Exploring community tuberculosis program in the pastoralist setting of Ethiopia: a qualitative study of community health workers' perspectives in Borena Zone, Oromia Region

Background Pastoralist 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. Method We 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. Results One 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. Conclusions Community 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.