The Impact of Polio Eradication on Routine Immunization and Primary Health Care: A Mixed-Methods Study

"Applying the resolve and dedication that characterizes polio eradication to a wider suite of services could provide communities with the services they are demanding, give workers a fresh reason for enthusiasm, and increase baseline RI coverage. The eradication of polio would probably not be far behind."

Observing that, after two decades of focused efforts to eradicate polio, the impact on health systems around the world continues to be controversial, this study evaluated the impact of polio eradication (PE) activities on routine immunisation (RI) and primary health care (PHC). This study quantitatively evaluated the effects of (1) the initial scale-up of PE activities and (2) the number of polio vaccination campaigns per year on measures of RI and PHC. (Analyses used multiple regression to examine the degree to which PE campaigns explain observed rates of change in diphtheria-tetanus-pertussis (DTP3) vaccination and attended birth coverage.) The study also qualitatively examined potential mediators of these relationships in 8 district-level case studies in 7 countries in Africa and South Asia. (The methodology is described in detail within the paper as well as within supplementary materials that contain further technical details about the global analysis and information on 8 country-specific analyses.)

The quantitative analysis did not find compelling evidence of widespread and significant effects of PE campaigns, either positive or negative, on measures of RI and maternal health care. The qualitative analysis revealed context-specific positive impacts of PE activities in many of the case studies, particularly disease surveillance and cold chain strengthening. For example: "Public awareness of vaccination and health services had increased markedly in the past 15 years in many of our case studies. Polio eradication activities made some contributions to this increase in awareness but were not the only or primary contributing factor in any case study." Also: "In most of our case studies, people working on polio eradication found, mapped, and repeatedly visited populations that were previously unreached by other health services. The maps and information created by polio eradication teams in the districts we studied represent a likely unprecedented collection of information on populations - including urban slum populations, pastoralists, and socially marginalized groups - most marginalized from health services. The extent to which this often detailed information was used to provide other health services to these populations varied widely across case studies." These impacts were dependent on the initiative of policymakers. Negative impacts, including service interruption and public dissatisfaction, were observed - primarily in districts with many campaigns per year.

The researchers conclude that PE activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.

An excerpt from the discussion section of the paper follows:
"In polio's final strongholds - Afghanistan, Pakistan, and Nigeria - community support, worker motivation, and high levels of baseline RI coverage will be critical to secure eradication. It is in these places where polio eradication's infrastructure could most immediately and dramatically benefit RI and PHC. In areas where few other health services are fully functioning, polio eradication has built robust and impressive systems for surveillance, communications, and outreach. These systems, built and maintained through often heroic effort by individuals involved in polio eradication, could provide strong support for other critical health services. Inspiring best practices observed in our case studies - including the examples in Cases 1 and 2 - show that polio eradication can make substantial contributions to health systems."