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 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 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 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 Ethics check-up of public health immunization programs in Canada

2021 ◽  
Vol 47 (04) ◽  
pp. 237-241
Author(s):  
Noni E MacDonald ◽  
Shawn Harmon ◽  
Janice E Graham
Keyword(s):  
Public Health ◽  
Health Interventions ◽  
World Health ◽  
Immunization Programs ◽  
Vaccine Research ◽  
Public Health Interventions ◽  
Immunization Program ◽  
Ethics Review ◽  
Health Organization ◽  
Effective Public Health

The World Health Organization (WHO) recognizes immunization as one of the most successful and effective public health interventions for saving lives. In developing a roadmap for prioritizing use of the coronavirus disease 2019 (COVID-19) vaccines in the context of limited supply, WHO highlighted the importance of a values (ethical principles) framework. Immunization does need to be subject to independent ethical scrutiny of vaccine research data, manufacturing practices, the legal and ethical assurance of informed consent, and also social justice issues with respect to program equity, including right to access. An ethics review of Australia’s immunization program was reported in 2012. This CANVax (Canadian Vaccination Evidence Resource and Exchange Centre) Brief offers an ethics review of immunization in Canada using the criteria utilized for Australia.

Responding to errors in the storage, handling, and administration of vaccines

2020 ◽  
Vol 31 (2) ◽  
pp. 62-69
Author(s):  
Dalia Youssef ◽  
Rachel Mearkle ◽  
Karen Ford
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health Interventions ◽  
Cold Chain ◽  
Public Health Interventions ◽  
Practical Advice ◽  
Practice Nurses ◽  
Complex Process ◽  
Effective Public Health

The storage, handling, and administration of vaccines is a complex process. When errors occur, practice nurses must respond appropriately. Dalia Youssef, Rachel Mearkle and Karen Ford provide an overview of recent guidance and advice on how to avoid and deal with vaccine incidents Vaccination is one of the most effective public health interventions. It helps to prevent infectious disease and save lives. However, the storage, handling, and administration of vaccines is a complex process that is not immune to error. Vaccine incidents—including interruption of the cold chain—can undermine vaccine quality and efficacy, and, in some cases, this could require revaccination of patients. In September 2019, Public Health England published updated guidance about responding to errors in the storage, handling, and administration of vaccines. This article provides an overview of this guidance and includes practical advice on how to avoid and deal with common vaccine-related incidents.

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