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