Table 3 Internal and external contributors and implementation challenges of strengthening service delivery across respondents
Biggest internal contributor to health services delivery strengthening activities (n = 848) | Freq. (%) | Illustrative Example |
 Process of conducting activities | 408 (48.11%) | Specific strategies to systematically reach difficult populations, including microplanning |
 Individual characteristics | 157 (18.51%) | Motivated and knowledgeable health workers and volunteers |
 Organizational settings | 148 (17.45%) | Collaboration and effective coordination among NGOs, government, and donors |
Polio program characteristics | 135 (15.92%) | Relative ease of storing and administering OPV |
Biggest external contributor to health services delivery strengthening activities (n = 843) | ||
 Social environment | 358 (42.47%) | High levels of trust and community awareness towards health workers and vaccines |
 Political environment | 221 (26.22%) | Strong political leadership and support, overall peace and stability in the country |
 Economic environment | 167 (19.81%) | Sufficient and timely funding |
 Technological environment | 79 (9.37%) | Expansion of mobile phone networks enhanced coordination and delivery |
 Other environment | 18 (2.14%) | Accessible geographies |
Challenges to strengthening health service delivery (n = 830) | ||
 External settings | 463 (55.78%) | Security challenges, community resistance |
 Implementation | 187 (22.53%) | Lack of adaptation to meet local needs and context |
 Individual | 82 (9.88%) | Lack of confidence or motivation among health workers |
 Organizational | 62 (7.47%) | Competing priorities, and lack of accountability mechanisms |
 Polio program-related | 36 (4.34%) | National immunization days and supplementary immunization activities do not support routine immunization |