A qualitative exploration of the contributions of Polio Eradication Initiative to the Nigerian health system: policy implications for polio transition planning

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.