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Table 1 Joint display of common barriers reported by each country in the survey and KIIs categorized by socioecological levels

From: Conflict, community, and collaboration: shared implementation barriers and strategies in two polio endemic countries

Socioecological Level Reported barrier at each SE level Percent of responses by country Illustrative quotes
Environmental Overalla AF 69.0% (n = 550/797)
NG 38.3% (n = 984/2570)
One thing is the territory controlled by Taliban that is 40–50% more or less. We have two problems there. Sometimes they ban polio program for example they banned the program in southern region, Kandahar, Helmand and Urozgan. There a million children were deprived of vaccines. This was a big challenge. Even if they allow the program they don’t allow house to house campaigns and instead they tell us to go site to site or mosque to mosque. In mosque to mosque, many children are missed especially the neonatal. People don’t bring the neonatal to the mosque. Second challenge is the campaign quality in these areas. Our monitor cannot go to Taliban controlled areas and cannot ensure reporting, so the campaign quality is compromised. - KII Afghanistan
Political/Social Social
(subset of environmental level)
AF 42.8% of all environmental barriers reported (n = 262/612)
NG 23.4% of all environmental barriers reported (n = 324/1379)
They think it is made of haram material. They think the vaccine will convert our children non-obedient and impolite or they reach adulthood quickly. - KII Afghanistan.
Political
(subset of environmental level)
AF 25.2% of all environmental barriers reported (n = 154/612)
NG 22.0% of all environmental barriers reported (n = 3030/1379)
There are times whereby there are clashes of activities, there may be a program polio eradication, side by side with another equally very important program, so in that case there are lots of clashes and you know it’s always not easy. I mean in some other cases, there are so many activities while the state is planning its own, maybe the ministry is calling you for one other activity, the National are planning their own. There was a scenario whereby we were having the last OBR that is Outbreak Response and National were coming with the CHIPS program, community health influencers promoter services which immunization is a component of it, you understand, so there is always this clash from below, within and above, so it’s not always easy. – KII Nigeria
Organizational Overalla AF 9.8% (n = 39/797)
NG 12.8% (n = 330/2570)
… it [the polio program] raises expectations that the government should do more. Sometimes the polio program is taken as hostage. People do not allow vaccination because there is no drinking water or too much garbage in a village nobody plans to pick them up. They say why they polio vaccine while their basic needs are not addressed. - KII Afghanistan
funds are always not sufficient to carry out planned activities, again equipment, infrastructure are not always sufficient. And I said again, the issue of acceptability s there and attitude of staff. – KII Nigeria
Individual perceptions of the organization (subset of individual level) AF 28% of all individual barriers reported (n = 22/85)
NG 17% of all individual barriers reported (n = 116/669)
they cannot provide accurate and reliable information to the people. - KII Afghanistan
Individual Overalla AF 8.5% (n = 68/797)
NG 17.5% (n = 449/2570)
Practitioners working in curative medicine in provinces also doubt the polio vaccines and argue how many doses should be given to children? In many occasion even those educated doctors have refused use vaccine. This refusal happened in accessible areas. This is creating suspicions in the community for other people. These practitioners should be educated on the benefit of vaccines and the side effects. – KII Afghanistan
Burning out, yes, because it can be tough, it can be tough, especially during implementation you eat only once a day, and you are working under the sun throughout sometimes you meet armed robbers along the way, otherwise you are taking the challenges as they come. – KII Nigeria
  1. Abbreviations: AF Afghanistan, NG Nigeria, SE Socioecological
  2. aOverall barriers are aligned with the first level of responses in the quantitative survey and can be compared directly across respondents within a certain country. Other aspects of the model were subsets of overall barriers and their denominators are not directly comparable as only respondents that met certain conditions were asked further questions