Table 2 Summary of interventions included in the review, the mechanisms by which these supported system resilience, outcomes and key contextual modifiers where these were identified. Multi-dimensional interventions are not included in this table because they comprise multiple discrete interventions acting in a variety of ways – please refer to the main text for further information on these
Intervention class | Intervention type | Mechanism | Outcomes | Contextual modifiers | Relevant studies |
|---|---|---|---|---|---|
Campaign | Adaptive. | Variable according to campaign structure approaches (see Additional file 4: appendix 4). All studies noted increases in coverage post-campaign but with variations according to geography or population group. | Wide variety of contexts described. Active conflict/insecurity strongly influenced choice of service delivery modality, in particular the extent to which community mobilisers were involved in demand-generation activities. | ||
Health financing | Payment for performance | Adaptive | Variable evidence of effects on coverage for selected antigens depending on the study – one showing a positive effect, one showing no effect, and one showing a marginal decrease in coverage over time. | All included studies applied in conflict-affected settings. (Positive) wider health system financing environment likely to have influenced outcomes in one of these studies [50]. | |
Funding disbursement | Adaptive | Rapid decline over time in difference between funds disbursed to health workers and funds accounted for. | Applied in conflict-affected setting only. Availability of a partner bank in-country with capacity to support mobile phone-based funding disbursement important to intervention delivery. | [53] | |
Private sector engagement | Transformative | Statistically significant increase in coverage for selected antigens in intervention area by comparison with controls. | Community-embeddedness of the intervention – through engagement of local councils – was important in supporting demand for vaccination through the public-private partnership. | [54] | |
Development financing | Adaptive | Improvements in coverage for selected antigens over time following uplift in macro-level financing. | Relevant countries included in both studies were primarily conflict-affected, with significant and ongoing disruption to health service delivery. | ||
Service integration | Mobile Health Teams | Adaptive | Improvements in coverage for selected antigens over time but with variations across population groups. | Both interventions applied in conflict-affected settings. Existence of established governance mechanisms (linked to agreed basic package of care in one study, and a strategic plan and accountability framework in the other) | |
Nutrition and routine immunisation | Adaptive | Increases in number of children immunised in one study (coverage not reported) and coverage for selected antigens in the second study following implementation. | Both studies implemented in South Sudan in context of ongoing instability. Existing service integration policy identified as important success factor for the intervention in supporting pooling of funds across service domains. | ||
Polio eradication and routine immunisation | Potentially transformative | Increases in coverage for selected antigens following implementation of the integrated interventions. | Both interventions implemented in conflict-affected contexts. Ability to mobilise sufficient financial resources to support delivery identified as a key success factor, as well as existence of established polio eradication architecture on which to capitalise. | ||
Governance and coordination | Civil-military engagement | Potentially transformative | Improvements in accessibility for targeted areas noted following intervention implementation, as well as reductions in number of zero-dose children. | Both interventions applied in conflict-affected settings. Existence of governance mechanisms linked military leadership at regional level and the polio eradication programme in each country identified as an important factor in promoting civil-military engagement. | |
Cross-border coordination | Transformative | Improvements in vaccination coverage, case ascertainment for AFP among high risk populations identified following intervention implementation. | Political commitment from country governments and brokering by WHO identified as important to success of intervention. Contextual challenges tempering effects included ongoing population movement from South Sudan and local factors including a health worker strike in Kenya. | [65] | |
Health workforce | Volunteer community mobilisers | Adaptive | Reduction in the number of missed opportunities for polio vaccination following intervention introduction. | Supportive infrastructure of the polio eradication initiative in-country identified as key to success of the intervention, as was population-level trust in these providers. | [66] |
Technical surge capacity | Adaptive | Reduction in both missed opportunities for polio vaccination and documented polio cases following intervention implementation. | Substantial funding (in this case from the Bill and Melinda Gates Foundation) identified as an important contextual factor supporting the intervention, as well as prior implementation of a performance and accountability framework in WHO country offices that supported assessment of performance against surge personnel contracts. | [67] | |
Health information and surveillance | Monitoring and planning | Adaptive | Variable according to the intervention – see Additional file 4: appendix 4. Reduction in the number of geographical locations with zero vaccination coverage by comparison with control areas in one (GIS-based) intervention. Effectiveness of rapid monitoring for campaign delivery unclear. | Prior experience of the polio eradication initiative with deployment of GIS-based population mapping supported intervention implementation. Continuing population movement undermined the effectiveness of rapid monitoring for campaign targeting in the second study. | |
Outreach surveillance | Adaptive | Reduction in reported polio case load, and improvements in performance against a series of AFP surveillance criteria. | Applied in a single post-conflict setting only. | [70] | |
Community engagement | Community mobilisation activities | Adaptive | Increases documented in vaccination coverage, or reductions in missed opportunities for vaccination depending on the study. | All four studies were implemented in northern Nigeria. An important factor influencing programme success in at least two of the studies included the long-established position of the polio eradication initiative and the supporting infrastructure it provided around which to build community mobilisation activities. Population trust in providers was also a key factor influencing success. | |