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

backgroundAlthough 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.

methodsA 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.

resultsThe 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.

conclusionThe 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.