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Political and governmental reforms impacted on immunization program sustainability both positively and negatively. This study aims to explore the sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We collected qualitative data through in-depth interviews with 27 key informants from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers, and Non-government Organizations (NGOs). We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Competing priority was identified as the significant challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at the sub-national level government. The government reform has led to a more democratic society, facilitating vaccine rejection and hesitancy. The multi-sector partnership played a significant role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign were essential to raising awareness of the community and policymakers\u00a0to keep polio in the agenda and to maintain the high polio immunization coverage.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Competing priority was the major factor affecting high polio immunization coverage during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-021-11642-7","type":"journal-article","created":{"date-parts":[[2021,9,6]],"date-time":"2021-09-06T10:03:31Z","timestamp":1630922611000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Ensuring sustainability of polio immunization in health system transition: lessons from the polio eradication initiative in Indonesia"],"prefix":"10.1186","volume":"21","author":[{"given":"Luthfi","family":"Azizatunnisa\u2019","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utsamani","family":"Cintyamena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yodi","family":"Mahendradhata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9340-3922","authenticated-orcid":false,"given":"Riris Andono","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,6]]},"reference":[{"key":"11642_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bmj.f6753","volume":"347","author":"DH Peters","year":"2013","unstructured":"Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. 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In addition, written informed consent was obtained from participants who agreed to have face to face interviews. Meanwhile, verbal consent was obtained from participants who wished to be interviewed via phone. Verbal consent was recorded before the interview was conducted. Face to face and phone interview have been stated in data collection methods in the study protocol. Phone interviews were conducted when the face-to-face interview was not possible, for example due to distance, and unmatched schedule. Therefore, phone interview and recorded verbal consent were conducted.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they do not have competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1624"}}