Eradicating polio in Pakistan: a systematic review of programs and policies

Ataullahjan, Anushka; Ahsan, Hanaa; Soofi, Sajid Bashir; Habib, Atif; Bhutta, Zulfiqar A

doi:10.1080/14760584.2021.1915139

Cited by 25 publications

(25 citation statements)

References 39 publications

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“…We found significantly lower odds of identifying polio implementation process as a main internal contributor for strengthening service delivery in Eastern Mediterranean region. For example, in Pakistan, polio supplementary immunization activites were criticized as being disjointed from routine childhood immunization services and other primary health care services [ 31 ]. Similarly in Afghanistan, Rodriguez et al found that the extensive separation of polio program from routine immunization significantly impacted service delivery strengthening at the sub-national levels [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Respondents cited security challenges, and community resistance to polio eradication interventions as the main forms of implementation challenges experienced. A recent review found insecurity and conflicts remain a persistent barrier to service delivery in Pakistan, [ 31 ] and Afghanistan continues to grapple with complex challenges of prolonged religious and ethnic conflicts, mistrust in health workers and political upheavals [ 37 ]. Community resistance is often the manifestation of a lack of community trust, which was a major challenge in the eradication of polio according to the polio IMB [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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How service delivery implementation strategies can contribute to attaining universal health coverage: lessons from polio eradication using an implementation science approach

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How service delivery implementation strategies can contribute to attaining universal health coverage: lessons from polio eradication using an implementation science approach

et al. 2022

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“…The Polio Eradication Programme also undertakes highly sensitive surveillance and detection and response activities to track and limit virus transmission across the country, as well as communication and social mobilisation activities which encourage health-seeking behaviours amongst communities. 1 The programme, while largely successful, has also been marked by complex challenges. Politicians and bureaucrats have interfered with the governance and management of the programme, and programme funds have sometimes been used for personal or political gain.…”

Section: Status Of Polio Vaccination In Pakistan Pakistan Polio Eradi...mentioning

confidence: 99%

Key Considerations: Localisation of Polio Vaccination Efforts in the Newly Merged Districts (Tribal Areas) of Pakistan

Hakeem¹,

Hussain²

2022

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Poliomyelitis (polio) remains a vital global public health challenge, particularly in countries where eradication efforts are ongoing. For almost three decades, polio programme and frontline workers in Pakistan have suffered human and financial losses due to complex political and bureaucratic management, local resistance to programme efforts, and the context of cross-border insurgency and insecurity.1 Many stakeholders in Pakistan continue to have low confidence in frontline workers and polio vaccination campaigns. In this environment, it is essential that vaccination programmes localise – by taking careful account of the local context, improving local ownership of the programmes, understanding and mitigating the issues at a grassroots level, and tailoring efforts to achieve polio eradication goals. This brief draws on evidence from academic and grey literature, data on polio vaccine uptake, consultations with partners working on polio eradication in Pakistan, and the authors’ own programme implementation experience in the country. The brief reviews the social, cultural, and contextual considerations relevant to increasing polio vaccine uptake amongst vulnerable groups in Pakistan’s tribal areas. It focuses on the current country context, in the aftermath of the 2018 merger of the former Federally Administered Tribal Areas (FATA) into Khyber Pakhtunkhwa province (KPK). This brief is part of a series authored by participants from the SSHAP Fellowship, and was written by Luqman Hakeem and Riaz Hussain from Cohort 2. Contributions were provided by response partners in Pakistan including health communication and delivery staff and local administrative authorities. This brief was reviewed by Muhammad Sufyan (University of Swabi) and Ilyas Sharif (Quaid-e-Azam College of Commerce, University of Peshawar). The brief was supported by Megan Schmidt-Sane and Santiago Ripoll at the Institute of Development Studies and is the responsibility of SSHAP.

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“…To this day, Pakistan continues to combat this deadly virus. A record low of eight cases was reported in 2017; however, this was followed by an increase in later years, with 12 cases in 2018, 147 cases in 2019, 84 cases in 2020, and 1 and 13 cases found in 2021 and 2022, respectively [2,3].…”

Section: Dear Editormentioning

confidence: 99%