title: The impact of polio eradication on routine immunization and primary health care: a mixed-methods study.
abstract: BACKGROUND
  After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
  
  
  METHODS
  Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
  
  
  RESULTS
  Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.
  
  
  CONCLUSIONS
  Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.
authors.affiliation: Department of Sociology and Anthropology, Middlebury College, Middlebury.
authors.forename: Svea
authors.initials: S
authors.lastname: Closser
authors.affiliation: Department of Sociology and Anthropology, Middlebury College, Middlebury.
authors.forename: Kelly
authors.initials: K
authors.lastname: Cox
authors.affiliation: ISciences, Burlington, Vermont.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Parris
authors.affiliation: ISciences, Burlington, Vermont.
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Landis
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco.
authors.forename: Judith
authors.initials: J
authors.lastname: Justice
authors.affiliation: Freelance Consultant, Secunderabad.
authors.forename: Ranjani
authors.initials: R
authors.lastname: Gopinath
authors.affiliation: Department of Anthropology, Oregon State University.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maes
authors.affiliation: Addis Ababa University, Ethiopia.
authors.forename: Hailom
authors.initials: H
authors.lastname: Banteyerga Amaha
authors.affiliation: Department of Sociology, Bayero University, Kano, Nigeria.
authors.forename: Ismaila Zango
authors.initials: IZ
authors.lastname: Mohammed
authors.affiliation: Department of Sociology, Bayero University, Kano, Nigeria.
authors.forename: Aminu Mohammed
authors.initials: AM
authors.lastname: Dukku
authors.affiliation: Independent Consultant, Corvallis, Oregon.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Omidian
authors.affiliation: MNCH-RH Department, Health Services Academy, Islamabad.
authors.forename: Emma
authors.initials: E
authors.lastname: Varley
authors.affiliation: Department of Sociology and Anthropology, Middlebury College, Middlebury.
authors.forename: Pauley
authors.initials: P
authors.lastname: Tedoff
authors.affiliation: Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Koon
authors.affiliation: National University of Rwanda School of Public Health, Kigali, Rwanda.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Nyirazinyoye
authors.affiliation: ISciences, Burlington, Vermont.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Luck
authors.affiliation: ISciences, Burlington, Vermont.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Pont
authors.affiliation: Department of Sociology and Anthropology, Middlebury College, Middlebury.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Neergheen
authors.affiliation: Department of Biomedical Ethics, McGill University, Montreal, Canada.
authors.forename: Anat
authors.initials: A
authors.lastname: Rosenthal
authors.affiliation: Global Public Health Solutions, Decatur, Georgia.
authors.forename: Peter
authors.initials: P
authors.lastname: Nsubuga
authors.affiliation: Deep Children Hospital and Research Centre, Gandhidham, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Thacker
authors.affiliation: Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: Rashid
authors.initials: R
authors.lastname: Jooma
authors.affiliation: Department of Sociology and Anthropology, Middlebury College, Middlebury.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nuttall
mesh_terms: D017954:Africa South of the Sahara; D001210:Asia, Southeastern; D060740:Disease Eradication / Q000379:methods*; D006801:Humans; D007114:Immunization / Q000379:methods* / Q000706:statistics & numerical data*; D011051:Poliomyelitis / Q000517:prevention & control*; D023321:Poliovirus Vaccines / Q000008:administration & dosage*; D011320:Primary Health Care / Q000706:statistics & numerical data*
chemical_list: D023321:Poliovirus Vaccines
keywords: eradication; health systems; poliomyelitis; routine immunization