Table 1 Definitions of contributors and challenges to successful strengthening of service delivery systems using CFIR constructs
Internal contributors | |
Individual characteristics | High levels of individual knowledge, self-efficacy, higher likelihood to provide sustained support through stages of change and good perception of the organization |
Organizational settings | Clear organizational structure with adequate personnel, strong formal and informal communication networks, healthy organizational culture, presence of leadership readiness for implementation |
GPEI program characteristics | Perception of internal vs external source of the interventions, perception of evidence strength and quality, relative advantage of polio program vs other programs, trialability, perceived complexity of implementation, design quality, costs of implementation and opportunity costs |
Process of conducting the activities | Stages of the implementation process: detailed planning, engaging with relevant stakeholders, good execution of activities, established mechanisms for monitoring and evaluating program progress and quality |
External contributors | |
Political | Political climate accepting of polio eradication activities, political structure conducive to coordinated action |
Economic | Sufficient revenue to fund activities |
Social | Social norms around immunization in communities where polio eradication activities were implemented |
Technological | Infrastructure or technological advances |
Implementation challenges: consisted of internal and external contributors that impeded national and subnational implementation of the polio program | |
Individual characteristics | Low levels of individual knowledge, lack of self-efficacy, lower likelihood to provide sustained support through stages of change and poor perception of the organization |
Organizational settings | Weak organizational structure with inadequate personnel, limited formal and informal communication networks, poor organizational culture, absence of leadership readiness for implementation |
GPEI program characteristics | Perception of internal vs external source of the interventions, perception of evidence strength and quality, relative advantage of polio program vs other programs, trialability, perceived complexity of implementation, design quality, costs of implementation and opportunity costs |
Process of conducting the activities | Stages of the implementation process: lack of advanced planning, challenges of attracting and engaging with relevant stakeholders, poor execution of activities, difficulty with monitoring and evaluating program progress and quality |
External settings | Challenges related to the external political, economic, social, and technological environments |