Methods for evaluating the impact of vertical programs on health systems: protocol for a study on the impact of the global polio eradication initiative on strengthening routine immunization and primary health care

Abstract

BackgroundThe impact of vertical programs on health systems is a much-debated topic, and more evidence on this complex relationship is needed. This article describes a research protocol developed to assess the relationship between the Global Polio Eradication Initiative, routine immunization, and primary health care in multiple settings.Methods/DesignThis protocol was designed as a combination of quantitative and qualitative research methods, making use of comparative ethnographies. The study evaluates the impact of the Global Polio Eradication Initiative on routine immunization and primary health care by: (a) combining quantitative and qualitative work into one coherent study design; (b) using purposively selected qualitative case studies to systematically evaluate the impact of key contextual variables; and (c) making extensive use of the method of participant observation to create comparative ethnographies of the impact of a single vertical program administered in varied contexts.DiscussionThe study design has four major benefits: (1) the careful selection of a range of qualitative case studies allowed for systematic comparison; (2) the use of participant observation yielded important insights on how policy is put into practice; (3) results from our quantitative analysis could be explained by results from qualitative work; and (4) this research protocol can inform the creation of actionable recommendations. Here, recommendations for how to overcome potential challenges in carrying out such research are presented. This study illustrates the utility of mixed-methods research designs in which qualitative data are not just used to embellish quantitative results, but are an integral component of the analysis.

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

“…Informed consent was obtained from all participants. A detailed description of our methods is available in an open-access article [ 20 ], and the full qualitative protocol is accessible online (available at: ).…”

Polio Eradication and Health Systems in Karachi: Vaccine Refusals in Context

“…The research described here, conducted in early 2012 with a brief follow-up in 2015, was part of a larger study examining the impact of polio eradication activities on health systems in a variety of contexts (Closser et al, 2012(Closser et al, , 2014. The study protocol was approved by the Middlebury College Institutional Review Board.…”

The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative

“…We describe in more detail elsewhere some challenges we faced in practice as well as modifications necessitated by security and other considerations (Closser et al. ). We relied on three major methods to collect data: document review, participant observation, and interviews.…”