Introduction

1. The progress towards eradication of poliovirus globally is one of the greatest success stories of the global health community. When the Global Polio Eradication Initiative started in 1988, polio paralysed more than 1000 children worldwide every day. Since then the global incidence of wild poliovirus cases has decreased by 99.9%, with only five cases of wild poliovirus reported in 2021. At present, only two countries in the world are categorized as polio endemic – Pakistan and Afghanistan. A total of around US$ 20 billion have been spent to support polio eradication activities globally since the launch of the Global Polio Eradication Initiative in 1988. Beyond achievements related to eradication of poliovirus, significant global funding for polio eradication programmes over the last three decades has supported wider health system strengthening efforts, including immunization, vaccine-preventable disease surveillance and outbreak responses.

2. The Seventieth World Health Assembly in May 2017 adopted decision WHA70(9) on poliomyelitis: polio transition planning, in which the Director-General was requested, inter alia, to develop a strategic action plan on polio transition by the end of 2017. The Strategic Action Plan on Polio Transition (2018–2023) (hereafter referred to as the Action Plan) was developed and presented to the World Health Assembly in May 2018. It has three key objectives, namely to:

(a) sustain a polio-free world after the eradication of poliovirus;

(b) strengthen immunization systems, including surveillance for vaccine-preventable diseases;

(c) strengthen emergency preparedness, detection and response capacity in countries to fully implement the International Health Regulations (2005).

3. Initially, 16 countries across three WHO regions were selected as polio transition priority countries with their selection based on their reliance on Global Polio Eradication Initiative resources. Later, four additional countries were added mainly because the fragility of their health systems and insecurity posed potential threats to polio gains in those countries.

Objective, scope and evaluation questions

4. The focus of the mid-term evaluation had two dimensions: an outcome-based dimension (assessing the status and implementation of the Action Plan) and a formative and forward-looking dimension.

5. The evaluation focused on progress across the 20 polio transition priority countries and further investigated progress at the regional and global levels. The evaluation aimed to:

document key achievements, best practices, challenges, gaps and areas for improvement in the design and implementation of the Action Plan;

identify the key contextual factors and changes in the global public health realm that have affected the development and implementation of the Action Plan and the road map developed in 2018; and

make recommendations, as appropriate, on the way forward to enable the successful implementation of the Action Plan.

6. The overarching evaluation questions are as follows:

i. What have been the key achievements, best practices, challenges, gaps and areas for improvement in the design of the Action Plan? (relevance)

ii. What have been the key achievements, best practices, challenges, gaps and areas for improvement in the implementation of the Action Plan? (effectiveness and efficiency)

iii. Does the implementation of the Action Plan have the potential to create and/or contribute to sustainable changes? (sustainability)

iv. What recommendations are appropriate on the way forward to enable successful implementation of the Action Plan?

7. Cross-cutting aspects of gender, equity and human rights were assessed to the extent possible throughout the evaluation by adopting WHO’s cross-cutting evaluation strategies on gender, equity, vulnerable populations, and human rights.

Source: World Health Organization