Table 5.

Examplary statements on classification of barriers to VHT role in preventing NCDs in communities

Structural Barriers	Exemplary Statements
Lack of VHT education on NCDs	Ppt#1-FGD4 “There is a lack of knowledge on the causes, signs and symptoms of NCDs amongst us VHTs, so it becomes a barrier in dealing with NCDs as one will be dealing with something we don’t know of.”
Lack of medical services, medications, equipment, personnel	Ppt#5-FGD2 “Sometimes, we refer people to the hospitals but they return without medications which affect our VHT work and also the community’s dealings with VHT workers.”
Lack of assistance/supervision from medical personnel	Ppt#3- FGD4 “Medical personnel are not monitoring or supervising VHTs.”
Functional barriers
Lack of transport to medical facilities	Ppt#5- FGD2 “Lack of equipment and means of transport (bicycle) affect our work, probably more in the rainy season.”
Community’s lack of money for medical services	Ppt#2- FGD1 “Due to lack of money, they (community) have no transport to reach the hospital and pay for the tests.”
Discouraging attitude of medical personnel towards community members	Ppt#11- FGD1 “Health workers scare off patients when the patients come in more than once if I as a VHT refer a patient to the hospital, the medical worker gives them medication. If the patient’s condition worsens, as a VHT, I encourage them to go back but the medical personnel complain that this particular patient would be depriving others from getting medication.”
Lack of monetary encouragement from organizations to aid VHT work	Ppt#2- FDG2 “Although we are not working for a salary, at least once in a while, we should be given something.”
Lack of VHT recognition by medical personnel	Ppt#11- FGD1 “It also hurts when I refer someone to the hospital with a reference letter and the medical officer throws out my reference letter.”
Community non-adherence to VHT recommendations	Ppt#7- FGD3 “We refer people to hospital and they don’t go. At one time, I gave transport to a client to go to the hospital but this person did not go. It hurts me as a VHT.”
Lack of VHT equipment/medication	Ppt#8- FGD3 “Lack of equipment such as BP machines, machines for testing diabetes. After having this equipment, people will come to me for help to get tested. With machines, they will trust the results and the information I give them; if I talk without proof or on assumption, they will be doubtful and ask for proof.”