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Neel AH, Olateju A, Peters MA, Schleiff M, Alonge O. Lessons from polio eradication: a synthesis of implementation strategies for global health services delivery from a scoping review. FRONTIERS IN HEALTH SERVICES 2024; 4:1287554. [PMID: 39170083 PMCID: PMC11335730 DOI: 10.3389/frhs.2024.1287554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 07/03/2024] [Indexed: 08/23/2024]
Abstract
Introduction There is limited guidance on strategies for delivering complex global health programs. We synthesized available evidence on implementation strategies and outcomes utilized in the global polio eradication initiative (GPEI) across low and middle-income country (LMIC) settings. Methods We nested our scoping review into a literature review conducted as part of a parent study, STRIPE. This review systematically searched PubMed for articles between 1 January 1988 and 25 April 2018 using polio search terms. Strategies from included studies were organized according to the Expert Recommendations for Implementing Change (ERIC) framework, specified using Proctor's framework, and linked to various outcomes (implementation, services delivery, impact). Results 152 unique articles fulfilled our inclusion criteria (from 1,885 articles included in the parent study). Only 43 out of the 152 articles described a suitable quantitative study design for evaluating outcomes. We extracted 66 outcomes from the 43 unique studies. Study publication dates ranged from 1989 to 2018 and represented diverse country settings. The most common implementation strategies were developing mechanisms for feedback, monitoring, and evaluation (n = 69); increasing awareness among the population (n = 58); involving stakeholders, workers, and consumers in the implementation efforts (n = 46); conducting workshops (n = 33); using mass media (n = 31); and building robust record systems to capture outcomes (n = 31). Coverage (n = 13) and morbidity (n = 12) were the most frequently identified outcomes, followed by effectiveness (n = 9) and fidelity (n = 6). Feasibility and sustainability were rarely evaluated. Conclusions This review provides a catalogue of implementation strategies and outcomes relevant for advancing global health services delivery in LMICs drawing from the GPEI. Implementation strategies reviewed were poorly described and not adequately linked to outcomes. It calls for additional implementation research to unravel the mechanisms of implementation strategies and their effectiveness, and adaptation of the ERIC framework in LMICs.
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Affiliation(s)
- Abigail H. Neel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adetoun Olateju
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael A. Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Meike Schleiff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Olakunle Alonge
- Sparkman Center for Global Health, University of Alabama at Birmingham, Birmingham, AL, United States
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Abubakar AT, Al-Mustapha AI, Oyewo M, Ibrahim A, Abdulrahim I, Yakub JM, Elelu N, Nguku P, Balogun MS, Awosanya EJ, Kia GSN, Kwaga JKP, Okoli I, Bolajoko MB, Alimi Y, Mbilo C, Dacheux L. Prospects for dog rabies elimination in Nigeria by 2030. Zoonoses Public Health 2024; 71:1-17. [PMID: 37933425 DOI: 10.1111/zph.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
The attainment of the global target of zero dog-mediated human rabies by 2030 depends on functional rabies programmes. Nigeria, a rabies-endemic country, and the most populous country in Africa has a very poor rabies control strategy with a score of 1.5 out of 5 based on the Stepwise Approach towards Rabies Elimination (SARE). In this article, we report a scoping review that we conducted to highlight the strengths, weaknesses, opportunities and threats as well as situational analysis of rabies control in Nigeria and suggest a timeline for key activities that are needed to ensure zero by 30. Our findings reveal that rabies is grossly under-reported as only 998 human and 273 dog-suspected rabies cases were reported across Nigeria between 2017 and 2022. Our literature review also demonstrates a paucity of information on rabies in both human and animal health sectors. A total of 49 studies on dog rabies in Nigeria, with a predominance of reports from the North Central geopolitical region (48%, n = 23) were therefore included in this study. Currently, only 16.2% (n = 6/37) of Nigerian states have available data related to the estimated dog populations, the dog ownership rates, the vaccination status of dogs or the incidence of dog bites. Based on a dog-to-human ratio of 1:16.3, we estimated that the dog population in Nigeria was 12,969,368 (95% CI: 12,320,900-13,617,836). Thus, to attain herd immunity and dog rabies control in Nigeria, at least 9.1 million dogs must be vaccinated annually. Our review reveals that, despite the strengths and available opportunities to achieve rabies control in Nigeria by 2030, the weaknesses and challenges will make the attainment of zero by 30 very difficult or impossible. Nigeria's best-case scenario by the year 2030 is SARE stage 3-4 (control-elimination) out of 5. Otherwise, the rabies control programme might not surpass SARE stages 2-3. To attain zero by 30, Nigeria must re-strategize its current rabies control programme by funding and implementing the national strategic plan for rabies control, creating a rabies desk office in the 37 states (FCT inclusive), rigorously conducting mass vaccination campaigns, providing post-exposure prophylaxis, prioritizing mass enlightenment with a focus on responsible pet ownership and conduct baseline national rabies surveillance in the animal and human health sectors.
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Affiliation(s)
- Ahmed Tijani Abubakar
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
| | - Ahmad Ibrahim Al-Mustapha
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Muftau Oyewo
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Ahmed Ibrahim
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
| | - Ibrahim Abdulrahim
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
| | - Jimoh Muhammad Yakub
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
| | - Nusirat Elelu
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ilorin, Ilorin, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | | | - Emmanuel Jolaoluwa Awosanya
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Grace Sabo Nok Kia
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria, Nigeria
- Africa Center for Excellence for Neglected Tropical Diseases and Forensic Biotechnology, Ahmadu Bello University, Zaria, Nigeria
| | - Jacob K P Kwaga
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria, Nigeria
- Africa Center for Excellence for Neglected Tropical Diseases and Forensic Biotechnology, Ahmadu Bello University, Zaria, Nigeria
| | - Ihekerenma Okoli
- Department of Veterinary and Pest Control Services, Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
| | | | - Yewande Alimi
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Celine Mbilo
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Laurent Dacheux
- National Reference Center for Rabies, Institut Pasteur, Paris, France
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Mathew P, Chandy SJ, Sivaraman S, Ranjalkar J, Ali HM, Thomas SA. Formulating a Community-Centric Indicator Framework to Quantify One Health Drivers of Antibiotic Resistance: A Preliminary Step towards Fostering 'Antibiotic-Smart Communities'. Antibiotics (Basel) 2024; 13:63. [PMID: 38247622 PMCID: PMC10812418 DOI: 10.3390/antibiotics13010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Antibiotic resistance (ABR) is increasing the mortality and morbidity associated with infectious diseases, besides increasing the cost of healthcare, saturating health system capacity, and adversely affecting food security. Framing an appropriate narrative and engaging local communities through the 'One Health' approach is essential to complement top-down measures. However, the absence of objective criteria to measure the performance of ABR interventions in community settings makes it difficult to mobilize interest and investment for such interventions. An exercise was therefore carried out to develop an indicator framework for this purpose. A comprehensive list of indicators was developed from experiences gathered through community engagement work in a local panchayat (small administrative area) in Kerala, India and a consultative process with health, veterinary, environment, and development experts. A prioritization exercise was carried out by global experts on ABR, looking at appropriateness, feasibility, and validity. A 15-point indicator framework was designed based on the prioritization process. The final set of indicators covers human health, animal health, environment management, and Water Sanitation and Hygiene (WASH) domains. The indicator framework was piloted in the panchayat (located in Kerala), which attained a score of 34 (maximum 45). The score increased when interventions were implemented to mitigate the ABR drives, indicating that the framework is sensitive to change. The indicator framework was tested in four sites from three other Indian states with different socioeconomic and health profiles, yielding different scores. Those collecting the field data were able to use the framework with minimal training. It is hoped that, this indicator framework can help policymakers broadly understand the factors contributing to ABR and measure the performance of interventions they choose to implement in the community as part of National Action Plan on AMR.
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Affiliation(s)
- Philip Mathew
- ReAct Asia Pacific, Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore 632002, Tamil Nadu, India; (P.M.); (S.S.); (H.M.A.); (S.A.T.)
| | - Sujith J. Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore 632002, Tamil Nadu, India;
| | - Satya Sivaraman
- ReAct Asia Pacific, Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore 632002, Tamil Nadu, India; (P.M.); (S.S.); (H.M.A.); (S.A.T.)
| | - Jaya Ranjalkar
- ReAct Asia Pacific, Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore 632002, Tamil Nadu, India; (P.M.); (S.S.); (H.M.A.); (S.A.T.)
| | - Hyfa Mohammed Ali
- ReAct Asia Pacific, Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore 632002, Tamil Nadu, India; (P.M.); (S.S.); (H.M.A.); (S.A.T.)
| | - Shruthi Anna Thomas
- ReAct Asia Pacific, Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore 632002, Tamil Nadu, India; (P.M.); (S.S.); (H.M.A.); (S.A.T.)
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Wakam Nkontchou B, Guenou E, Buh Nkum C, Mairousgou Tchida C, Nono AM, Ateudjieu J. The Polio Vaccination Status of Non-polio Acute Flaccid Paralysis Cases in the Far North Region of Cameroon: A Five-Year Retrospective Study From 2015 to 2019. Cureus 2024; 16:e52740. [PMID: 38384598 PMCID: PMC10880869 DOI: 10.7759/cureus.52740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The Expanded Program on Immunization (EPI) of Cameroon contributes to the reduction of polio, but the rate of non-polio acute flaccid paralysis (NPAFP) is still high. The aim of this study was to describe the immunization profile of NPAFP cases and the performance of polio surveillance in the Far North Region of Cameroon between 2015 and 2019. METHODS A retrospective secondary data analysis was conducted using the national EPI and regional AFP surveillance case-based database from 2015 to 2019. Analyses were carried out using Epi-Info statistical software (version 7) (Centers for Disease Control and Prevention, Atlanta, GA). RESULTS The surveillance network of the region reported 848 cases of NPAFP between 2015 and 2019. The sex distribution of the AFP cases revealed that 43.3% were females and 56.7% were males. Cases with AFP aged less than five years accounted for the largest proportion of cases (67.2%). Overall, 733/848 (86.4%) of the AFP cases received at least three doses of the oral polio vaccine (OPV). The AFP detection rate substantially increased in the region after the introduction of community-based surveillance in 2016. The mean NPAFP level during the study period was 7.3/100,000 children aged less than 15 years. The mean proportion of AFP cases with two adequate stools was 668/848 (78.7%), and the mean proportion of stools to the national reference laboratory within three days was 466/848 (54.9%). CONCLUSION Only 86.4% of AFP cases received three or more doses of OPV required for immunization. The stool specimen management indices were not good enough to confirm that no case of poliovirus was missed in the laboratory. To strengthen the country's polio-free status, surveillance should be strengthened in least-performing health districts to improve the quality of AFP case investigations after detection.
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Affiliation(s)
| | - Etienne Guenou
- Epidemiological Surveillance Section, National Public Health Laboratory, Ministry of Public Health, Yaoundé, CMR
- Health Research, Meilleur Accès aux Soins de Santé (M.A. SANTE), Yaoundé, CMR
| | - Collins Buh Nkum
- Health Research, Meilleur Accès aux Soins de Santé (M.A. SANTE), Yaoundé, CMR
- Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, CMR
| | - Celine Mairousgou Tchida
- Regional Centre for Epidemic Prevention and Control, Far North Regional Public Health Delegation, Ministry of Public Health, Maroua, CMR
| | | | - Jerome Ateudjieu
- Health Research, Meilleur Accès aux Soins de Santé (M.A. SANTE), Yaoundé, CMR
- Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, CMR
- Division of Health Operations Research, Cameroon Ministry of Public Health, Yaoundé, CMR
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Patel C, Rendell N, Sargent GM, Ali A, Morgan C, Fields R, Sheel M. Measuring National Immunization System Performance: A Systematic Assessment of Available Resources. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e220055. [PMID: 37348935 PMCID: PMC10285727 DOI: 10.9745/ghsp-d-22-00555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Vaccination coverage is widely used to assess immunization performance but, on its own, provides insufficient information to drive improvements. Assessing the performance of underlying components of immunization systems is less clear, with several monitoring and evaluation (M&E) resources available for use in different operational settings and for different purposes. We studied these resources to understand how immunization system performance is measured. METHODS We reviewed peer-reviewed and gray literature published since 2000 to identify M&E resources that include national-level indicators measuring the performance of immunization systems or their components (governance, financing, regulation, information systems, vaccine logistics, workforce, service delivery, and demand generation). We summarize indicators by the system components or outcomes measured and describe findings narratively. RESULTS We identified 20 resources to monitor immunization program objectives and guide national strategic decision-making, encompassing 631 distinct indicators. Indicators for immunization program outcomes comprised the majority (124/631 [19.7%]), largely vaccination coverage (110/124 [88.7%]). Almost all resources (19/20 [95%]) included indicators for vaccine logistics (83/631 [13.2%]), and those for regulation (19/631 [3.0%]) and demand generation (28/631 [4.4%]) were least common. There was heterogeneity in how information systems (92/563 [14.6%]) and workforce (47/631 [7.4%]) were assessed across resources. Indicators for vaccination coverage in adults, data use in decision-making, equity and diversity, effectiveness of safety surveillance, and availability of a public health workforce were notably lacking. CONCLUSIONS Between the resources identified in this review, we identified considerable variability and gaps in indicators assessing the performance of some immunization system components. Given the multitude of indicators, policymakers may be better served by tailoring evaluation resources to their specific context to gain useful insight into health system performance and improve data use in decision-making for immunization programs.
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Affiliation(s)
- Cyra Patel
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia.
| | - Nicole Rendell
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
| | - Ginny M Sargent
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
| | - Akeem Ali
- World Health Organization, Seoul, Republic of Korea
| | - Christopher Morgan
- Jhpiego, Baltimore, MD, USA
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
| | - Rebecca Fields
- JSI Research & Training Institute, Inc., Arlington, VA, USA
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Bertoldo LAA, Oliveira MICD, Boccolini CS. Violations in the marketing of milks and complementary foods that compete with breastfeeding in Rio de Janeiro City, Brazil. REVISTA PAULISTA DE PEDIATRIA 2023; 41:e2021228. [PMID: 35830162 PMCID: PMC9273118 DOI: 10.1590/1984-0462/2023/41/2021228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
Objective: To analyze if milk and complementary foods are being sold under the Brazilian Code of Marketing of Infant and Toddler's Food, Teats, Pacifiers and Baby Bottles (NBCAL), Law 11265/2006 of breastfeeding protection. Methods: Epidemiological survey that analyzed the marketing practices of pharmacies, supermarkets, and department stores in the Southern region of the city of Rio de Janeiro, Brazil, by direct observation. Results: Among the 349 stores in Rio de Janeiro's South Region, 339 traded milk and complementary foods and, among them, 60.8% were not complying with NBCAL. Infractions to NBCAL were more common for the selling of milk (58.6%) than complementary foods (22.8%). The most recurrent promotion strategy infringing NBCAL was discount pricing without the Ministry of Health disclaimer. Conclusions: Most retail stores infringe NBCAL in the commercialization of milk and complementary foods in the city of Rio de Janeiro, Brazil, a violation of the right to information that may impact mothers’ choice regarding their child's feeding.
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Ogbuabor DC, Ghasi N, Nwangwu N, Okenwa UJ, Ezenwaka U, Onwujekwe O. Stakeholders' perspectives on internal accountability within a sub-national immunization program: A qualitative study in Enugu State, South-East Nigeria. Niger J Clin Pract 2022; 25:2030-2038. [PMID: 36537462 DOI: 10.4103/njcp.njcp_522_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Weak accountability hinders the effectiveness of routine immunization (RI) systems in low- and middle-income countries, yet studies on accountability of immunization programs are scarce. Aim: The study explored stakeholders' perspectives on the functioning of internal accountability within the National Program on Immunization in Enugu State, southeast Nigeria. SUBJECTS AND METHODS We used semi-structured in-depth interviews to collect data from RI officials at state government, local government, and health facility levels (n = 35) in Enugu State between June and July 2021. We adopted maximum variation sampling to purposively select individuals with roles in immunization. The interview guide was developed based on an accountability framework with three dimensions-the axes of power, ability, and justice. Data were analyzed thematically using NVivo software (version 11). The major themes were role clarity, performance standards, supervision, data use, human resources, funding, motivation, sanctions, political influence, and community engagement. RESULTS Performance targets for immunization coverage and reporting timeline were not always met due to multiple accountability failures. Weaknesses in the formal rules that distribute roles among the immunization workforce comprise a lack of deployment letters, unavailability of job descriptions, and inadequate staff orientation. Local officials have a narrow decision space regarding staff posting, transfer, and discipline. Performance accountability was constrained by staff shortages, uneven staff distribution, absenteeism, infrequent supervision, weak data monitoring system, and underfunding. Despite being motivated by job recognition and accomplishments, low motivation from an insecure working environment and lack of financial incentives undermined the constructive agency of service delivery actors. The sanctions framework exists but is weakly enforced due to fear of victimization. Political commitment to the immunization program was low. Yet, political decision-makers interfered with staff recruitment, distribution, and discipline. Community engagement improved resource availability through paid volunteer health workers and maintenance of facilities. However, health facility committees were poorly resourced, non-functional, and lacked the power to sanction erring health workers. CONCLUSIONS Immunization service delivery actors can be held accountable for program performance when there are sufficient formal instruments that provide roles and responsibilities, needed resources, motivated and supervised staff, an effective sanctions framework, genuine political participation, and strong community engagement.
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Affiliation(s)
- D C Ogbuabor
- Department of Health Administration and Management; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria
| | - N Ghasi
- Department of Management, University of Nigeria Enugu Campus, Nsukka, Nigeria
| | - N Nwangwu
- Department of Sociology, Enugu State University of Science and Technology, Enugu, Nigeria
| | - U J Okenwa
- Enugu State Ministry of Health, Enugu, Nigeria
| | - U Ezenwaka
- Department of Health Administration and Management; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria
| | - O Onwujekwe
- Department of Health Administration and Management; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria
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Oteri AJ, Adamu U, Dieng B, Bawa S, Terna N, Nsubuga P, Owoaje ET, Kassogue M, Jean Baptiste AE, Braka F, Shuaib F. Nigeria experience on the use of polio assets for the 2017/18 measles vaccination campaign follow-up. Vaccine 2021; 39 Suppl 3:C3-C11. [PMID: 33962837 DOI: 10.1016/j.vaccine.2021.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018. METHODS We documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators. RESULTS All the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015. CONCLUSION Polio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources. This approach may have resulted in better MVC outcomes and contributed to Nigeria's efforts in measles control and elimination.
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Affiliation(s)
| | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunisations, Nigeria
| | - Samuel Bawa
- World Health Organisation, Country Office, Abuja, Nigeria.
| | | | | | - Eme T Owoaje
- College of Medicine, University of Ibadan. Nigeria
| | - Modibo Kassogue
- United Nations Children's Fund, Country Office, Abuja, Nigeria
| | | | - Fiona Braka
- World Health Organisation, Country Office, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Momoh J, Oteri AJ, Mogekwu F, Onwu N, Dieng B, Bawa S, Braka F, Nsubuga P, Shuaib F. Ensuring accountability in implementation of supplementary immunisation activities: A case study of the 2017/2018 measles vaccination campaign in Nigeria. Vaccine 2021; 39 Suppl 3:C12-C20. [PMID: 33714654 DOI: 10.1016/j.vaccine.2021.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 01/27/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Globally, there is a growing concern with accountability and health systems. This has been attributed majorly to discontent with health system performance. Within the Nigerian health system, weak accountability has been consistently singled out as a key challenge underpinning the poor performance of the immunisation programme. In preparation for the 2017/2018 Measles Vaccination Campaign in Nigeria, the National Measles Technical Coordinating Committee (NMTCC) was inaugurated with one of its key mandates being to ensure accountability in the conduct of the 2017/2018 MVC. This paper aims to share the innovative measures applied in the 2017/2018 Measles MVC to improve accountability and to highlight the contribution of the accountability framework to improving measles vaccination coverage. METHODS We identified gaps in accountability from the post-campaign coverage reports and reviews of previous campaigns. We adapted an accountability framework developed by the Nigeria National Routine Immunization Strategic Plan (2013-2015),- which cuts across all levels. Selected indicators were used to monitor the implementation of the framework. Administrative actions such as sanctions and rewards were taken as necessary. FINDINGS We found that the implementation of the accountability framework was highly instrumental in achieving a high level of coordination among all stakeholders and to improving efficient utilization of resources. We also found that the implementation of the accountability framework in the 2017/2018 MVC contributed to the improved performance of states in terms of measles vaccination coverage compared to the 2015/2016 campaign. CONCLUSION We have demonstrated that the implementation of the accountability framework in the 2017/2018 MVC led to a considerable reduction in the misuse and abuse of resources and also contributed to remarkable improvement in the measles vaccination coverages across states compared to the 2015/2016 MVC.
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Affiliation(s)
- Jenny Momoh
- Volunteer, National Measles Technical Coordinating Committee, Nigeria
| | | | - Fred Mogekwu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Nneka Onwu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Gavi Vaccine Alliance, Switzerland
| | - Samuel Bawa
- World Health. Organization, Country Office, Abuja, Nigeria
| | - Fiona Braka
- World Health. Organization, Country Office, Abuja, Nigeria
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, United States
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Tesfaye B, Sowe A, Kisangau N, Ogange J, Ntoburi S, Nekar I, Muitherero C, Camara Y, Gathenji C, Langat D, Sergon K, Limo H, Nzunza R, Kiptoon S, Kareko D, Onuekwusi I. An epidemiological analysis of Acute Flaccid Paralysis (AFP) surveillance in Kenya, 2016 to 2018. BMC Infect Dis 2020; 20:611. [PMID: 32811467 PMCID: PMC7437168 DOI: 10.1186/s12879-020-05319-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 08/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background The poliovirus has been targeted for eradication since 1988. Kenya reported its last case of indigenous Wild Poliovirus (WPV) in 1984 but suffered from an outbreak of circulating Vaccine-derived Poliovirus type 2 (cVDPV2) in 2018. We aimed to describe Kenya’s polio surveillance performance 2016–2018 using WHO recommended polio surveillance standards. Methods Retrospective secondary data analysis was conducted using Kenyan AFP surveillance case-based database from 2016 to 2018. Analyses were carried out using Epi-Info statistical software (version 7) and mapping was done using Quantum Geographic Information System (GIS) (version 3.4.1). Results Kenya reported 1706 cases of AFP from 2016 to 2018. None of the cases were confirmed as poliomyelitis. However, 23 (1.35%) were classified as polio compatible. Children under 5 years accounted for 1085 (63.6%) cases, 937 (55.0%) cases were boys, and 1503 (88.1%) cases had received three or more doses of Oral Polio Vaccine (OPV). AFP detection rate substantially increased over the years; however, the prolonged health workers strike in 2017 negatively affected key surveillance activities. The mean Non-Polio (NP-AFP) rate during the study period was 2.87/ 100,000 children under 15 years, and two adequate specimens were collected for 1512 (88.6%) AFP cases. Cumulatively, 31 (66.0%) counties surpassed target for both WHO recommended AFP quality indicators. Conclusions The performance of Kenya’s AFP surveillance system surpassed the minimum WHO recommended targets for both non-polio AFP rate and stool adequacy during the period studied. In order to strengthen the country’s polio free status, health worker’s awareness on AFP surveillance and active case search should be strengthened in least performing counties to improve case detection. Similar analyses should be done at the sub-county level to uncover underperformance that might have been hidden by county level analysis.
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Affiliation(s)
- Brook Tesfaye
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya.
| | - Alieu Sowe
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Ngina Kisangau
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - John Ogange
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Stephen Ntoburi
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Irene Nekar
- Polio Surge Consultant, African Field Epidemiology Network, Nairobi, Kenya
| | - Charles Muitherero
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Yaya Camara
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Carolyne Gathenji
- Horn of Africa Polio Eradication Coordination Office, Nairobi, Kenya
| | - Daniel Langat
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | - Kibet Sergon
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Hilary Limo
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | - Rosemary Nzunza
- Kenya Medical Research Institute, Center for Virus Research, Ministry of Health, Nairobi, Kenya
| | - Shem Kiptoon
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - David Kareko
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | - Iheoma Onuekwusi
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
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Tesfaye B, K Makam J, Sergon K, Onuekwusi I, Muitherero C, Sowe A. The role of the Stop Transmission of Polio (STOP) program in developing countries: the experience of Kenya. BMC Public Health 2020; 20:1110. [PMID: 32664859 PMCID: PMC7362661 DOI: 10.1186/s12889-020-09196-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background In 1988, the 41st World Health Assembly (WHA) marked the launch of the Global Polio Eradication Initiative (GPEI) for the eradication of polio. A key component of the GPEI has been the development and deployment of a skilled workforce to implement eradication activities. In 1989, the Stop Transmission of Polio (STOP) was initiated to address skilled human resource gaps and strengthen poliovirus surveillance. This paper describes the role of the STOP 52 team in technical capacity building and health system strengthening in the implementation of polio eradication strategies in Kenya following the outbreak of Circulating Vaccine-derived Poliovirus type 2 (cVDPV2). Methods Overview of the STOP program, deployment, and the modality of support are described. Descriptive analysis was conducted using data collected by the STOP 52 team during integrated supportive supervisory visits conducted from July 2018 to September 2019. Analyses were carried out using Epi-Info statistical software (Version 7.0) and maps were developed using Quantum Geographic Information System (Q-GIS) (version 3.12.0). Results The STOP 52 team supportively supervised 870 health facilities on Expanded Program on Immunization (EPI), and Acute Flaccid Paralysis (AFP) and other Vaccine-Preventable Diseases (VPDs) surveillance in 16 (34.1%) of the 47 counties during the study period. AFP surveillance was conducted in all health facilities supervised leading to the detection and investigation of 11 unreported AFP cases. The STOP 52 team, as part of the outbreak response, provided technical support to five successive rounds of polio Supplementary Immunization Activities (SIAs) conducted during the study period. Moreover, in addressing programmatic data needs, the STOP 52 Data Manager played a valuable role in enhancing the quality and use of data for evidence-based planning and decision-making. The STOP 52 team contributed to the development of operational plans, guidelines and training manuals, and participated in the delivery of various Training of Trainers (TOT) and On-the-Job Training (OJT) on EPI, AFP and other VPDs surveillance including data management. Conclusion The STOP 52 team has contributed to polio eradication efforts in Kenya by enhancing AFP and other VPDs surveillance, supporting polio SIAs, strengthening EPI, use of quality EPI, AFP and other VPDs data, and capacity building of Frontline Health Workers (FLWs). The use of Open Data Kit (ODK) technology during supportive supervision, and AFP and other VPDs surveillance was found to be advantageous. A national STOP program should be modeled to produce a homegrown workforce to ensure the availability of more sustainable technical support for polio eradication efforts in Kenya and possibly other polio-affected countries.
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Affiliation(s)
- Brook Tesfaye
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya.
| | - Jeevan K Makam
- The Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kibet Sergon
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Iheoma Onuekwusi
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Charles Muitherero
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
| | - Alieu Sowe
- World Health Organization, Kenya Country Office, United Nations Office in Nairobi (UNON), Gigiri Complex, Block U, Nairobi, Kenya
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Warigon C, Alemu W, Braka F, Tashikalmah H, Yehushualet Y, Hammanyero K, Bawa S, Oviaesu D, Tegegne S, Maiiyali MU, Jean Baptiste AE, Nsubuga P, Agyemang CB. Institutionalizing documentation for WHO Nigeria country office visibility and improved donor relations, 2013-2016. BMC Public Health 2018; 18:1315. [PMID: 30541609 PMCID: PMC6291914 DOI: 10.1186/s12889-018-6191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The mandate and unique experience of the World Health Organization (WHO) globally, enables over 190 countries, Nigeria inclusive, to depend on the technical support provided by the organization to define and mitigate the threats to public health. With other emerging health actors competing for scarce donors’ resources, the demand for visibility has invariably equaled expectations on WHO’s expertise and technical support. However, the inability to systematically document activities conducted by WHO personnel before 2013 overshadowed most of its invaluable contributions due to poor publicity. The inauguration of the Communications Group in December 2013 with a visibility plan necessitated a paradigm shift towards building a culture of documentation to engender visibility. Methods We used a pre-post design of activities to evaluate the effectiveness of specific interventions implemented to improve visibility from 2013 to 2016. The paper highlights how incorporating communication strategies into the accountability framework of staff contributed in changing the landscape as well as showcasing the activities of WHO in Nigeria for improved donor relations. Results With the specific interventions implemented to improve WHO’s visibility in Nigeria, we found that donor relations improved between 2013 and 2015. It is not a mere coincidence that the period corresponds with the era of incorporation of documentation into the accountability framework of technical staff for visibility as locally mobilized resources increased to record 112% in 2013 and 2014. The intervention assisted in the positive projection of WHO and its donors by the Nigeria media. Conclusion Despite several interventions, which worked, made WHO ubiquitous and added awareness and visibility for donors who funded various projects, other factors could have contributed towards achieving results. Notwithstanding, incorporating documentation component into the accountability framework of field staff and clusters has significantly improved communication of WHO’s work and promoted healthy competition for increased visibility.
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Affiliation(s)
- Charity Warigon
- World Health Organization, Country Representative Office, Abuja, Nigeria.
| | | | - Fiona Braka
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Hallah Tashikalmah
- National Primary Health Care Development Agency (NPHCDA), Abuja, Nigeria
| | - Yared Yehushualet
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Samuel Bawa
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - David Oviaesu
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Sisay Tegegne
- World Health Organization, Country Representative Office, Abuja, Nigeria
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Nomhwange TI, Shuaib F, Braka F, Godwin S, Kariko U, Gregory U, Tegegne SG, Okposen B, Onoka C. Routine immunization community surveys as a tool for guiding program implementation in Kaduna state, Nigeria 2015-2016. BMC Public Health 2018; 18:1313. [PMID: 30541515 PMCID: PMC6291913 DOI: 10.1186/s12889-018-6197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Routine childhood immunization remains an important strategy for achieving polio eradication and maintaining a polio-free world. To address gaps in reported administrative coverage data, community surveys were conducted to verify coverage, and guide strategic interventions for improved coverage. Methods We reviewed the conduct of community surveys by World Health Organization (WHO) field volunteers deployed as part of the surge capacity to Kaduna state and the use of survey results between July 2015 and June 2016. Monthly and quarterly collation and use of these data to guide the deployment of various interventions aimed at strengthening routine immunization in the state. Results Over 97,000 children aged 0–11 months were surveyed by 138 field volunteers across 237 of the 255 wards in Kaduna state. Fully or appropriately immunized children increased from 67% in the fourth quarter of 2015 to 76% by the end of the second quarter of 2016. Within the period reviewed, the number of local government areas with < 80% coverage reduced from eight to zero. Conclusions The routine conduct of community surveys by volunteers to inform interventions has shown an improvement in the vaccination status of children 0–11 months in Kaduna state and remains a useful tool in addressing administrative data quality issues.
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Affiliation(s)
| | | | - Fiona Braka
- World Health Organization Country Office, Abuja, Nigeria
| | - Sambo Godwin
- World Health Organization, Kaduna Field Office, Kaduna, Nigeria
| | - Usman Kariko
- Kaduna State Primary Healthcare Development Agency, Kaduna, Nigeria
| | - Umeh Gregory
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | - Chima Onoka
- National Primary Health Care Agency, Abuja, Nigeria
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Ongwae KM, Bawa SB, Shuaib F, Braka F, Corkum M, Isa HK. Use of Dedicated Mobile Teams and Polio Volunteer Community Mobilizers to Increase Access to Zero-Dose Oral Poliovirus Vaccine and Routine Childhood Immunizations in Settlements at High Risk for Polio Transmission in Northern Nigeria. J Infect Dis 2017; 216:S267-S272. [PMID: 28838155 PMCID: PMC5853824 DOI: 10.1093/infdis/jiw520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The Polio Eradication Initiative in Nigeria, which started >20 years ago, faced many challenges, including initial denial, resistance from communities, and prolonged regional safety concerns. These challenges led into the structuring of the response including the development of the National Emergency Action Plan, improved partner coordination and government engagement, and the establishment of a Polio Emergency Operations Centre. Although monthly supplementary immunization activities (SIAs) continued, the targeting of settlements at high risk for polio transmission with routine immunization (RI) and other selected primary healthcare (PHC) services using dedicated mobile teams and volunteer community mobilizers (VCMs) became a key strategy for interrupting polio transmission in the high-risk areas. These efforts could have contributed to the wild poliovirus–free 2-year period between 24 July 2014 and 11 August 2016, when 2 cases of the virus were reported from Borno State, Northern Nigeria. Methods A narrative analysis of polio-related program and other official documents was conducted to identify the relevant human resources and their role in the Polio Eradication Initiative and in RI. The data used in the article was obtained from United Nations Children's Fund (UNICEF) and World Health Organization project reports and a draft evaluation report of the dedicated mobile teams approach in Northern Nigeria. Results The data from 6 of the states that commenced the provision of polio, RI, and other selected PHC services using the dedicated mobile teams approach in 2014 showed an overall increase in the percentage of children aged 12–23 months in the settlements at high risk for polio transmission with a RI card seen, from 23% to 56%, and an overall increase in fully immunized children aged 12–23 months, from 19% to 55%. The number of newborns given the first dose of oral poliovirus vaccine (OPV) according to the RI schedule and the number of children given zero-dose OPV with the assistance of the VCMs similarly increased between 2013 and 2015. In 2015, VCMs helped track 167 092 newborns and also linked 156 537 infants aged <1 year to RI services in the 6 states. Conclusions The analysis illustrates that polio personnel in Northern Nigeria are used in increasing access to zero-dose OPV, RI, and selected PHC services. The increase in the services generated represented the increasing role of the dedicated mobile teams and polio VCMs in strengthening RI.
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Affiliation(s)
- Kennedy M Ongwae
- Health, United Nations Children's Fund (UNICEF), Islamabad, Pakistan
| | | | - Faisal Shuaib
- Polio, National Primary Health Care Development Agency, Federal Ministry of Health, Abuja, Nigeria
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Thompson KM, Duintjer Tebbens RJ. Lessons From the Polio Endgame: Overcoming the Failure to Vaccinate and the Role of Subpopulations in Maintaining Transmission. J Infect Dis 2017; 216:S176-S182. [PMID: 28838194 PMCID: PMC5853387 DOI: 10.1093/infdis/jix108] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Recent detections of circulating serotype 2 vaccine-derived poliovirus in northern Nigeria (Borno and Sokoto states) and Pakistan (Balochistan Province) and serotype 1 wild poliovirus in Pakistan, Afghanistan, and Nigeria (Borno) represent public health emergencies that require aggressive response. Methods We demonstrate the importance of undervaccinated subpopulations, using an existing dynamic poliovirus transmission and oral poliovirus vaccine evolution model. We review the lessons learned during the polio endgame about the role of subpopulations in sustaining transmission, and we explore the implications of subpopulations for other vaccine-preventable disease eradication efforts. Results Relatively isolated subpopulations benefit little from high surrounding population immunity to transmission and will sustain transmission as long as they do not attain high vaccination coverage. Failing to reach such subpopulations with high coverage represents the root cause of polio eradication delays. Achieving and maintaining eradication requires addressing the weakest links, which includes immunizing populations in insecure areas and/or with disrupted or poor-performing health systems and managing the risks of individuals with primary immunodeficiencies who can excrete vaccine-derived poliovirus long-term. Conclusions Eradication efforts for vaccine-preventable diseases need to create performance expectations for countries to immunize all people living within their borders and maintain high coverage with appropriate interventions.Keywords. Polio; eradication; transmission; heterogeneity.
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Toda M, Njeru I, Zurovac D, Kareko D, O-Tipo S, Mwau M, Morita K. Understanding mSOS: A qualitative study examining the implementation of a text-messaging outbreak alert system in rural Kenya. PLoS One 2017. [PMID: 28628629 PMCID: PMC5476271 DOI: 10.1371/journal.pone.0179408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Outbreaks of epidemic diseases pose serious public health risks. To overcome the hurdles of sub-optimal disease surveillance reporting from the health facilities to relevant authorities, the Ministry of Health in Kenya piloted mSOS (mobile SMS-based disease outbreak alert system) in 2013-2014. In this paper, we report the results of the qualitative study, which examined factors that influence the performances of mSOS implementation. In-depth interviews were conducted with 11 disease surveillance coordinators and 32 in-charges of rural health facilities that took part in the mSOS intervention. Drawing from the framework analysis, dominant themes that emerged from the interviews are presented. All participants voiced their excitement in using mSOS. The results showed that the technology was well accepted, easy to use, and both health workers and managers unanimously recommended the scale-up of the system despite challenges encountered in the implementation processes. The most challenging components were the context in which mSOS was implemented, including the lack of strong existing structure for continuous support supervision, feedback and response action related to disease surveillance. The study revealed broader health systems issues that should be addressed prior to and during the intervention scale-up.
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Affiliation(s)
- Mitsuru Toda
- Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Japan International Cooperation Agency (JICA), Tokyo, Japan
- * E-mail:
| | - Ian Njeru
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Dejan Zurovac
- Oxford University, Oxford, United Kingdom
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Kareko
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Shikanga O-Tipo
- Kenya Ministry of Health Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Matilu Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Kouichi Morita
- Nagasaki University Institute of Tropical Medicine, Nagasaki, Japan
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Kassahun A, Braka F, Gallagher K, Gebriel AW, Nsubuga P, M'pele-Kilebou P. Introducing an accountability framework for polio eradication in Ethiopia: results from the first year of implementation 2014-2015. Pan Afr Med J 2017; 27:12. [PMID: 28890753 PMCID: PMC5578725 DOI: 10.11604/pamj.supp.2017.27.2.10939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/23/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction the World Health Organization (WHO), Ethiopia country office, introduced an accountability framework into its Polio Eradication Program in 2014 with the aim of improving the program's performance. Our study aims to evaluate staff performance and key program indicators following the introduction of the accountability framework. Methods the impact of the WHO accountability framework was reviewed after its first year of implementation from June 2014 to June 2015. We analyzed selected program and staff performance indicators associated with acute flaccid paralysis (AFP) surveillance from a database available at WHO. Data on managerial actions taken were also reviewed. Performance of a total of 38 staff was evaluated during our review. Results our review of results for the first four quarters of implementation of the polio eradication accountability framework showed improvement both at the program and individual level when compared with the previous year. Managerial actions taken during the study period based on the results from the monitoring tool included eleven written acknowledgments, six discussions regarding performance improvement, six rotations of staff, four written first-warning letters and nine non-renewal of contracts. Conclusion the introduction of the accountability framework resulted in improvement in staff performance and overall program indicators for AFP surveillance.
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Affiliation(s)
- Aron Kassahun
- World Health Organization Country Office, Addis Ababa, Ethiopia
| | - Fiona Braka
- World Health Organization Country Office, Addis Ababa, Ethiopia
| | - Kathleen Gallagher
- World Health Organization Country Office, Addis Ababa, Ethiopia.,Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA, USA
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