What is after polio? Priorities & Adaptability in Angola, Ethiopia, Kenya, Nigeria, Somalia, and South Sudan

Abstract

Background: The final chapter of polio is not complete. But the task of adapting the polio infrastructure is upon us now. Polio eradication has been a shared global priority. The challenge before us lies in defining the next health priority to share. Actively listening to stakeholders revealed a more complex priority: it was not one specific disease. Methods and materials: Based on the use of the Implementation Science conceptual framework to predict implementation success, this dissertation aimed to identify public health priorities to which the built polio infrastructure should be applied, and opportunities to adapt to future health initiatives. Qualitative interviews with polio stakeholders were analyzed for overall trends, by specific socio-ecological level, and by individual country context. Results: “Health Systems & Infrastructure” and “Routine Immunization” were the most frequently occurring priorities that stakeholders identified as the desired focus that should be addressed with the built polio infrastructure. Challenging the historic tactic of targeting one disease for eradication, stakeholders called for a broader bolstering of health systems. The adaptability findings closely reflected and further informed the findings of the shared priorities. Examples and opportunities were associated with the overall identified priorities: Health Systems & Infrastructure and Routine Immunization. Polio stakeholders were aware of and primed for adapting the polio infrastructure to other health priorities. They recognized and even suggested a less siloed approach to public health, harkening to overall health systems bolstering. Conclusion: Recommendations were developed to be in alignment with the prodigiously shared priority of stakeholders interviewed; to improve Health Systems & Infrastructure, explicitly to address improving the capacity of health monitoring and surveillance. More specifically, while focusing on improving overall Health Systems & Infrastructure, a recommendation was made to task-shift the built polio infrastructure to address routine immunization, pivoting away from one disease focus. Lastly, a recommendation was made to encourage partners to look more broadly at how polio infrastructure legacy planning can affect larger societal needs. The momentum and capacity built through the stalwart organizations and individuals engaged in polio eradication should be harnessed to improve diverse public health outcomes.