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

摘要

Background: Lessons from polio eradication efforts and the Global Polio Eradication Initiative (GPEI) are useful forimproving health service delivery and outcomes globally. The Synthesis and Translation of Research andInnovations from Polio Eradication (STRIPE) is a multi-phase project which aims to map, package and disseminateknowledge from polio eradication initiatives as academic and training programs. This paper discusses initial findingsfrom 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 (scopingreview, survey, key informant interviews (KIIs), health system analyses). This paper utilized a sequential mixed method designcombining data from the survey and KIIs. The survey included individuals involved in polio eradication between 1988 and2019, and described the contexts, implementation strategies, intended and unintended outcomes of polio eradicationactivities across levels. KIIs were conducted among a nested sample in seven countries (Afghanistan, Bangladesh, theDemocratic 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 74countries; 194 KIIs were conducted. External factors including social, political, and economic factors were the most frequentlycited 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 deliverystrategies. 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 healthprograms. Common implementation strategies emerged across countries; however, these strategies were only effectivewhere organizational and individual capacity were sufficient, and where strategies were appropriately tailored to thesociopolitical context. To maximize gains, readiness assessments at different levels should predate future global healthprograms and initiatives should consider system integration earlier to ensure program institutionalization and minimizesystem distortions.