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Table 2 Examples of questions structured according to the building blocks

From: Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework

Building block Measles study New vaccine study Polio study
Service delivery Do measles campaigns affect your capacity to reach remote areas for routine outreach services? Has the number of outreach activities changed because you started offering the new vaccine? Are routine immunization activities affected during polio campaign days?
Health workforce Do measles campaigns take staff away from routine activities? Did the training focus solely on the new vaccine or did it cover issues relevant for other vaccines or health services too? Are health workers’ motivation levels the same as before polio campaigns began?
Health information system Was there any change in the processes for identifying high risk groups and their vaccination coverage rates? Have immunisation documents been reprinted to include the new vaccine? If yes, has this changed the time required and data completeness? Has the surveillance system changed as a result of polio?
Medical products, vaccines and technologies Have measles campaigns lead to additional infrastructure, such as waste management equipment? Has the cold chain capacity related to the new vaccine had any impact for products other than vaccines, such as ARVs? Have there been any changes in the cold chain infrastructure over the last 10–15 years? Are any of these changes a result of polio?
Financing and sustainability Have donor funds been earmarked to measles campaigns? Has funding requirements for the new vaccine affected the level of funding for other routine health related activities? Is funding for polio separate from other health programs?
Leadership/governance Do you think measles campaigns tend to strengthen or weaken policy processes? Did the planning for the new vaccine have any effect on planning activities of other health services? In the past, have government officials given a high level of attention to routine immunization activities? Has this changed as a result of polio?