countries were represented in this review, with India, Nigeria, Pakistan, Ethiopia, and Afghanistan having the most representation of available studies. We identified 36 barriers and 16 facilitators. Seven themes emerged from these barriers and facilitators: fear, community trust, infrastructure, beliefs about the intervention, influential opinions, intervention design, and geo-politics. The most frequently cited CFIR constructs for the facilitators and barriers were knowledge and beliefs about the intervention, followed by available resources. This study identified a wide range of barriers and facilitators to polio vaccination implementation across the globe, adding to the scarce body of literature on these barriers and facilitators from an implementation perspective and using a determinant framework. The diversity of factors among different groups of people or countries highlights the relevance of contexts. Implementers should be conversant with the contexts within which polio eradication programs boost intervention coverage and capacity. This study provides policymakers, practitioners, and researchers with a tool for planning and designing polio immunization programs. Trial registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42020222115).
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Affiliation(s)
- Obidimma Ezezika
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- African Centre for Innovation and Leadership Development, Abuja, Nigeria
| | - Meron Mengistu
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Eric Opoku
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Aiman Farheen
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Anuradha Chauhan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Kathryn Barrett
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
- University of Toronto Scarborough Library, Toronto, Canada
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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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Vassallo A, Dunbar K, Ajuwon B, Lowbridge C, Kirk M, King C, Sheel M. Assessing the impact of polio supplementary immunisation activities on routine immunisation and health systems: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-006568. [PMID: 34776411 PMCID: PMC8593720 DOI: 10.1136/bmjgh-2021-006568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction The Global Polio Eradication Initiative uses polio supplementary immunisation activities (SIAs) as a strategy to increase vaccine coverage and cease poliovirus transmission. Impact of polio SIAs on immunisation systems is frequently debated. We reviewed the impact of polio SIAs on routine immunisation and health systems during the modern era of polio eradication. Methods We searched nine databases for studies reporting on polio SIAs and immunisation coverage, financial investment, workforce and health services delivery. We conducted a narrative synthesis of evidence. Records prior to 1994, animal, modelling or case studies data were excluded. Results 20/1637 unique records were included. Data on vaccine coverage were included in 70% (14/20) studies, workforce in 65% (13/20) and health services delivery in 85% (17/20). SIAs positively contributed to vaccination uptake of non-polio vaccines in seven studies, neutral in three and negative in one. Some polio SIAs contributed to workforce strengthening through training and capacity building. Polio SIAs were accompanied with increased social mobilisation and community awareness building confidence in vaccination programmes. Included studies were programmatic in nature and contained variable data, thus could not be justly critically appraised. Conclusion Polio SIAs are successful at increasing polio vaccine coverage, but the resources and infrastructures were not always utilised for delivery of non-polio vaccines and integration into routine service delivery. We found a gap in standardised tools to evaluate SIAs, which can then inform service integration. Our study provides data to inform SIAs evaluations, and provides important considerations for COVID-19 vaccine roll-out to strengthen health systems. PROSPERO registration number CRD42020152195.
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Affiliation(s)
- Amy Vassallo
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kimberly Dunbar
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Busayo Ajuwon
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher Lowbridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Martyn Kirk
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Catherine King
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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13
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Kalbarczyk A, Rao A, Alonge O. A mixed methods study to develop a tool to assess institutional readiness to conduct knowledge translation activities in low-income and middle-income countries. BMJ Open 2021; 11:e050049. [PMID: 34635520 PMCID: PMC8506882 DOI: 10.1136/bmjopen-2021-050049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This paper describes the development of a tool for assessing organisational readiness to conduct knowledge translation (KT) among academic institutions in low-income and middle-income countries (LMICs). DESIGN A literature review and stakeholder consultation process were conducted to identify constructs relevant for assessing KT readiness in LMICs. These were face-validated with LMIC stakeholders and organised into a Likert-scale questionnaire. PARTICIPANTS The questionnaire was distributed to researchers based at six LMIC academic institutions and members of a global knowledge-to-action thematic working group. OUTCOME MEASURES An exploratory factor analysis was used to identify underlying dimensions for assessing institutional readiness to conduct KT. RESULTS 111 respondents with varied KT experiences from 10 LMICs were included in the analysis. We selected 5 factors and 23 items, with factor loadings from 0.40 to 0.77. These factors include (1) institutional climate, (2) organisation change efficacy, (3) prioritisation and cosmopolitanism, (4) self-efficacy, and (5) financial resources. These factors accounted for 69% of the total variance, with Cronbach's alpha coefficients of 0.78, 0.73, 0.62, 0.68 and 0.52, respectively. CONCLUSIONS This study identifies a tool for assessing readiness of LMIC academic institutions to conduct KT and unique opportunities for building capacity. The organisational focus of these factors underscores the need for strategies that address organisational systems and structures in addition to individual skills. Future research will be conducted to understand determinants of these factors and develop a comprehensive set of capacity building strategies responsive to academic institutions in LMICs.
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Affiliation(s)
- Anna Kalbarczyk
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aditi Rao
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olakunle Alonge
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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14
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Kalbarczyk A, Closser S, Rao A, Akinyemi O, Anwar HB, Mafuta E, Majumdar P, Alonge OO. Translating Implementation Experiences and Lessons Learned From Polio Eradication Into a Global Health Course: Insights From an International Consortium. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:682-689. [PMID: 34593590 PMCID: PMC8514025 DOI: 10.9745/ghsp-d-20-00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/18/2021] [Indexed: 12/03/2022]
Abstract
Using international collaborations to develop educational materials presents several challenges but offers enormous benefits in gleaning a wealth of information, perspectives, and context. The global course that resulted from this collaboration mirrors the goals of implementation science more broadly—to bring the findings of research into routine practice to improve health services. Lessons learned from one global health program can inform responses to challenges faced by other programs. One way to disseminate these lessons is through courses. However, such courses are often delivered by and taught to people based in high-income countries and thus may not present a truly global perspective. The Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) is a consortium of 8 institutions in Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, and the United States that seeks to carry out such a transfer of the lessons learned in polio eradication. This short report describes the collaborative process of developing content and curriculum for an international course, the learnings that emerged, the barriers we faced, and recommendations for future similar efforts. Various parts of our course were developed by teams of researchers from countries across South Asia and sub-Saharan Africa. We held a series of regional in-person team meetings hosted in different countries to improve rapport and provide a chance to work together in person. The course content reflects the diversity of team members’ knowledge in a variety of contexts. Challenges to this effort included team coordination (e.g., scheduling across time zones); hierarchies across and between countries; and the coronavirus disease (COVID-19) pandemic. We recommend planning for these hierarchies ahead of time and ensuring significant in-person meeting time to make the most of international collaboration.
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Affiliation(s)
- Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Svea Closser
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aditi Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oluwaseun Akinyemi
- Department of Health Policy and Management, College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Humarya Binte Anwar
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eric Mafuta
- University of Kinshasa School of Public Health, Kinshasa, The Democratic Republic of the Congo
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Azizatunnisa' L, Cintyamena U, Mahendradhata Y, Ahmad RA. Ensuring sustainability of polio immunization in health system transition: lessons from the polio eradication initiative in Indonesia. BMC Public Health 2021; 21:1624. [PMID: 34488698 PMCID: PMC8419659 DOI: 10.1186/s12889-021-11642-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sustaining an effective evidence-based health intervention will maximize its impact on public health. Political and governmental reforms impacted on immunization program sustainability both positively and negatively. This study aims to explore the sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia. METHODS We collected qualitative data through in-depth interviews with 27 key informants from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers, and Non-government Organizations (NGOs). We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness. RESULTS Competing priority was identified as the significant challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at the sub-national level government. The government reform has led to a more democratic society, facilitating vaccine rejection and hesitancy. The multi-sector partnership played a significant role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign were essential to raising awareness of the community and policymakers to keep polio in the agenda and to maintain the high polio immunization coverage. CONCLUSION Competing priority was the major factor affecting high polio immunization coverage during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.
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Affiliation(s)
- Luthfi Azizatunnisa'
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Utsamani Cintyamena
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Riris Andono Ahmad
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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16
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Akinyemi OO, Adebayo A, Bassey C, Nwaiwu C, Kalbarczyk A, Fatiregun AA, Alonge OO, Owoaje E. Assessing community engagement in Nigeria polio eradication initiative: application of the Consolidated Framework for Implementation Research. BMJ Open 2021; 11:e048694. [PMID: 34373306 PMCID: PMC8354285 DOI: 10.1136/bmjopen-2021-048694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study employed the Consolidated Framework for Implementation Research (CFIR) to assess factors that enhanced or impeded the implementation of community engagement strategies using the Nigerian polio programme as a point of reference. DESIGN This study was a part of a larger descriptive cross-sectional survey. The CFIR was used to design the instrument which was administered through face-to-face and phone interviews as well as a web-based data collection platform, Qualtrics. SETTING The study took place in at least one State from each of the six geopolitical zones in Nigeria (Nasarawa, Borno, Kano, Sokoto, Anambra, Bayelsa, Lagos, Ondo and Oyo States as well as the Federal Capital Territory). PARTICIPANTS The respondents included programme managers, policy-makers, researchers and frontline field implementers affiliated with the Global Polio Eradication Initiative (PEI) core partner organisations, the three tiers of the government health parastatals (local, state and federal levels) and academic/research institutions. RESULTS Data for this study were obtained from 364 respondents who reported participation in community engagement activities in Nigeria's PEI. Majority (68.4%) had less than 10 years' experience in PEI, 57.4% were involved at the local government level and 46.9% were team supervisors. Almost half (45.0%) of the participants identified the process of conducting the PEI program and social environment (56.0%) as the most important internal and external contributor to implementing community engagement activities in the community, respectively. The economic environment (35.7%) was the most frequently reported challenge among the external challenges to implementing community engagement activities. CONCLUSION Community engagement strategies were largely affected by the factors relating to the process of conducting the polio programme, the economic environment and the social context. Therefore, community engagement implementers should focus on these key areas and channel resources to reduce obstacles to achieve community engagement goals.
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Affiliation(s)
| | - Adedamola Adebayo
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Christopher Bassey
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Chioma Nwaiwu
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | - Anna Kalbarczyk
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Akinola A Fatiregun
- Ondo State Field Office, World Health Organization Country Office for Nigeria, Ondo, Nigeria
| | - Olakunle O Alonge
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eme Owoaje
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
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17
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Neel AH, Closser S, Villanueva C, Majumdar P, Gupta SD, Krugman D, Akinyemi OO, Deressa W, Kalbarczyk A, Alonge O. 30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation. BMJ Glob Health 2021; 6:bmjgh-2021-006002. [PMID: 34344665 PMCID: PMC8336205 DOI: 10.1136/bmjgh-2021-006002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time. Methods We constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011–2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication. Results Pursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise. Conclusion It benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate.
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Affiliation(s)
- Abigail H Neel
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Svea Closser
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine Villanueva
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Piyusha Majumdar
- SDG School of Public Health, Indian Institute of Health Management Research, Jaipur, Rajasthan, India
| | - S D Gupta
- SDG School of Public Health, Indian Institute of Health Management Research, Jaipur, Rajasthan, India
| | - Daniel Krugman
- Anthropology, Middlebury College, Middlebury, Vermont, USA
| | | | - Wakgari Deressa
- Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anna Kalbarczyk
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olakunle Alonge
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rodriguez DC, Neel AH, Mahendradhata Y, Deressa W, Owoaje E, Akinyemi O, Sarker M, Mafuta E, Gupta SD, Salehi AS, Jain A, Alonge O. The effects of polio eradication efforts on health systems: a cross-country analysis using the Develop-Distort Dilemma. Health Policy Plan 2021; 36:707-719. [PMID: 33882118 PMCID: PMC8173659 DOI: 10.1093/heapol/czab044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/12/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Vertical disease control programmes have enormous potential to benefit or weaken health systems, and it is critical to understand how programmes' design and implementation impact the health systems and communities in which they operate. We use the Develop-Distort Dilemma (DDD) framework to understand how the Global Polio Eradication Initiative (GPEI) distorted or developed local health systems. We include document review and 176 interviews with respondents at the global level and across seven focus countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We use DDD domains, contextual factors and transition planning to analyse interactions between the broader context, local health systems and the GPEI to identify changes. Our analysis confirms earlier research including improved health worker, laboratory and surveillance capacity, monitoring and accountability, and efforts to reach vulnerable populations, whereas distortions include shifting attention from routine health services and distorting local payment and incentives structures. New findings highlight how global-level governance structures evolved and affected national actors; issues of country ownership, including for data systems, where the polio programme is not indigenously financed; how expectations of success have affected implementation at programme and community level; and unresolved tensions around transition planning. The decoupling of polio eradication from routine immunization, in particular, plays an outsize role in these issues as it removed attention from system strengthening. In addition to drawing lessons from the GPEI experience for other efforts, we also reflect on the use of the DDD framework for assessing programmes and their system-level impacts. Future eradication efforts should be approached carefully, and new initiatives of any kind should leverage the existing health system while considering equity, inclusion and transition from the start.
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Affiliation(s)
- Daniela C Rodriguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Abigail H Neel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sekip Utara, Yogyakarta 55281, Indonesia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia
| | - Eme Owoaje
- College of Medicine, University of Ibadan, AddL P.M.B 3017 G.P.O Ibadan, Nigeria
| | - Oluwaseun Akinyemi
- College of Medicine, University of Ibadan, AddL P.M.B 3017 G.P.O Ibadan, Nigeria
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka-1212, Bangladesh.,Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa School of Public Health, Kinshasa, The Democratic Republic of Congo
| | - Shiv D Gupta
- Indian Institute of Health Management Research, 1 Prabhu Dayal Marg, Near Sanganer Airport Terminal 1, Jaipur 302029, India
| | | | - Anika Jain
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
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Kalbarczyk A, Rodriguez DC, Mahendradhata Y, Sarker M, Seme A, Majumdar P, Akinyemi OO, Kayembe P, Alonge OO. Barriers and facilitators to knowledge translation activities within academic institutions in low- and middle-income countries. Health Policy Plan 2021; 36:728-739. [PMID: 33661285 PMCID: PMC8173595 DOI: 10.1093/heapol/czaa188] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
The barriers and facilitators of conducting knowledge translation (KT) activities are well-established but less is known about the institutional forces that drive these barriers, particularly in low resource settings. Understanding organizational readiness has been used to assess and address such barriers but the employment of readiness assessments has largely been done in high-income countries. We conducted a qualitative study to describe the institutional needs and barriers in KT specific to academic institutions in low- and middle-income countries. We conducted a review of the grey and published literature to identify country health priorities and established barriers and facilitators for KT. Key-informant interviews (KII) were conducted to elicit perceptions of institutional readiness to conduct KT, including experiences with KT, and views on motivation and capacity building. Participants included representatives from academic institutions and Ministries of Health in six countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria). We conducted 18 KIIs, 11 with members of academic institutions and 7 with policymakers. KIIs were analysed using a deductive and inductive coding approach. Our findings support many well-documented barriers including lack of time, skills and institutional support to conduct KT. Three additional institutional drivers emerged around soft skills and the complexity of the policy process, alignment of incentives and institutional missions, and the role of networks. Participants reflected on often-lacking soft-skills needed by researchers to engage policy makers. Continuous engagement was viewed as a challenge given competing demands for time (both researchers and policy makers) and lack of institutional incentives to conduct KT. Strong networks, both within the institution and between institutions, were described as important for conducting KT but difficult to establish and maintain. Attention to the cross-cutting themes representing barriers and facilitators for both individuals and institutions can inform the development of capacity building strategies that meet readiness needs.
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Affiliation(s)
- Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Yodi Mahendradhata
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Bulaksumur Yogyakarta, Indonesia
| | - Malabika Sarker
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,Heidelberg Global Institute of Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Assefa Seme
- Addis Ababa University School of Public Health, Ethiopia
| | - Piyusha Majumdar
- Indian Institute of Health Management Research, Bengaluru, India
| | - Oluwaseun O Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Patrick Kayembe
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Kalbarczyk A, Rao A, Adebayo A, Decker E, Gerber S, Morgan R. The influence of gender dynamics on polio eradication efforts at the community, workplace, and organizational level. Glob Health Res Policy 2021; 6:19. [PMID: 34183074 PMCID: PMC8240204 DOI: 10.1186/s41256-021-00203-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Globally, gender as a barrier or facilitator in achieving health outcomes is increasingly being documented. However, the role of gender in health programming and organization is frequently ignored. The Global Polio Eradication Initiative, one of the largest globally coordinated public health programs in history, has faced and worked to address gender-based challenges as they emerge. This paper seeks to describe the role of gender power relations in the polio program across global, national, subnational, and front-line levels to offer lessons learned for global programs. METHODS We conducted qualitative key-informant interviews with individuals purposively selected from the polio universe globally and within seven country partners: Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, and Nigeria. The interview tool was designed to explore nuances of implementation challenges, strategies, and consequences within polio eradication. All interviews were conducted in the local or official language, audio-recorded, and transcribed. We employed a deductive coding approach and used four gender analysis domains to explore data at the household, community, workplace, and organizational levels. RESULTS We completed 196 interviews globally and within each partner country; 74.5% of respondents were male and 25.5% were female. Male polio workers were not allowed to enter many households in conservative communities which created demand for female vaccinators. This changed the dynamics of front-line program teams and workplaces and empowered many women to enter the workplace for the first time. However, some faced challenges with safety and balancing obligations at home. Women were less likely to receive promotions to managerial or supervisory roles; this was also reflected at the global level. Some described how this lack of diverse management and leadership negatively affected the quality of program planning, delivery and limited accountability. CONCLUSIONS Gender power relations play an important role in determining the success of global health programs from global to local levels. Without consideration of gender, large-scale programs may fail to meet targets and/or reinforce gender inequities. Global disease programs should incorporate a gender lens in planning and implementation by engaging men and boys, supporting women in the workplace, and increasing diversity and representation among leadership.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Wolfe St, Baltimore, MD, USA.
| | - Aditi Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Wolfe St, Baltimore, MD, USA
| | | | - Ellie Decker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Wolfe St, Baltimore, MD, USA
| | - Sue Gerber
- Bill and Melinda Gates Foundation, Seattle, USA
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Wolfe St, Baltimore, MD, USA
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21
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Haenssgen MJ, Closser S, Alonge O. Impact and effect mechanisms of mass campaigns in resource-constrained health systems: quasi-experimental evidence from polio eradication in Nigeria. BMJ Glob Health 2021; 6:bmjgh-2020-004248. [PMID: 33685940 PMCID: PMC7942242 DOI: 10.1136/bmjgh-2020-004248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/12/2021] [Accepted: 02/10/2021] [Indexed: 12/04/2022] Open
Abstract
Background Mass campaigns are a key strategy for delivering life-saving interventions under Global Health Initiatives, especially in weak health system contexts. They are frequently designed parallel to the health system to rapidly achieve programme targets such as vaccination coverage, but we lack quantitative evidence demonstrating their impact and effect mechanisms on health system performance at sub-/national level. This longitudinal study responds to this gap through an analysis of polio eradication campaigns in Nigeria. Methods Using four rounds of Demographic and Health Surveys in Nigeria between October 2000 and December 2017, we created a longitudinal dataset containing 88 881 under-5 children/pregnancies. We estimated the relationships between individuals’ campaign exposure and health system performance indices (full RI schedule attainment, maternal healthcare services utilisation and child survival) using multilevel, mixed-effects regression models applied nationally and stratified by the six geopolitical zones in Nigeria. Results Nationally, high-frequency mass campaigns had detrimental health systems effects that potentially left 3.6 million children deprived of full immunisation. The frequency of campaigns was most concentrated in regions with weak health systems, where the operations of RI were disrupted, alongside negative effects on child survival and institutional delivery. In contrast, regions with relatively strong health systems and few campaigns experienced beneficial effects on maternal healthcare service utilisation. Conclusions As we provide evidence that well-functioning health systems can benefit from mass campaigns under Global Health Initiatives, our work also challenges the established wisdom to intensify mass campaigns in weaker health systems to bypass service provision bottlenecks. Mass campaigns do not inherently benefit or damage a health system, but frequent campaigns in weak health system contexts can impede service provision. We call for an additional burden of proof and active efforts to integrate mass campaigns into routine health services by harmonising implementation plans and service delivery in weak health system contexts.
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Affiliation(s)
- Marco J Haenssgen
- Department of Global Sustainable Development, School of Cross-Faculty Studies, University of Warwick, Coventry, UK.,Institute of Advanced Study, Milburn House, University of Warwick, Coventry, UK
| | - Svea Closser
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olakunle Alonge
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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22
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Cintyamena U, Azizatunnisa' L, Ahmad RA, Mahendradhata Y. Scaling up public health interventions: case study of the polio immunization program in Indonesia. BMC Public Health 2021; 21:614. [PMID: 33781243 PMCID: PMC8008664 DOI: 10.1186/s12889-021-10647-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/18/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The scaling up of public health interventions has received greater attention in recent years; however, there remains paucity of systematic investigations of the scaling up processes. We aim to investigate the overall process, actors and contexts of polio immunization scaling up in Indonesia from 1988 until 2018. METHODS A mixed method study with sequential explanatory design was conducted. We carried out a quantitative survey of 323 actors involved in the polio program at national and sub-national levels, followed by Key Informant Interviews (KII)s. Document review was also carried out to construct a timeline of the polio eradication program with milestones. We carried out descriptive statistical analysis of quantitative data and thematic analysis of qualitative data. RESULTS The scaling up of polio immunization in Indonesia started as a vertical expansion approach led by the Ministry of Health within a centralized health system. The coverage of immunization increased dramatically from 5% in the earlier 80s to 67.5% in 1987; incremental increases followed until achieving Universal Child Immunization (UCI) in 1990 and subsequently 95% coverage in 1995. Engagement of stakeholders and funding made the scaling up of polio immunization a priority. There was also substantial multisector involvement, including institutions and communities. Local area monitoring (LAM) and integrated health posts (Posyandu) were key to the polio immunization implementation strategy. Challenges for scaling up during this centralized period included cold chain infrastructure and limited experience in carrying out mass campaigns. Scaling up during the decentralized era was slower due to expansion in the number of provinces and districts. Moreover, there were challenges such as the negative perception of immunization side-effects, staff turnover, and the unsmooth transition of centralization towards decentralization. CONCLUSION Vertical scaling up of polio immunization program intervention was successful during the centralized era, with involvement of the president as a role model and the engine of multi sector actors. Posyandu (integrated health posts) played an important role, yet its revitalization after the reform-decentralization era has not been optimum.
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Affiliation(s)
- Utsamani Cintyamena
- Center for Tropical Medicine, Faculty Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Luthfi Azizatunnisa'
- Center for Tropical Medicine, Faculty Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Riris Andono Ahmad
- Center for Tropical Medicine, Faculty Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. .,Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Owoaje E, Rahimi AO, Kalbarczyk A, Akinyemi O, Peters MA, Alonge OO. Conflict, community, and collaboration: shared implementation barriers and strategies in two polio endemic countries. BMC Public Health 2020; 20:1178. [PMID: 33339525 PMCID: PMC7747362 DOI: 10.1186/s12889-020-09235-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Afghanistan and Nigeria are two of the three remaining polio endemic countries. While these two countries have unique sociocultural characteristics, they share major polio risk factors. This paper describes the countries' shared contexts and highlights important lessons on implementing polio eradication activities among hard-to-reach populations relevant for future global health programs. METHODS A grey literature review of the Global Polio Eradication Initiative (GPEI) followed by an online survey was conducted in both countries. The survey was targeted to individuals who have been involved continuously in polio eradication activities for 12 months or more since 1988. A sub-set of respondents from the survey was recruited for key-informant interviews (KII). The survey and KIIs were conducted between September 2018-April 2019. A cross-case comparison analysis was conducted to describe shared implementation challenges, strategies, and unintended consequences of polio eradication activities across these contexts. RESULTS Five hundred thirteen and nine hundred twenty-one surveys were completed in Afghanistan and Nigeria respectively; 28 KIIs were conducted in Afghanistan and 29 in Nigeria. Major polio eradication activities in both countries include house-to-house campaigns, cross-border stations, outreach to mobile populations, and surveillance. Common barriers to these activities in both countries include civil unrest and conflict; competing political agendas; and vaccine refusal, fatigue, and mistrust, all of which are all bases for describing hard-to-reach populations. Both countries employed strategies to engage community leadership, political and religious groups through advocacy visits, and recruited community members to participate in program activities to address misconceptions and distrust. Recruitment of female workers has been necessary for accessing women and children in conservative communities. Synergy with other health programs has been valuable; health workers have improved knowledge of the communities they serve which is applicable to other initiatives. CONCLUSIONS The power of community engagement at all levels (from leadership to membership) cannot be overstated, particularly in countries facing civil unrest and insecurity. Workforce motivation, community fatigue and mistrust, political priorities, and conflict are intricately interrelated. Community needs should be holistically assessed and addressed;programs must invest in the needs of health workers who engage in these long-term health programs, particularly in unsafe areas, to alleviate demotivation and fatigue.
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Affiliation(s)
- Eme Owoaje
- University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA.
| | | | - Michael A Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA
| | - Olakunle O Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA
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24
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Deressa W, Kayembe P, Neel AH, Mafuta E, Seme A, Alonge O. Lessons learned from the polio eradication initiative in the Democratic Republic of Congo and Ethiopia: analysis of implementation barriers and strategies. BMC Public Health 2020; 20:1807. [PMID: 33339529 PMCID: PMC7747367 DOI: 10.1186/s12889-020-09879-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) has partnered with 200 countries to vaccinate over 2.5 billion children against poliomyelitis. The polio eradication approach has adapted to emerging challenges and diverse contexts. Knowledge assets gained from these experiences can inform implementation of future health programs, but only if efforts are made to systematically map barriers, identify strategies to overcome them, identify unintended consequences, and compare experiences across country contexts. METHODS A sequential explanatory mixed methods design, including an online survey followed by key informant interviews (KIIs), was utilized to map tacit knowledge derived from the polio eradication experience from 1988 to 2019. The survey and KIIs were conducted between September 2018 and March 2019. A cross-case comparison was conducted of two study countries, the Democratic Republic of Congo (DRC) and Ethiopia, which fit similar epidemiological profiles for polio. The variables of interest (implementation barriers, strategies, unintended consequences) were compared for consistencies and inconsistencies within and across the two country cases. RESULTS Surveys were conducted with 499 and 101 respondents, followed by 23 and 30 KIIs in the DRC and Ethiopia, respectively. Common implementation barriers included accessibility issues caused by political insecurity, population movement, and geography; gaps in human resources, supply chain, finance and governance; and community hesitancy. Strategies for addressing these barriers included adapting service delivery approaches, investing in health systems capacity, establishing mechanisms for planning and accountability, and social mobilization. These investments improved system infrastructure and service delivery; however, resources were often focused on the polio program rather than strengthening routine services, causing community mistrust and limiting sustainability. CONCLUSIONS The polio program investments in the DRC and Ethiopia facilitated program implementation despite environmental, system, and community-level barriers. There were, however, missed opportunities for integration. Remaining pockets of low immunization coverage and gaps in surveillance must be addressed in order to prevent importation of wild poliovirus and minimize circulating vaccine-derived poliovirus. Studying these implementation processes is critical for informing future health programs, including identifying implementation tools, strategies, and principles which can be adopted from polio eradication to ensure health service delivery among hard-to-reach populations. Future disease control or eradication programs should also consider strategies which reduce parallel structures and define a clear transition strategy to limit long-term external dependency.
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Affiliation(s)
- Wakgari Deressa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Abigail H Neel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Eric Mafuta
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Olakunle Alonge
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Peters MA, Deressa W, Sarker M, Sharma N, Owoaje E, Ahmad RA, Saljuqi T, Mafuta E, Alonge O. Sampling method for surveying complex and multi-institutional partnerships: lessons from the Global Polio Eradication Initiative. BMC Public Health 2020; 20:1197. [PMID: 32787958 PMCID: PMC7421812 DOI: 10.1186/s12889-020-08592-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complex global initiatives, like the Global Polio Eradication Initiative (GPEI), have prevented millions of paralyses and improved the health status of diverse populations. Despite the logistical challenges these initiatives must overcome at several levels, scant methods exist for systematically identifying and reaching a range of actors involved in their implementation. As a result, efforts to document the lessons learned from such initiatives are often incomplete. This paper describes the development and application of the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) systematic approach for identifying a comprehensive sample of actors involved in the GPEI. RESULTS The survey for collecting lessons learned from the GPEI was conducted at the global level and within seven countries that represented GPEI operational contexts. Standard organizational and operational levels, as well as goals of program activities, were defined across contexts. Each survey iteration followed similar methodologies to theorize a target population or "universe" of all polio-related actors in the study area, enumerate a source population of specific individuals within the target population, and administer the survey to individuals within the source population. Based on the systematic approach used to obtain a comprehensive sample for lessons learned in GPEI, steps for obtaining a comprehensive sample for studying complex initiatives can be summarized as follows: (i) State research goal(s); (ii) Describe the program of interest; (iii) Define a sampling universe to meet these criteria; (iv) Estimate the size of the sampling universe; (v) Enumerate a source population within the universe that can be feasibly reached for sampling; (vi) Sample from the source population; and (vii) Reflect on the process to determine strength of inferences drawn. CONCLUSIONS The application of these methods can inform future evaluations of complex public health initiatives, resulting in better adoption of lessons learned, ultimately improving efficacy and efficiency, and resulting in significant health gains. Their use to administer the STRIPE lessons learned survey reflects experiences related to implementation challenges and strategies used to overcome barriers from actors across an extensive range of organizational, programming, and contextual settings.
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Affiliation(s)
- Michael A Peters
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Wakgari Deressa
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Malabika Sarker
- BRAC University JP Grant School of Public Health, Dhaka, Bangladesh
| | - Neeraj Sharma
- Indian Institute of Health Management Research, Jaipur, India
| | - Eme Owoaje
- University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Tawab Saljuqi
- Global Innovations Consultancy Services, Kabul, Afghanistan
| | - Eric Mafuta
- University of Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Olakunle Alonge
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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