Apr 24, 2026
Protocol for a systematic review of accountability and corruption within Pakistan's polio eradication program
- Imre Papp1,
- Zubia Mumtaz1
- 1School of Public Health, University of Alberta
Protocol Citation: Imre Papp, Zubia Mumtaz 2026. Protocol for a systematic review of accountability and corruption within Pakistan's polio eradication program. protocols.io https://dx.doi.org/10.17504/protocols.io.q26g7okq1vwz/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: April 23, 2026
Last Modified: April 24, 2026
Protocol Integer ID: 315631
Keywords: pakistan, polio, corruption, accountability, governance, poliomyelitis, health system governance, overall efficacy of the polio eradication program, polio eradication program, corruption in pakistan, examining accountability, corrupt practice, governance within the program, intervention implementation, systematic review, policy, overall efficacy, thematic synthesis approach alongside grade
Abstract
This protocol outlines a systematic review examining accountability and corruption in Pakistan's polio eradication program. The review will systematically search five databases (Embase - Embase via Ovid, PubMed, SSCI - Social Science Citation Index, Scopus, and EconLit), apply predefined inclusion and exclusion criteria, and use Thomas and Harden’s thematic synthesis approach alongside GRADE and GRADE-CERQual to assess confidence in findings.
The review is expected to generate in-depth, contextually grounded insights into how Pakistan's polio eradication program takes shape in the field, and how this is influenced by accountable, or alternatively, corrupt practices. Findings will likely identify recurring structural and organizational drivers, as well as their implications for daily workforce behaviour and functioning, and the overall efficacy of the polio eradication program. These findings are expected to inform policy and intervention implementation to promote more accountable and just governance within the program.
Guidelines
Several limitations of this review should be acknowledged. First, the restriction to English-language publications may result in the exclusion of relevant studies published in other languages, potentially introducing language bias. Second, the sensitivity of this topic may limit the transparency of findings.
Systematically search five databases: Embase - Embase via Ovid, PubMed, SSCI - Social Science Citation Index, Scopus, and EconLit.
Use search terms related to: a) Pakistan (including province names) AND b) corruption or accountability or governance or integrity AND c) polio or poliomyelitis or "polio vaccine"
If satisfied with search results, save search string and record date of search. Download RIS file of publications.
If not satisfied, refine search and reassess before recording search string.
Upload RIS files containing search results to Covidence software [1] for review.
Covidence automatically removes most duplicates. If some remain, remove manually.
Assess eligibility based on title relevance according to inclusion and exclusion criteria. Two independent reviewers complete the screening process (steps 6-8) and must reach consensus. If there is disagreement regarding the eligibility of a study at any point in the screening process (steps 6-8), the reviewers should discuss together and reach an agreement.
Inclusion criteria: research took place in Pakistan, is related to a polio eradication program, and addresses program efficacy/accountability/corruption. Written in English language, published between 2000 and 2026.
Exclusion criteria: research not in Pakistan or relating to the polio program, studies assessing the efficacy of the vaccine itself (and not the delivery program), articles not related to the success/limitations of eradication efforts. Not written in English language, or published before 2000.
Repeat step 6, this time assessing abstract relevance to determine potential eligibility.
Conduct a full-text review of remaining studies to determine eligibility.
While conducting full-text reviews, look through citations for any further potentially relevant articles.
Finally, search WHO, UNICEF, World Bank, and Global Polio Eradication Initiative (GPEI) database for any grey literature surrounding polio governance, accountability, and/or corruption.
Import articles into analysis software (i.e., Quirkos) to facilitate systematic coding and organization of data.
Analyze data using Thomas and Harden's thematic synthesis approach [2]. First, conduct line-by-line coding on the findings sections of each included study, generating codes inductively from the data. Coding is to be conducted iteratively, with initial codes refined and expanded as new studies are incorporated.
Codes should then be grouped into descriptive themes that capture recurring patterns across studies. A constant comparative approach should be used to examine similarities and differences within and across studies, ensuring that themes remain grounded in the primary data.
Analytical themes can then be developed through interpretive analysis, moving beyond the original study findings to generate higher-order insights related to the research question. The development of analytical themes involves ongoing discussion among the research team to challenge assumptions and ensure coherence. To enhance the credibility of the synthesis, illustrative participant quotes will be used to support key themes, and an audit trail of analytical decisions will be maintained throughout the process.
Extract descriptive data from each included study in a spreadsheet. The spreadsheet should contain the following fields: 1) title, 2) author, 3) year of publication, 4) country and setting of study, 5) aim of study, 6) study design, 7) start/end date, 8) population, 9) inclusion criteria, 10) # of participants, 11) identified themes/subthemes (for qualitative work), 12) important quotes (for qualitative work), 13) key findings/results summary, 14) limitations, 15) notes.
Assess methodological quality and confidence in the findings using the GRADE or GRADE-CERQual approach, for quantitative and qualitative findings, respectively [3,4].
The methodological quality of included qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist. Each study will be evaluated across domains including study design, data collection, reflexivity, ethical considerations, and rigor of analysis. Quality appraisal will be conducted independently by at least two reviewers, with disagreements resolved through discussion.
Each review finding will be evaluated across four domains:
- Methodological limitations: the extent to which there are concerns about the design or conduct of the primary studies contributing to a finding
- Coherence: the degree to which the finding is well grounded in and supported by the data across studies
- Adequacy of data: the richness and quantity of data supporting the finding
- Relevance: the applicability of the data to the review question and context
Each finding will be assigned an overall level of confidence (high, moderate, low, or very low), and a summary of qualitative findings table will be produced.
Protocol references
[1] Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org.
[2] Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8: 45. doi:10.1186/1471-2288-8-45
[3] What is GRADE? [Internet]. [place unknown]: GRADE; 2023 [cited 2023 Sep 26]. Available from:
https://www.gradeworkinggroup.org/.
[4] Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implementation Science. 2018;13: 2. doi:10.1186/s13012-017-0688-3