TY - JOUR
T1 - Lessons learned from the polio eradication initiative in the Democratic Republic of Congo and Ethiopia
T2 - analysis of implementation barriers and strategies
AU - Deressa, Wakgari
AU - Kayembe, Patrick
AU - Neel, Abigail H.
AU - Mafuta, Eric
AU - Seme, Assefa
AU - Alonge, Olakunle
N1 - Funding Information:
Surveillance is managed in the DRC by the EPI with support from the WHO, though the National Institute of Biomedical Research (INRB), a specialized program of the Ministry of Health, is responsible for assessing adequacy of and evaluating stool samples. Since 2009 surveillance functions in Ethiopia have also been managed separately from ministry functions by the Centre of Public Health Emergency Management (PHEM). Based at the Ethiopian Public Health Institute (EPHI), PHEM is an autonomous agency accountable to the Ministry of Health (MOH) which hosts the National Polio Laboratory of Ethiopia. Notably, oversight of laboratory activities (both the DRC and Ethiopia have accredited laboratories within the Global Polio Laboratory Network) is distinct from community-based surveillance. As noted above, a key strategy in Ethiopia has been to conduct active surveillance in remote areas to detect AFP cases via the CORE group network.
Funding Information:
The authors would like to acknowledge the lead and team members of the other academic institutions included under the STRIPE academic consortium: Professor S.D. Gupta and Drs. Piyusha Majumdar, D.K. Magnal, and Neeraj Sharma of the IIHMR University India, Drs. Yodi Mahendradhata and Riris Andono Ahmad of the Gadjah Mada University Indonesia, Professor Eme Owoaje and Dr. Oluwaseun Akinyemi of the University of Ibadan Nigeria, Drs. Ahmad Shah Salehi, Tawab Saljuqi and Ahmad Omid Rahimi of Global Innovation Consultancy Services Afghanistan, and Professor Malabika Sarker, Dr. Yameen Mazumder, and Humayra Binte Anwar of BRAC University Bangladesh. The authors would also like to acknowledge Johns Hopkins University colleagues Svea Closser and Priyanka Agrawal for their inputs. Finally, we would like to thank the data collectors and study participants for their time and contributions to the study. This article has been published as part of BMC Public Health, Volume 20, Supplement 4, 2020: Lessons Learned from Global Polio Eradication ? Part 2. The full contents of the supplement are available at https://bmcpublichealth.biomedcentral.com/articles/supplements/volume-20-supplement-4.
Funding Information:
This study is funded by the Bill and Melinda Gates Foundation. The funder did not play any role in writing the protocol or interpreting the data. The funder provided and coordinated external peer-review for the study proposal.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - Democratic Republic of Congo
KW - Ethiopia
KW - Global Polio Eradication Initiative
KW - Implementation science
KW - Knowledge translation
UR - http://www.scopus.com/inward/record.url?scp=85097774723&partnerID=8YFLogxK
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U2 - 10.1186/s12889-020-09879-9
DO - 10.1186/s12889-020-09879-9
M3 - Article
C2 - 33339529
AN - SCOPUS:85097774723
SN - 1471-2458
VL - 20
JO - BMC public health
JF - BMC public health
M1 - 1807
ER -