Table 5 Key Theme: Factors Contributing to the low community TB performance, Borena zone of Oromia Region, Ethiopia in 2020

Community related Factors

. Many community members consider TB related signs and symptoms as mild and self limiting complaints and do not accept our referral to health facilities. Some members miss understand our messages about TB prevention methods and tend to discriminate people who have cough or on anti TB treatment… (CHW-12)

Physical access to Health facilities

… We do not have the facilities to test for TB in this health post. We do not have the skill and material to take and send samples to health facilities either. We just inform people with sign and symptom of TB and give a referral slip to go to other health facilities for the test. The health facilities are bout 40 Kms from here and also there is no transportation facility. Not only diagnostic health facility, but our health post is far from villages. Therefore, access to health facilities is inadequate in our pastoral community and there is a need to revise TB prevention and control approach in our setting… (CHW-16)

Community Health workers related Factors

… Most of us (CHWs) are female. Pastoral community settlement is highly scattered and mobile from place to place in search of pasture. Some of us have their own baby to care for and living place nearby health post is not good or non existent either. Travelling long distance on foot in this hot and hard to reach areas is difficult and we are unable to perform as required unless some solution is given from concerned bodies… ( CHW-1 )

Direct none medical cost related Factors

… Due to the distance of the referral health facilities and lack of transport facilities presumptive TB cases have to pay money which they cannot afford for the transportation to health facilities for laboratory test. As we refer them based on signs and symptoms, sometimes laboratory tests turn out to be negative. In such cases, referred people complain that we caused them to incur unnecessary cost and this affects acceptance health education messages and referral…. ( CHW- 4 )

Referral Health Facilities related Factors

… Referral health facility to which we refer has its own problem. Sometimes, the referral health facilities are not provided the requires services for various reasons, some which are lack of responsible health worker and lack laboratory supplies. Even when available, the laboratory result turn around time is not short enough and people coming from far villages can not wait and may need a second day return. This incurs additional cost to the patients and discourage them affecting health care seeking… (CHW – 10)