Contribution of Global Polio Eradication Initiative–Funded Personnel to the Strengthening of Routine Immunization Programs in the 10 Focus Countries of the Polio Eradication and Endgame Strategic Plan

Abstract

Background.The Polio Eradication and Endgame Strategic Plan (PEESP) established a target that at least 50% of the time of personnel receiving funding from the Global Polio Eradication Initiative (GPEI) for polio eradication activities (hereafter, “GPEI-funded personnel”) should be dedicated to the strengthening of immunization systems. This article describes the self-reported profile of how GPEI-funded personnel allocate their time toward immunization goals and activities beyond those associated with polio, the training they have received to conduct tasks to strengthen routine immunization systems, and the type of tasks they have conducted.Methods.A survey of approximately 1000 field managers of frontline GPEI-funded personnel was conducted by Boston Consulting Group in the 10 focus countries of the PEESP during 2 phases, in 2013 and 2014, to determine time allocation among frontline staff. Country-specific reports on the training of GPEI-funded personnel were reviewed, and an analysis of the types of tasks that were reported was conducted.Results.A total of 467 managers responded to the survey. Forty-seven percent of the time (range, 23%–61%) of GPEI-funded personnel was dedicated to tasks related to strengthening immunization programs, other than polio eradication. Less time was spent on polio-associated activities in countries that had already interrupted wild poliovirus (WPV) transmission, compared with findings for WPV-endemic countries. All countries conducted periodic trainings of the GPEI-funded personnel. The types of non–polio-related tasks performed by GPEI-funded personnel varied among countries and included surveillance, microplanning, newborn registration and defaulter tracing, monitoring of routine immunization activities, and support of district immunization task teams, as well as promotion of health behaviors, such as clean-water use and good hygiene and sanitation practices.Conclusion.In all countries, GPEI-funded personnel perform critical tasks in the strengthening of routine immunization programs and the control of measles and rubella. In certain countries with very weak immunization systems, GPEI-funded personnel provide critical support for the immunization programs, and sudden discontinuation of their employment would potentially disrupt the immunization programs in their countries and create a setback in capacity and effectiveness that would put children at higher risk for vaccine-preventable diseases.

Addressing the Challenges and Opportunities of the Polio Endgame: Lessons for the Future

“…Several of the articles in this supplement take stock of how GPEI resources support RI activities and contribute to strengthening RI services, with the specific aim of identifying services that may be at risk when polio resources diminish after eradication [80,81]. Deutsch et al and Ongwae et al describe how use of polio resources, social mobilization networks, and experience may also be valuable to broader health programs and RI activities [82,83].…”

“…As illustrated by Van den Ent et al, the polio infrastructure, workforce, and financial resources substantially contribute to immunization services beyond polio [81]. Moreover, the GPEI has amassed tremendously useful lessons and programmatic experience during the past 3 decades in what has been one of the largest mobilizations of the public health community in history toward any one disease.…”

Transitioning Lessons Learned and Assets of the Global Polio Eradication Initiative to Global and Regional Measles and Rubella Elimination

“…The global and regional needs for measles elimination overlap geographically with those of the 16 priority countries for polio transition, where GPEI assets are concentrated and the highest burden of measles cases and deaths, as well as rubella and CRS cases, occur [ 21 ]. The 16 countries with 95% of polio assets and infrastructure are Afghanistan, Angola, Bangladesh, Cameroon, Chad, the Democratic Republic of the Congo (DRC), Ethiopia, India, Indonesia, Myanmar, Nepal, Nigeria, Pakistan, Somalia, Sudan, and South Sudan.…”

“…A 2014 survey of 467 country-level program managers in 10 countries (Afghanistan, Angola, Chad, the DRC, Ethiopia, India, Nigeria, Pakistan, Somalia, and South Sudan) found that, overall, they spent 22% of their time on routine immunization and 46% of their time on immunization goals and activities beyond polio. They also reported spending 8% of their time on measles and rubella, highlighting the important support GPEI assets are currently providing to measles and rubella control and elimination activities [ 21 ]. The heavy dependence of EPI on GPEI resources was highlighted in pilot case studies in the DRC and Nepal.…”

“…GPEI surveillance officers, particularly in polio-nonendemic countries, play a critical role in measles and rubella fever/rash surveillance [ 2 6]. For example, in the DRC, GPEI-funded WHO surveillance teams spent approximately one quarter of their time on surveillance of other infectious diseases [ 21 ]. Staff noted that the GPEI provides tools, training, equipment, and funding for local surveillance in health districts and that technical assistance to polio laboratories benefitted national laboratories with best practices shared across disease areas.…”