{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T13:39:13Z","timestamp":1771076353478,"version":"3.50.1"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1178578"],"award-info":[{"award-number":["OPP1178578"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Vertical disease control programmes have enormous potential to benefit or weaken health systems, and it is critical to understand how programmes\u2019 design and implementation impact the health systems and communities in which they operate. We use the Develop\u2013Distort Dilemma (DDD) framework to understand how the Global Polio Eradication Initiative (GPEI) distorted or developed local health systems. We include document review and 176 interviews with respondents at the global level and across seven focus countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We use DDD domains, contextual factors and transition planning to analyse interactions between the broader context, local health systems and the GPEI to identify changes. Our analysis confirms earlier research including improved health worker, laboratory and surveillance capacity, monitoring and accountability, and efforts to reach vulnerable populations, whereas distortions include shifting attention from routine health services and distorting local payment and incentives structures. New findings highlight how global-level governance structures evolved and affected national actors; issues of country ownership, including for data systems, where the polio programme is not indigenously financed; how expectations of success have affected implementation at programme and community level; and unresolved tensions around transition planning. The decoupling of polio eradication from routine immunization, in particular, plays an outsize role in these issues as it removed attention from system strengthening. In addition to drawing lessons from the GPEI experience for other efforts, we also reflect on the use of the DDD framework for assessing programmes and their system-level impacts. Future eradication efforts should be approached carefully, and new initiatives of any kind should leverage the existing health system while considering equity, inclusion and transition from the start.<\/jats:p>","DOI":"10.1093\/heapol\/czab044","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T20:19:26Z","timestamp":1616530766000},"page":"707-719","source":"Crossref","is-referenced-by-count":10,"title":["The effects of polio eradication efforts on health systems: a cross-country analysis using the Develop\u2013Distort Dilemma"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2523-1123","authenticated-orcid":false,"given":"Daniela C","family":"Rodriguez","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail H","family":"Neel","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yodi","family":"Mahendradhata","sequence":"additional","affiliation":[{"name":"Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sekip Utara, Yogyakarta 55281, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wakgari","family":"Deressa","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, School of Public Health, Addis Ababa University, P. O. Box 9086, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eme","family":"Owoaje","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Ibadan, AddL P.M.B 3017 G.P.O Ibadan, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwaseun","family":"Akinyemi","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Ibadan, AddL P.M.B 3017 G.P.O Ibadan, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malabika","family":"Sarker","sequence":"additional","affiliation":[{"name":"BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka-1212, Bangladesh"},{"name":"Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Mafuta","sequence":"additional","affiliation":[{"name":"Kinshasa School of Public Health, University of Kinshasa School of Public Health, Kinshasa, The Democratic Republic of Congo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiv D","family":"Gupta","sequence":"additional","affiliation":[{"name":"Indian Institute of Health Management Research, 1 Prabhu Dayal Marg, Near Sanganer Airport Terminal 1, Jaipur 302029, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad Shah","family":"Salehi","sequence":"additional","affiliation":[{"name":"Global Innovation Consulting Services, Kabul, Afghanistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anika","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olakunle","family":"Alonge","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"key":"2021070819030423300_R1","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1093\/heapol\/czs084","article-title":"Systems thinking for strengthening health systems in LMICs: need for a paradigm shift","volume":"27","author":"Adam","year":"2012","journal-title":"Health Policy and Planning"},{"key":"2021070819030423300_R2","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1093\/heapol\/czx122","article-title":"Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan","volume":"32","author":"Alonge","year":"2017","journal-title":"Health Policy and 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