Background: Sustaining an effective evidence-based health intervention will maximize its impact in public health. Political and governmental reforms impact immunization program sustainability both positively and negatively. This study aims to explore sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia.
Methods: We collected qualitative data through in-depth interviews with 27 key informants in from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers and NGOs at national and sub-national level. We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness.
Results: Competing priority was identified as the major challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at sub-national level government. The government reform has led to a more democratic society, which is also conducive for rejection and vaccine hesitancy. Multi sector partnership has been identified to play a big role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign are essential to raise awareness for the community and policy makers to maintain the high polio immunization coverage.
Conclusion: Competing priority was the major factor that affected high coverage of polio immunization during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.