Table 3 ERIC-Derived Implementation Strategies Utilized to Address Barriers to Polio Eradication
Implementation Strategy Type | DRC | Ethiopia |
|---|---|---|
Planning and resource mobilization | ||
Develop a formal implementation blueprint | Develop microplans and promote bottom-up planning | Develop microplans and promote bottom-up planning Develop and utilize planning tools, e.g. integrated activity reports, training manuals, standard operating procedures, risk analyses |
Acquire additional funding to facilitate implementation | Advocate government to set-up budget line for polio program Mobilize resources from local partners Utilize non-polio funding, e.g. Gavi grants, to cover cost of infrastructure improvements | Utilize non-program funds as stop gap until reimbursement possible Mobilize resources from local partners |
Change service sites to increase access | Conduct mobile polio campaigns; set-up satellite sites under the supervision of rotating nurse | Conduct mobile polio campaigns in high population-movement zones Conduct frequent campaigns at border areas, in geographically inaccessible districts |
Other | Not identified | Adjust dates, timing of campaigns based on available financial resources, vaccine supply |
Management and problem-solving | ||
Assess organizational ability and readiness | Organize program review meetings to analyze program results and pitfalls, and come up with solutions | Not identified |
Adapt physical structure and equipment to interventions | Not identified | Build and use solar refrigerators to ensure cold chain effectiveness |
Build robust record systems to capture outcomes | Not identified | Leverage digital solutions to send reports from health facility to district and zone levels Utilize GPS technology to monitor community health worker activities at district and community level Utilize ODK systems to enable surveillance reporting in hard-to-reach areas |
Centralize assistance for implementation issues | Not identified | Maintain frequent contact between regional health bureaus and federal ministry of health to manage problems as they occurred |
Offer incentives or disincentives to providers and consumers | Use fiduciary agencies | Integrate health services, e.g. measles, tetanus vaccinations, newborn care, vitamin A supplementation, with polio campaigns Increase pay and compensation for health workers on campaigns, i.e. via stipends, materials, trainings |
Monitoring and evaluation | ||
Develop mechanisms for feedback, monitoring and evaluation | Strengthen the national information system by establishing report analyses at each level, providing feedback for improvement | Conduct post-campaign evaluations to inform follow-up implementation activities Develop and conduct regular technical assessments at various levels of the health system |
Conduct cyclical small tests of change | Not identified | Conduct regular review meetings to assess implementation status and performance, course correct |
Engagement and capacity-building | ||
Build multidisciplinary partnerships and coalitions (to share knowledge, resources) | Not identified | Build partnerships to enable cross-border collaboration among health workers, volunteers, border security and immigration authorities, local leaders, including forming a cross-border health committee |
Leverage existing collaborations and networks | Support international efforts to halt armed and inter-ethnic conflicts | Notify regional authorities of upcoming campaigns and request support, including obtaining support letters |
Conduct workshops (to educate stakeholders, provide feedback or iterate program implementation processes) | Provide on-the-spot supervision to health workers conducting polio eradication activities to course correct, ensure fidelity | Â |
Involve stakeholders, workers and consumers in the implementation effort | Engage peacekeeping troops in transport of vaccines to insecure zones | Engage schoolteachers in community mobilization, polio campaigns, community-based surveillance Utilize transport mechanisms from other sectors, traditional means of transport to facilitate campaign delivery |
Recruit, designate and train leaders | Conduct continuous human resource training to build a pool of qualified candidates Train health workers in social mobilization | Capacity building of existing health professionals via in-service training Recruit health extensions workers, community volunteers to conduct vaccination, social mobilization, community-based surveillance |
Promote supervision | Use polio resources to improve supervision of other activities | Â |
Communication and advocacy | ||
Identify and prepare champions and early adopters | Advocate to actors at all levels of the health system, as well as opinion leaders, political leaders, notable persons/celebrities Involve members of parliament in polio program to garner support, including setting up parliamentary committee for immunization advocacy | Engage religious leaders as liaisons with community to increase community awareness and participation |
Increase awareness among the population | Sensitize communities about benefit of immunization through social communication | Conduct intensive health education activities regarding importance of repeated polio doses, IPV |