Opportunities and barriers arising from the COVID-19 pandemic for health campaign integration across immunizations, neglected tropical diseases, insecticide-treated bed nets, and vitamin A supplementation: A qualitative key informant interview study

In low- and middle-income countries, health campaigns play a crucial role in addressing high-priority health concerns such as neglected tropical diseases (NTDs), malaria, vaccine-preventable diseases and nutrition (vitamin A supplementation). Many health campaigns are conducted throughout the calendar year, resulting in multiple campaigns annually in some communities. Campaign integration offers an opportunity to increase efficiencies across programs and limit the strain on healthcare workers, communities, and health systems. The response to the COVID-19 pandemic provided opportunities for campaign integration to mitigate losses from missed campaign deliveries. As the interest in integration grows, there is a need to understand existing barriers, bottlenecks, and opportunities for better integration, whether through co-delivery or increased collaboration. This qualitative study aimed to understand the opportunities and barriers to campaign co-delivery and collaboration from the perspective of 26 stakeholders involved in vaccine-preventable diseases, vitamin A supplementation, NTDs, and malaria programs. Key informants included campaign managers, implementing partners, donors, and decision-makers at the country and state levels in five countries: Côte d'Ivoire, Ethiopia, Guyana, Indonesia, and Nigeria. Results indicated that campaigns were integrated at various levels, from partial integration and co-delivery to fully integrated delivery within existing health services. Most emerging factors were categorized as either facilitating or hindering campaign integration. Enablers to campaign integration included joint planning and appreciation for human resources, while target population variation, prioritization of one intervention by another, and overburdening of healthcare workers, community health workers and community drug distributors were identified as specific barriers. An emerging theme was the importance of leadership, reinforcing the need for country ownership, political will, and positive stakeholder relationships. Further research is warranted to identify optimal combinations of campaign commodities, strategies to ensure stakeholder engagement throughout the integration process, methods to factor in local community context, and the expansion of lessons learned from the COVID-19 pandemic.