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As countries face a reduction of external funding due to changing income status or phasing out of mass campaigns as disease elimination targets are met, the delivery of health interventions may be transitioned into the routine primary health care system. More evidence is needed on the process of transition, factors affecting transition and the outcomes of transferring ownership of campaigns to health systems. The Health Campaign Effectiveness Coalition contributed to filling this gap. Following HCE Coalition’s support to country projects in the areas of neglected tropical diseases, malaria, immunizations, and nutrition, key insights are now available on the transition process and effects. In a new report, HCE Coalition’s synthesis of the implementation research delves into the findings of projects in Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Nigeria, and Vanuatu. HCE Coalition highlights the challenges, solutions and offers 10 promising practices in four themes: a phased transition framework; inclusive engagement of stakeholders; management and strengthening of human resources for health service delivery; adequate and efficient information systems, including for supply chain management. Campaign planners and managers can adopt the promising practices, tailored to their local context, and anticipate the challenges and solutions to make the benefits of campaigns when they are transitioned to the health system.
Health campaigns are time-bound efforts to address an epidemiological need, fill a service delivery gap, or provide surge coverage for a health intervention. Historically, campaigns have been primarily funded by donors, but governments are making efforts to reduce reliance on external support and facilitate linkage with ongoing primary health care (PHC) services. Transitioning a campaign into the PHC system may be prompted by external factors such as rising income status, which limits the need for development aid, or the phasing out of campaigns, such as polio vaccination days, after country targets have been met. If the transition of health campaigns into the PHC system is not well planned and managed, such a transition could reduce gains made in population coverage of vaccines, preventive chemotherapy, vitamin A supplementation, and interventions to prevent malaria. Little is known about the process of fostering campaigns’ transition to and linkages with PHC systems and its effects.
In 2021, following development of the Health Campaign Effectiveness Coalition’s Research and Learning Agenda, the Coalition issued a request for proposals for implementation research studies from partners in low- and middle-income countries to address questions related to transitioning health campaigns. Six implementation research projects were funded in Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Nigeria, and Vanuatu that related to neglected tropical diseases, malaria, and nutrition. Over 18 months, the projects assessed campaign transitions to the PHC system, the fostering of greater linkages between campaigns and the PHC system, and the support needed to the routine system for a transitioned intervention. Two of the six projects were exploratory. Four projects evaluated a transition in process or that had been completed. Findings from these studies were assessed in a qualitative evidence synthesis to identify common challenges and solutions proposed by the projects, enablers, promising practices. We also describe outcomes related to the beneficiaries of the interventions.
Challenges related to transitioning campaigns to the PHC system included uneven government commitment, sociocultural barriers, stock-outs of drugs, lack of funding, increased health care provider workload, limited monitoring tools, and poor coordination. Solutions and promising practices were identified to both address challenges and inform future campaign transitions to, and linkages with, the PHC system. Ten promising practices within four overarching themes emerged:
Phased Transition Plan
Inclusive Engagement of Stakeholders
Management and Strengthening of Human Resources
Adequate and Efficient Information Systems, Including for Supply Chain Management
Outcomes related to the interactions with beneficiaries of the interventions were identified in five studies, with different studies measuring different outcomes. In the project in Nigeria, after transitioning neglected tropical disease campaigns to country ownership in four districts, coverage of deworming to address soil-transmitted helminthiasis remained high, whereas coverage for schistosomiasis declined due to drug supply unavailability. The project in Vanuatu also found that coverage of the campaign targeting yaws, scabies, and soil-transmitted helminths was maintained at high levels when integrated with skin exams and referral of suspected skin cases to the PHC system, although coverage was slightly below the target. In projects in Vanuatu and Ghana high acceptability was gained as seen in surveys with health workers and the community.
Conclusion
Planners, managers, and funders of campaigns should adopt the promising practices, adapted to their local context, that focus on how to include all stakeholders at all levels during a phased transition; strengthen and manage human resources; and develop appropriate data and information management systems, including for the supply chain. The knowledge gaps that remain relate to determining the optimal time and stages needed to transition different campaigns across health programs and piloting and evaluating efforts to strengthen the PHC systems taking ownership of transitioned campaign interventions. Stakeholders involved in monitoring programs and conducting research should study the outcomes of adopting the promising practices and filling the knowledge gaps.
