Joseph M. Zulu - Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia
Patricia Maritim - Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia
Adam Silumbwe - Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia
Hikabasa Halwiindi - Department of Community and Family Medicine, School of Public Health, The University of Zambia, Lusaka, Zambia
Patricia Mubita - Department of Environmental Health, School of Public Health, The University of Zambia, Lusaka, Zambia
George Sichone - Participatory Research and Innovations Management (PRIM), Lusaka, Zambia
Chileshe H. Mpandamabula - Rigor Data Research, Consultancy Firm, Lusaka, Zambia
Frank Shamilimo - Ministry of Health, Lusaka, Zambia
Charles Michelo - Department of Epidemiology and Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia

Background  Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHSs) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia. Methods  Qualitative data was collected through in-depth interviews (IDIs) and focus group discussions (FGDs) (n = ۴۵) in February ۲۰۲۰ in Luangwa District. Thirty-one IDIs were conducted with hydrocele patients, community health workers (CHWs), health workers, traditional leaders and traditional healers. Two FGDs were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach. Results  The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries. Conclusion  Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.

Trust, Community Health Systems, Hydrocele, Morbidity Management, Disability Prevention, Zambia