Quality of institutional delivery case services at public health facilities in north-west Ethiopia

Abstract

Background: As demonstrated by the inadequate provision of quality childbirth care, the contribution of quality delivery care to the use of women's services in Ethiopia is very limited. The goal of this research was to analyse the quality of childbirth care at the public hospitals in Ethiopia, including the structure, process and outcome dimension based on the Donabedian quality framework and to propose client centre guidelines to enhance quality of childbirth care service in Ethiopia. Method:-The research employed a convergent parallel mixed-method design, collected data simultaneously though the data were analysed separately. To obtain data from 192 healthcare professionals and 793 mothers who delivered in the selected hospitals, the data is collected using standardised questionnaire and exit interviews. In addition, an interview guide was used to perform in-depth interviews to examine the experience of mothers, the healthcare providers, and attendants. Statistical Package for the Social Sciences [SPSS] version 23 was used to analyze the data. A logistic regression and hierarchical logistic regression model were used. An open version of Code 3.6.2.0 was used for qualitative data analysis. Using a thematic research approach, qualitative data were analysed by creating themes and categories. Finally, based on the key findings of the report, the literature review, the ideas of experts and the observation of the researcher, the guideline was developed. Result: - Overall, only one (12.5 %) hospital out of eight hospitals provided good quality of care by achieving 75% and above in the three quality measurement components. While in any of the three quality components, 3 (37.5 %) hospitals were not reached. In addition, 4(50 %) of eight hospitals achieved one (1/3) of the three quality components. The level of input was higher than the other elements of quality. Provider’s work experience and hospital type have a significant association for process quality components. Maternal education, income, transport ANC visit and process quality have a significant association for maternal satisfaction. These quantitative findings are supported by in-idepth interviews. Lack of working experience and service given by students in referral hospitals are major barriers to deliver quality childbirth care services. Conclusion: - the overall quality of institutional delivery service was poor especially referral hospitals. Therefore, maternal and child health programs should be targeted and institutional delivery service should be implemented based on the standards.