Synthesis and translation of research and innovations from polio eradication (STRIPE): initial findings from a global mixed methods study

Abstract

Background Lessons from polio eradication efforts and the Global Polio Eradication Initiative (GPEI) are useful for improving health service delivery and outcomes globally. The Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) is a multi-phase project which aims to map, package and disseminate knowledge from polio eradication initiatives as academic and training programs. This paper discusses initial findings from the knowledge mapping around polio eradication activities across a multi-country context. Methods The knowledge mapping phase (January 2018 – December 2019) encompassed four research activities (scoping review, survey, key informant interviews (KIIs), health system analyses). This paper utilized a sequential mixed method design combining data from the survey and KIIs. The survey included individuals involved in polio eradication between 1988 and 2019, and described the contexts, implementation strategies, intended and unintended outcomes of polio eradication activities across levels. KIIs were conducted among a nested sample in seven countries (Afghanistan, Bangladesh, the Democratic Republic of Congo, Ethiopia, India, Indonesia, Nigeria) and at the global level to further explore these domains. Results The survey generated 3955 unique responses, mainly sub-national actors representing experience in over 74 countries; 194 KIIs were conducted. External factors including social, political, and economic factors were the most frequently cited barriers to eradication, followed by the process of implementing activities, including program execution, planning, monitoring, and stakeholder engagement. Key informants described common strategies for addressing these barriers, e.g. generating political will, engaging communities, capacity-building in planning and measurement, and adapting delivery strategies. The polio program positively affected health systems by investing in system structures and governance, however, long-term effects have been mixed as some countries have struggled to institutionalize program assets. Conclusion Understanding the implementing context is critical for identifying threats and opportunities to global health programs. Common implementation strategies emerged across countries; however, these strategies were only effective where organizational and individual capacity were sufficient, and where strategies were appropriately tailored to the sociopolitical context. To maximize gains, readiness assessments at different levels should predate future global health programs and initiatives should consider system integration earlier to ensure program institutionalization and minimize system distortions.

Sampling method for surveying complex and multi-institutional partnerships: lessons from the Global Polio Eradication Initiative

“…The Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) project seeks to map, package and disseminate knowledge gained from the GPEI and polio eradication activities and is described elsewhere [18]. To that end, the project conducted a "tacit knowledge survey" to capture ideas, approaches and experiences that are not documented, but relevant to understanding both intended and unintended results from polio eradication activities.…”

“…Since it was not feasible to systematically collect lessons learned from every context where GPEI has operated, seven countries were purposively selected to represent a range of epidemiologic and operational contexts: Afghanistan, Bangladesh, Democratic Republic of Congo (DRC), Ethiopia, India, Indonesia, and Nigeria. The context typologies for polio implementation were defined based on the epidemiological, geographical, income, conflict, and other status 2 [18]. Relevant organizations were broadly defined to include those involved with funding, researching, designing, managing, and implementing activities that contribute to polio eradication.…”

“…The best method of reaching international, national, and some state-level actors was generally recognized to be an online survey (available in English and locally relevant languages), while in-person interviews were employed particularly to reach front-line immunizers. All methods utilized the same survey questionnaire (made available elsewhere in this series, see [18]), however questionnaires administered to field workers were translated into more accessible, locally appropriate terminologies.…”

“…The IMB largely relies on data provided by GPEI organizations, as well as conversations with GPEI and government organizations, and short field visits [24,25]. The STRIPE project collects much of the same data as the IMB; with reports and data provided by GPEI organizations captured in the series of literature reviews and conversations with policymakers captured in key informant interviews [18]. While the IMB has recommended the collection and review of field-level perspectives since its earliest days, there has yet to be a systematic collection of perspectives across the entire range of actors involved in polio eradication [25].…”

Scaling Up Public Health Interventions: A Case Study of the Polio Immunization Program in Indonesia

“…As part of the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) project (https://stripe.jhu.edu/), we conducted a convergent mixed-method study complemented by document review (11). We systematically collected documents and reports on polio related information.…”