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Open Access Highly Accessed Study protocol

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

Svea Closser1*, Anat Rosenthal2, Thomas Parris3, Kenneth Maes4, Judith Justice5, Kelly Cox6, Matthew A Luck3, R Matthew Landis3, John Grove7, Pauley Tedoff6, Linda Venczel8, Peter Nsubuga9, Jennifer Kuzara10 and Vanessa Neergheen6

Author Affiliations

1 Department of Sociology and Anthropology, Middlebury College, 306 Munroe Hall, Middlebury, VT, 05753, USA

2 Department of Sociology and Anthropology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel

3 ISciences, LLC, 61 Main St, Burlington, VT, 05401, USA

4 Department of Anthropology, Oregon State University, 238 Waldo Hall, Corvallis, OR, 97331, USA

5 Department of Anthropology, History, and Social Medicine, University of California, San Francisco, 3333 California Street Suite 340, Box 0646, San Francisco, CA, 94118, USA

6 201 Munroe Hall, Middlebury College, Middlebury, VT, 05753, USA

7 Infectious Diseases, Global Health Program, Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98102, USA

8 Polio Program, Global Development Program, Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98102, USA

9 Global Public Health Solutions, 4025 Runnymede Dr, Lilburn, GA, 30047, USA

10 Department of Anthropology, Emory University, 1557 Dickey Dr, Atlanta, GA, 30322, USA

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BMC Public Health 2012, 12:728  doi:10.1186/1471-2458-12-728

Published: 1 September 2012

Abstract

Background

The 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/Design

This 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.

Discussion

The 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.

Keywords:
Polio; Eradication; Vertical program; Routine immunization; Primary health care; Comparative ethnography; Health systems