<< Back To Home

Documentation of polio eradication initiative best practices: Experience from WHO African Region

Friday, 7th of October 2016 Print

 

Vaccine, Volume 34, Issue 43, 10 October 2016, Pages 5144–5149

Polio Eradication Initiative Best Practices in the WHO African Region

Documentation of polio eradication initiative best practices: Experience from WHO African Region

Excerpt below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X1630384X

 

 Show more

http://dx.doi.org/10.1016/j.vaccine.2016.05.058

Highlights

•PEI generated tremendous amount of manpower with diverse public health skills.

•PEI put systems in place to accelerate the eradication of polio in the Region.

•Innovations were developed and applied in target delivery of polio vaccines.

•PEI accumulated lessons and best practices that will benefit larger public health.

•A protocol developed to document the best practices is presented here.


Abstract

Background

The African Region is set to achieving polio eradication. During the years of operations, the Polio Eradication Initiative [PEI] in the Region mobilized and trained tremendous amount of manpower with specializations in surveillance, social mobilization, supplementary immunization activities [SIAs], data management and laboratory staff. Systems were put in place to accelerate the eradication of polio in the Region. Standardized, real-time surveillance and response capacity were established. Many innovations were developed and applied to reaching people in difficult and security challenged terrains. All of these resulted in accumulation of lessons and best practices, which can be used in other priority public health intervention if documented.

Methods

The World Health Organization Regional Office for Africa [WHO/AFRO] developed a process for the documentation of these best practices, which was pretested in Uganda. The process entailed assessment of three critical elements [effectiveness, efficiency and relevance] five aspects [ethical soundness, sustainability, involvement of partners, community involvement, and political commitment] of best practices. A scored card which graded the elements and aspects on a scale of 0–10 was developed and a true best practice should score >50 points. Independent public health experts documented polio best practices in eight countries in the Region, using this process. The documentation adopted the cross-sectional design in the generation of data, which combined three analytical designs, namely surveys, qualitative inquiry and case studies. For the selection of countries, country responses to earlier questionnaire on best practices were screened for potential best practices. Another criterion used was the level of PEI investment in the countries.

Results

A total of 82 best practices grouped into ten thematic areas were documented. There was a correlation between the health system performances with DPT3 as proxy, level of PEI investment in countries with number of best practice.

The application of the process for the documentation of polio best practices in the African Region brought out a number of advantages. The triangulation of data collected using multiple methods and the collection of data from all levels of the programme proved useful as it provided opportunity for data verification and corroboration. It also helped to overcome some of the data challenge.


1. Introduction

By September 2015 Africa was on the verge of achieving the targets of polio eradication. The last case wild poliovirus was reported in the Region was reported in July 2014, from Nigeria. The Region was also set to confront vaccine derived polioviruses, with its efficient surveillance and response systems put in place. Over the years of implementing the polio eradication initiative in the African Region an impressive amount of practices, resources and systems aimed at achieving the eradication targets were generated [1], [2], [3], [4] and [5]. The initiative provided resources for primary healthcare generally [1]. The outcome has been significant improvement in surveillance for acute flaccid paralysis (AFP) with involvement of communities in active AFP case search and other communicable diseases as well as sample collection and quick turnover in laboratory processing, for prompt response to polio cases. The effects of polio eradication activities on health systems in the African Region, despite security and health system challenges in some countries have been evaluated and documented in a few studies [6] and [7].

Over time, the field staff acquired tremendous set skills and competencies that were necessary for the realization of not only polio eradication goals but of wider public health targets. Polio staff provided services in sectors, other than polio, such as disease surveillance and the health information system [8]. Several public health programmes have also used best practices acquired from polio eradication to support in routine immunization, child health, control and elimination of neglected tropical diseases, integrated disease surveillance and response, control and prevention of non-communicable disease [8].

It is expected that the polio best practices, if systematically documented and widely adopted will contribute significantly to fast-tracking attainment of targets and objectives of other priority health programmes in the World Health Organization (WHO) African Region and thereby contribute to the legacy of polio eradication in the African Region. There have been calls for a standardized documentation of polio best practices, which are in use by other public health interventions. In its review of the Global Vaccine Action Plan (GVAP) in 2013, the Strategic Advisory Group of Experts (SAGE) called on technical agencies to support the documentation and adaptation of polio best practices to improve other elimination efforts and routine immunization [9]. Earlier, in March 2012, an internal WHO-African Regional Office (AFRO) consultation on Polio Eradication in the African Region recommended the documentation and publication of polio best practices [10].

In 2014, the WHO-AFRO developed a standard process for the documentation of polio best practices, and commissioned a team of independent public health experts, who successfully applied the process in documenting polio best practices in Angola, Chad Cote DIvoire and the Democratic Republic of Congo. Other countries covered were Ethiopia, Nigeria, Tanzania and Togo. This paper presents the process used for the documentation of polio best practices in the eight countries; how the countries implemented the best practices is presented in several companion papers. It is hoped that this will provide useful and instructive lessons for other programmes in the future.

40762727