Background: Despite substantial progress made towards the control and elimination neglected tropical diseases (NTDs) in Ethiopia using preventive chemotherapy (PC) for lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma, and soil-transmitted helminths, its implementation is facing challenges to achieve equitable coverage especially under mobile populations.  This study, therefore, aimed at exploring multiple stakeholders’ perspectives and experiences on barriers, facilitators, and potential solutions to equitable coverage of PC in a mobile nomadic setting of Southern Ethiopia.

Methods: This study was conducted in the South Omo zone in August 2019. Qualitative data collection methods involving key informant interviews (KIIs) and focus group discussions (FGDs) were used to collect data from a total of 27 KIIs and 16 FGDs in a nomadic community of Southern Ethiopia using a semi-structured tool. Data were analyzed using a thematic approach, supported by NVivo 11 software.

Results: This study revealed multiple barriers affecting equitable access and use of PC, and its facilitators and possible solutions were revealed by taking four dimensions (availability, accessibility, acceptability, and effective coverage) into consideration. The emerged barriers were lack of resource and infrastructure;  inadequate information, mobilization and community engagement,  lack of awareness, inappropriate scheduling of MDA, distribution of drugs at central point, mobile nature of nomadic communities, security challenges, low school attendance, misconception, misbelief, distrust of government, rumor and drugs’ side-effects, lack of community drug distributors’ (CDDs’) motivation, weak leadership and supportive system. On the other hand, the emerged facilitators were the provision of drugs at no-cost, partners' support, the presence of the religious and cultural organization, and decentralization of services. The possible suggested solutions were increasing partnership, improve supervision, engaging parents in mass drug administration (MDA), arrange a visiting schedule out of working hours, involve the village chief in training, intensify awareness creation, home-to-home visit, and plan mop-up activities.

Conclusions: There is a need of addressing barriers that affect efforts in equitable implementation of MDA to ensure no one is left behind from PC in nomadic settings of Southern Ethiopia. Most importantly, information, mobilization and community engagement, mobile nature of the nomadic community, and high level of low school attendance should take special consideration when MDA is planned in these settings.