Barriers for the Functional Implementation of Community Health Volunteers in Health Developmental Army in Debre Libanos District, Oromia, Ethiopia: A Descriptive Qualitative Study

Abstract

Background

Although the existing evidence suggests that the implementation of the health, developmental army (HDA) brought promising successes towards the delivery of Health Extension Programs (HEPs), pieces of evidence have shown that there are problems related to its functionality. Therefore, this study explored barriers to the functionality of HDAs.

Methods

A descriptive qualitative study was conducted from March 11 to April 7, 2019, in the Debre Libanos District, Oromia, Ethiopia. The study participants were purposively recruited from six kebeles. They were recently delivered mothers, pregnant women, other reproductive age group community members, health workers, kebele chairman, HDA team leaders, and religious leaders. Five in-depth interviews, seven key informant interviews, and four focus group discussions were conducted with a total of 52 participants. Data were audio-recorded, transcribed verbatim, and translated. The inductive thematic analysis approach was used and the data were coded, categorized, and themes were developed using Atlas ti.7.1. software package.

Results

The barriers to the functionality of HDAs were organized into four major themes. First, it was affected by structure, monitoring, or supervision-related challenges. Second, community-related barriers such as perceptions and attitudes towards HDAs, and the need for incentives or compensation from the HDAs affected the functionality. Third, it was affected by the lack of multi-sectoral collaboration to strengthen, monitor, or supervise the HDAs. Lastly, behavior, residence, or shortage of health extension workers affected its implementation. In addition, the study found that, as a result of poor functionality of HDAs, service utilization was decreased, especially antenatal care, postnatal care, sick newborn treatment, etc.

Conclusion

The functionality of HDAs was affected by a variety of barriers. Therefore, there is a need to develop different strategies and take action to address the explored barriers to improve their capacity and implementation status for increasing health care service utilization.

Keywords:

• Health Developmental Army
• health extension worker
• Health Extension Program
• community health volunteers
• barriers
• Ethiopia

Abbreviations

HAD, Health Developmental Army; HEP, Health Extension Program; HEW, health extension worker.

Data Sharing Statement

All study data were reported within the manuscript.

Ethics Approval and Consent to Participate

Ethical approval was obtained from the Jimma University Research Ethical Review Board, Ethiopia. The right of research participants was maintained by ensuring non-maleficence and underscoring the benefits of the study. Study participants were informed adequately about the purpose of the study, voluntary participation and right to participate or withdraw at any time. To ensure their privacy and autonomy, codes were given to participants and they were informed that the study uses the codes in place of their names in connection with the study findings or their answers on discussions or interviews. Time was given to them to reflect and provide a detailed explanation of the issue. Written informed consent was taken from all study participants for participation in the study and records their voice. Furthermore, the authors confirmed that there participant’s response was anonymized to ensure their confidentiality.

Acknowledgments

We acknowledge research assistants, and study participants for their voluntary participation.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. The authors reviewed the manuscript and it is their original work.

Disclosure

The authors declared that they have no competing interests in this work.