EXPLORING THE FIDELITY AND ACCEPTABILITY OF POLIO PROGRAM IN KARACHI, PAKISTAN THROUGH A REALIST EVALUATION
Mayera Tufail, Prof. dr. Yodi Mahendradhata, MPH., PhD., FRSPH, Dr. Dra. Retna Siwi Padmawati, MA.
2024 | Tesis | S2 Ilmu Kesehatan Masyarakat
Latar
Belakang: Pada tahun 2022, Pakistan masih menjadi endemis virus polio,
melaporkan 22 kasus pada tahun 2022, termasuk ko-sirkulasi WTPV tipe 1 dan VDPV
tipe 2. Karachi, kesulitan mempertahankan tingkat imunisasi, dengan cakupan
vaksinasi OPV3 plus IPV di 47 -62%. Kegagalan indikator kualitas kampanye
mengakibatkan hilangnya anak-anak dan tingginya populasi berpindah, sehingga
membahayakan kesetiaan program. Etnis berbahasa Pashto, sebuah kelompok yang
terpinggirkan, berkontribusi terhadap keraguan terhadap vaksin, sehingga mempengaruhi
penerimaan program.
Tujuan:
Menjelaskan dampak penerimaan dan kesetiaan program terhadap kinerja program
polio.
Metode:
Kami melakukan studi metode campuran evaluasi realis di dua SHRUC Karachi:
Islamia Colony-9 (IC) dan Ittehad Town-2 (IT). Daerah-daerah ini mengalami
tingkat penolakan yang tinggi dan masih melewatkan anak-anak selama kampanye,
dengan populasi termasuk pengungsi Afghanistan dan etnis berbahasa Pashto. Data
kuantitatif sekunder dikumpulkan dan dilanjutkan dengan wawancara dengan para
pemangku kepentingan, petugas kesehatan garis depan (FLW), pemberi pengaruh di
masyarakat, dan orang tua dari anak di bawah 5 tahun untuk memberikan masukan
pada teori program.
Hasil:
IC secara konsisten melaporkan anak-anak yang terus-menerus tidak terjawab
selama kampanye (2,0-7,0%), sedangkan IT melaporkan persentase yang berkisar
antara 1,4 hingga 3,2%. Status indikator LQAS lulus untuk 73% kampanye IC dan
64% kampanye TI antara tahun 2021-23. Wawancara kualitatif mengidentifikasi
tema-tema umum: etnis Pashtun memainkan peran penting dalam penerimaan vaksin,
kesalahpahaman dan keyakinan agama yang memicu penolakan, kompensasi rendah dan
kondisi kerja yang menantang bagi FLW, vertikalitas program polio, dan
ketergantungan pemerintah pada staf mitra.
Kesimpulan:
Penolakan, yang seringkali berakar pada kesalahpahaman dan keyakinan yang
salah, khususnya di kalangan etnis Pashtun, terus mengancam penerimaan program.
Meskipun ketelitian program tetap memuaskan dengan dukungan dari organisasi
mitra, pemberian layanan terpadu menghadapi tantangan implementasi. Studi ini
memerlukan perubahan dalam kebijakan program polio.
Kata
Kunci: Polio, fidelity, akseptabilitas dan evaluasi realis.
Background:
As of 2022, Pakistan remains endemic for the polio virus, reporting 22 cases in
2022, including co-circulation of both WTPV type 1 and VDPV type 2. Karachi,
struggles with maintaining immunization rates, with OPV3 plus IPV vaccination
coverage at 47-62%. Failed campaign quality indicators result in missed
children and a high-risk mobile population, jeopardizing program fidelity.
Pashto-speaking ethnicity, a marginalized group, contribute to vaccine
hesitancy, affecting program acceptability.
Objective:
Explain the impact of program acceptability and fidelity on polio program
performance.
Method:
We conducted a realist evaluation mixed-methods study in two Karachi SHRUCs:
Islamia Colony-9 (IC) and Ittehad Town-2 (IT). These areas experience high
refusal rates and still missed children during campaigns, with a population
including Afghan refugees and Pashto-speaking ethnicity. Secondary quantitative
data was collected followed by interviews with stakeholders, frontline health
workers (FLWs), community influencers, and parents of children under 5 to inform
program theories.
Results:
IC consistently reported persistent missed children during campaigns
(2.0-7.0%), while IT reported percentages ranging from 1.4 to 3.2%. LQAS
indicator status passed for 73% of IC campaigns and 64% of IT campaigns between
2021-23. Qualitative interviews identified common themes: Pashtun ethnicities
playing a central role in vaccine acceptability, misconceptions and religious
beliefs fueling refusals, low compensation and challenging work conditions for
FLWs, verticality of the polio program, and government dependence on partner
staff.
Conclusion:
Refusals, often rooted in misconceptions and false beliefs, particularly within
Pashtun ethnicities, continue to threaten program acceptability. While program
fidelity remains satisfactory with support from partner organizations,
integrated service delivery faces implementation challenges. This study
warrants change in polio program policies.
Keywords: Polio, fidelity, acceptability and realist evaluation.
Kata Kunci : Polio, fidelity, acceptability and realist evaluation