scholarly journals Pathways for scaling up public health interventions

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Devon Indig ◽  
Karen Lee ◽  
Anne Grunseit ◽  
Andrew Milat ◽  
Adrian Bauman
Keyword(s):  
Public Health ◽  
Scaling Up ◽  
Health Interventions ◽  
Public Health Interventions

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Utsamani Cintyamena ◽  
Luthfi Azizatunnisa’ ◽  
Riris Andono Ahmad ◽  
Yodi Mahendradhata
Keyword(s):  
Public Health ◽  
Role Model ◽  
Local Area ◽  
Scaling Up ◽  
Health Interventions ◽  
Cold Chain ◽  
Public Health Interventions ◽  
Immunization Program ◽  
Integrated Health ◽  
Polio Immunization

Abstract Background The scaling up of public health interventions has received greater attention in recent years; however, there remains paucity of systematic investigations of the scaling up processes. We aim to investigate the overall process, actors and contexts of polio immunization scaling up in Indonesia from 1988 until 2018. Methods A mixed method study with sequential explanatory design was conducted. We carried out a quantitative survey of 323 actors involved in the polio program at national and sub-national levels, followed by Key Informant Interviews (KII)s. Document review was also carried out to construct a timeline of the polio eradication program with milestones. We carried out descriptive statistical analysis of quantitative data and thematic analysis of qualitative data. Results The scaling up of polio immunization in Indonesia started as a vertical expansion approach led by the Ministry of Health within a centralized health system. The coverage of immunization increased dramatically from 5% in the earlier 80s to 67.5% in 1987; incremental increases followed until achieving Universal Child Immunization (UCI) in 1990 and subsequently 95% coverage in 1995. Engagement of stakeholders and funding made the scaling up of polio immunization a priority. There was also substantial multisector involvement, including institutions and communities. Local area monitoring (LAM) and integrated health posts (Posyandu) were key to the polio immunization implementation strategy. Challenges for scaling up during this centralized period included cold chain infrastructure and limited experience in carrying out mass campaigns. Scaling up during the decentralized era was slower due to expansion in the number of provinces and districts. Moreover, there were challenges such as the negative perception of immunization side-effects, staff turnover, and the unsmooth transition of centralization towards decentralization. Conclusion Vertical scaling up of polio immunization program intervention was successful during the centralized era, with involvement of the president as a role model and the engine of multi sector actors. Posyandu (integrated health posts) played an important role, yet its revitalization after the reform-decentralization era has not been optimum.

scholarly journals Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review

2019 ◽  
Vol 35 (2) ◽  
pp. 219-234 ◽  
Author(s):  
Susan E Bulthuis ◽  
Maryse C Kok ◽  
Joanna Raven ◽  
Marjolein A Dieleman
Keyword(s):  
Public Health ◽  
Scale Up ◽  
Scaling Up ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Factors Influencing ◽  
Low And Middle Income ◽  
The Way

Abstract To achieve universal health coverage, the scale-up of high impact public health interventions is essential. However, scale-up is challenging and often not successful. Therefore, a systematic review was conducted to provide insights into the factors influencing the scale-up of public health interventions in low- and middle-income countries (LMICs). Two databases were searched for studies with a qualitative research component. The GRADE-CERQual approach was applied to assess the confidence in the evidence for each key review finding. A multi-level perspective on transition was applied to ensure a focus on vertical scale-up for sustainability. According to this theory, changes in the way of organizing (structure), doing (practice) and thinking (culture) need to take place to ensure the scale-up of an intervention. Among the most prominent factors influencing scale-up through changes in structure was the availability of financial, human and material resources. Inadequate supply chains were often barriers to scale-up. Advocacy activities positively influenced scale-up, and changes in the policy environment hindered or facilitated scale-up. The most outstanding factors influencing scale-up through changes in practice were the availability of a strategic plan for scale-up and the way in which training and supervision was conducted. Furthermore, collaborations such as community participation and partnerships facilitated scale-up, as well as the availability of research and monitoring and evaluation data. Factors influencing scale-up through a change in culture were less prominent in the literature. While some studies articulated the acceptability of the intervention in a given sociocultural environment, more emphasis was placed on the importance of stakeholders feeling a need for a specific intervention to facilitate its scale-up. All identified factors should be taken into account when scaling up public health interventions in LMICs. The different factors are strongly interlinked, and most of them are related to one crucial first step: the development of a scale-up strategy before scaling up.

scholarly journals Scaling Up Public Health Interventions: A Case Study of the Polio Immunization Program in Indonesia

2020 ◽  
Author(s):  
Utsamani Cintyamena ◽  
Luthfi Azizatunnisa ◽  
Riris Ahmad ◽  
Yodi Mahendradhata
Keyword(s):  
Public Health ◽  
Role Model ◽  
Local Area ◽  
Scaling Up ◽  
Health Interventions ◽  
Cold Chain ◽  
Public Health Interventions ◽  
Immunization Program ◽  
Integrated Health ◽  
Polio Immunization

Abstract Background: The scaling up of public health interventions has received greater attention in recent years; however, there remains paucity of systematic investigations of the scaling up processes. We aim to investigate the overall process, actors and contexts of polio immunization scaling up in Indonesia from 1988 until 2018. Methods: A mixed method study with sequential explanatory design was conducted. We carried out a quantitative survey of 323 actors involved in the polio program at national and sub-national levels, followed by Key Informant Interviews (KII)s. Document review was also carried out to construct a timeline of the polio eradication program with milestones. We carried out descriptive statistical analysis of quantitative data and thematic analysis of qualitative data.Results: The scaling up of polio immunization in Indonesia started as a vertical expansion approach led by the Ministry of Health within a centralized health system. The coverage of immunization increased drastically from 5% in the earlier 80s to 67.5% in 1987; incremental increases followed until achieving Universal Coverage Immunization (UCI) in 1990 and subsequently 95% coverage in 1995. Engagement of stakeholders and funding made the scaling up of polio immunization a priority. There was also substantial multisector involvement, including institutions and communities. Local area monitoring (LAM) and integrated health posts (Posyandu) were key to the polio immunization implementation strategy. Challenges for scaling up during this centralized period included cold chain infrastructure and limited experience in carrying out mass campaigns. Scaling up during the decentralized era was slower due to expansion in the number of provinces and districts. Moreover, there were challenges such as the negative perception of immunization side-effects, staff turnover, and the unsmooth transition of centralization towards decentralization.Conclusion: Vertical scaling up of polio immunization program intervention was successful during the centralized era, with involvement of the president as a role model and the engine of multi sector actors. Posyandu (integrated health posts) played an important role, yet its revitalization after the reform-decentralization era has not been optimum.

scholarly journals An analysis of COVID-19 clusters in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pooja Sengupta ◽  
Bhaswati Ganguli ◽  
Sugata SenRoy ◽  
Aditya Chatterjee
Keyword(s):  
Public Health ◽  
Cluster Analysis ◽  
Population Density ◽  
Case Studies ◽  
Compartment Model ◽  
Health Interventions ◽  
Disease Spread ◽  
Second Phase ◽  
Public Health Interventions ◽  
Homogeneous Groups

Abstract Background In this study we cluster the districts of India in terms of the spread of COVID-19 and related variables such as population density and the number of specialty hospitals. Simulation using a compartment model is used to provide insight into differences in response to public health interventions. Two case studies of interest from Nizamuddin and Dharavi provide contrasting pictures of the success in curbing spread. Methods A cluster analysis of the worst affected districts in India provides insight about the similarities between them. The effects of public health interventions in flattening the curve in their respective states is studied using the individual contact SEIQHRF model, a stochastic individual compartment model which simulates disease prevalence in the susceptible, infected, recovered and fatal compartments. Results The clustering of hotspot districts provide homogeneous groups that can be discriminated in terms of number of cases and related covariates. The cluster analysis reveal that the distribution of number of COVID-19 hospitals in the districts does not correlate with the distribution of confirmed COVID-19 cases. From the SEIQHRF model for Nizamuddin we observe in the second phase the number of infected individuals had seen a multitudinous increase in the states where Nizamuddin attendees returned, increasing the risk of the disease spread. However, the simulations reveal that implementing administrative interventions, flatten the curve. In Dharavi, through tracing, tracking, testing and treating, massive breakout of COVID-19 was brought under control. Conclusions The cluster analysis performed on the districts reveal homogeneous groups of districts that can be ranked based on the burden placed on the healthcare system in terms of number of confirmed cases, population density and number of hospitals dedicated to COVID-19 treatment. The study rounds up with two important case studies on Nizamuddin basti and Dharavi to illustrate the growth curve of COVID-19 in two very densely populated regions in India. In the case of Nizamuddin, the study showed that there was a manifold increase in the risk of infection. In contrast it is seen that there was a rapid decline in the number of cases in Dharavi within a span of about one month.

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