Department of Global Sustainable Development, School of Cross-Faculty Studies, University of Warwick, Coventry, UK.
Institute of Advanced Study, Milburn House, University of Warwick, Coventry, UK.
BMJ Glob Health. 2021 Mar;6(3). doi: 10.1136/bmjgh-2020-004248.
Mass campaigns are a key strategy for delivering life-saving interventions under Global Health Initiatives, especially in weak health system contexts. They are frequently designed parallel to the health system to rapidly achieve programme targets such as vaccination coverage, but we lack quantitative evidence demonstrating their impact and effect mechanisms on health system performance at sub-/national level. This longitudinal study responds to this gap through an analysis of polio eradication campaigns in Nigeria.
Using four rounds of Demographic and Health Surveys in Nigeria between October 2000 and December 2017, we created a longitudinal dataset containing 88 881 under-5 children/pregnancies. We estimated the relationships between individuals' campaign exposure and health system performance indices (full RI schedule attainment, maternal healthcare services utilisation and child survival) using multilevel, mixed-effects regression models applied nationally and stratified by the six geopolitical zones in Nigeria.
Nationally, high-frequency mass campaigns had detrimental health systems effects that potentially left 3.6 million children deprived of full immunisation. The frequency of campaigns was most concentrated in regions with weak health systems, where the operations of RI were disrupted, alongside negative effects on child survival and institutional delivery. In contrast, regions with relatively strong health systems and few campaigns experienced beneficial effects on maternal healthcare service utilisation.
As we provide evidence that well-functioning health systems can benefit from mass campaigns under Global Health Initiatives, our work also challenges the established wisdom to intensify mass campaigns in weaker health systems to bypass service provision bottlenecks. Mass campaigns do not inherently benefit or damage a health system, but frequent campaigns in weak health system contexts can impede service provision. We call for an additional burden of proof and active efforts to integrate mass campaigns into routine health services by harmonising implementation plans and service delivery in weak health system contexts.
在全球卫生倡议下，大规模运动是提供救生干预措施的关键策略，尤其是在卫生系统薄弱的情况下。它们通常与卫生系统并行设计，以快速实现疫苗接种覆盖率等项目目标，但我们缺乏定量证据证明它们对国家以下各级卫生系统绩效的影响和作用机制。本纵向研究通过分析尼日利亚的脊灰根除运动来填补这一空白。
利用 2000 年 10 月至 2017 年 12 月期间在尼日利亚进行的四轮人口与健康调查，我们创建了一个包含 88881 名 5 岁以下儿童/妊娠的纵向数据集。我们使用多水平、混合效应回归模型，在全国范围内以及按尼日利亚六个地缘政治区进行分层，估计个体接触运动与卫生系统绩效指数（全面免疫接种时间表完成情况、孕产妇保健服务利用情况和儿童生存情况）之间的关系。
在全国范围内，高频率的大规模运动对卫生系统产生了不利影响，可能使 360 万儿童无法完全接种疫苗。运动的频率主要集中在卫生系统薄弱的地区，这些地区的 RI 运作受到干扰，同时对儿童生存和机构分娩产生负面影响。相比之下，卫生系统相对较强、运动较少的地区，孕产妇保健服务利用率受益。
由于我们提供了证据表明运行良好的卫生系统可以从全球卫生倡议下的大规模运动中受益，因此我们的工作也对加强在卫生系统薄弱地区的大规模运动以绕过服务提供瓶颈的既定观点提出了挑战。大规模运动本身不会使卫生系统受益或受损，但在卫生系统薄弱的情况下频繁开展运动可能会阻碍服务提供。我们呼吁在卫生系统薄弱的情况下，通过协调实施计划和服务提供，将大规模运动纳入常规卫生服务，需要额外的证明和积极的努力。
