Facilitators and barriers of infectious diseases surveillance activities: lessons from the Global Polio Eradication Initiative - a mixed-methods study

OBJECTIVES: To document lessons from the Global Polio Eradication Initiative (GPEI) by determining factors associated with successful surveillance programme globally as well as at national and subnational levels. The process of conducting surveillance has been previously recognised in the literature as important for the success of polio surveillance activities. DESIGN: A cross-sectional survey with closed and open-ended questions. SETTINGS: Survey of persons involved in the implementation of surveillance activities under the GPEI at the global level and in seven low-income and middle-income countries. PARTICIPANTS: Individuals (n=802) with ≥12 months of experience implementing surveillance objective of the GPEI between 1988 and 2019. MAIN OUTCOME MEASURES AND METHODS: Quantitative and qualitative analyses were conducted. Logistic regression analyses were used to assess factors associated with implementation process as a factor for successful surveillance programme. Horizontal analysis was used to analyse qualitative free-text responses on facilitators and barriers identified for conducting surveillance activities successfully. RESULTS: Overall, participants who reported challenges relating to GPEI programme characteristics had 50% lower odds of reporting implementation process as a factor for successful surveillance (adjusted OR (AOR): 0.50, 95% CI: 0.29 to 0.85). Challenges were mainly perceptions of external intervention source (ie, surveillance perceived as ‘foreign’ to local communities) and the complexity of surveillance processes (ie, surveillance required several intricate steps). Those who reported organisational challenges were almost two times more likely to report implementation process as a factor for successful surveillance (AOR: 1.89, 95% CI: 1.07 to 3.31) overall, and over threefolds (AOR: 3.32, 95% CI: 1.14 to 9.66) at the national level. CONCLUSIONS: Programme characteristics may have impeded the process of conducting surveillance under the GPEI, while organisational characteristics may have facilitated the process. Future surveillance programmes should be designed with inputs from local communities and frontline implementers.