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Table 1 Polio immunization scaling up elements

From: Scaling up public health interventions: case study of the polio immunization program in Indonesia

  Vertical Scaling Up in Centralization
(1983–2000)
Scaling Up in Decentralization
(2006–2014)
Innovation
 Strengthening service quality Request support from NGO to strengthening logistics for immunization. Developed LAM, ASP, immunization supervision checklist NIDs, SIAs, polio eradication was expanded to AFP surveillance and lab containment
 New technology To ensure cold chain: use oil-powered electricity, kerosene, and solar panel electricity Switch from tOPV to bOPV, introduce Inactivated Poliovirus Vaccine. Immunization information system to trace childrens’ immunization status. Intensified research and development of non-porcine vaccines. Development vaccine combination.
 Improving community-based interventions Involving PKK. Integrated immunization in Posyandu; together with MCH and community nutrition Involving community organization. Massive campaign by public figure
 Services for underserved population Additional frontline worker to improve coverage. “Jurim” or special officer for immunization Nusantara sehat program, flying health care
 New service delivery protocols, training, curricula, educational approaches LAM continuous training at PHO, DHO, PHC, as well sub-district head. Delivery and training of ASP National guidelines. Implementing minimum service standard at district level.
 Financial, organizational, or managerial restructuring Polio is integrated to immunization program and immunization was the only activity in polio eradication initiative. No special budget from government for polio immunization, so integrated to existing program. Budget support from international and national NGO
 Other capacity building interventions Strong leadership from MoH stakeholder; both advocation and dissemination to upper level and to implementer in subnational level were great  
Organization MoH and its networking, partner NGO, community local government, MoH and its networking, FDA, Bio Farma, private providers, partner NGO, community, other ministries
Resource team Policy maker in MoH, program managers, representatives of national and international NGO, researchers Local stakeholder/ decision maker, policy maker from MoH, House of Representatives, Ministry of National Development Planning, Ministry of Home Affairs, program managers, representatives of national and international NGO, researchers, service providers
Scaling up strategy Vertical scaling up Diversification; through dissemination and advocacy to other sectors
Environment
 Policies and politics Polio immunization program is new. Support from president and other sectors’ ministries. However, after decentralization transition, political support from subnational government was not strong enough.
 Bureaucracy MoH through DGCG and DSHQ, also its networking conducted the program Tiered managerial process at MoH and its networking. Local governments have their own authority to determine priority program. Regulation and legal protection are needed as basic element of health intervention activities.
 Socio-economic and cultural conditions Consists of numerous ethnicities and cultures. Indonesia was classified as low-income country. Community pride in their own religions, cultures, and ethnicities. Socio-economic disparities.
 People’s needs, perspectives, and rights Community could obtain health service equally. People felt pride when participated. Availability of choices in health service activities