Abstract
BackgroundPastoralist community accounts for a significant portion of the population in Ethiopia. This community is different from majority of the country’s population. Access to TB prevention and control services is uneven in the country. The community TB program is designed to improve the access. Exploring the program performance from the perspectives of its implemters in a pastoral setting remains important.MethodWe conducted a qualitative study using an interpretive description method in the pastoralist community setting of Ethiopia. Study participants were recruited from geographically dispersed areas. We collected data through in-depth interview using semi-structured interview guides and audio recordings during February 01–30, 2020. The guides were developed in consultation with TB program experts and clinicians treating TB patients in the study area. Notes were taken at the interviews to enrich transcription of the data. Principal investigator conducted the interview. The subsequent interviews were informed by emerging ideas from forgoing interview transcriptions and continued until data saturation was achieved.ResultsOne hundred and fifty six codes, nine categories and three themes emanated. The first theme was inadequate community TB performance and some of its codes include inadequate presumptive TB case identification and compromised directly observed treatment short course service delivery. The second theme was factors contributing to the program performance. Community factors, lack of physical access to health facilities and indirect non-medical cost were some categories under this theme. The final theme was suggested solutions; and its categories include a need for active community involvement and modification of service delivery approaches.ConclusionsCommunity TB performance was inadequate in the pastoralist community. Multifaceted factors contributed to the inadequate program performance. Socioeconomic and access related factors were major contributers. Aligning the program to the context of the pastoralist community setting is required to improve the performance.
Highlights
Pastoralist community accounts for a significant portion of the population in Ethiopia
Community TB performance was inadequate in the pastoralist community
Twenty two community health workers, called health extension worker, who had three or more years of work experience at the time of interview were included in the study
Summary
Pastoralist community accounts for a significant portion of the population in Ethiopia. Access to TB prevention and control services is uneven in the country. TB case, the notification is neither adequate for WHO estimated incident cases nor consistent across local diversities in the country due to variation in access to TB prevention and control services [6]. Pastoral community is one of the most marginalized settings in the country, in regions where the agrarian community is predominant [7]. Pastoral communities occupy 43 % of the land mass of Africa and Ethiopia is one of 36 countries with large area of the pastoralist livelihood community [8]. Pastoralism is a culture, livelihood system, extensive use of rangelands It is the key production system practiced in the arid and semi-arid dryland areas. Pastoralists live in areas often described as marginal, remote, conflict prone, food insecure and associated with high levels of vulnerability
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