A strategy to improve quality of obstetric and newborn care in Ethiopian health centres

Abstract

Attaining the global Sustainable Development Goal (SDG) target to reduce the maternal mortality rate to 70 per 100000 live births by 2030 needs improvingnot only the coverage but also the quality of obstetric and newborn care. The aim of the study was to develop a strategy to improve the quality of obstetric and newborn care in Ethiopian health centres. The objectives of the study were to assess the quality of obstetric and newborn careand identify the barriers and efforts to improve it. The study was conducted from January 25 to December 31, 2021 in 50 health centres of Addis Ababa city. The study used a sequential explanatory mixed methods design. In the quantitative phase, face-to-faceinterviews were conducted with 500 women and 338 midwives using structured questionnaires. Labour and deliveryrecords of the 500 women were reviewed. Structured observation, review of registers,and interviewswith maternity unit heads were conducted at the 50 health centresusing a structured questionnaire. In the qualitative phase an in-depth interview was conducted with 33 midwives and health centre managers. The quantitative phase data was analysed using descriptive statistics and multilinear logistic regression. The qualitative phase data was analysed using the Colaizziseven-step process for qualitative data analysis. The study revealed that only a third of the 50health centreswere providing good quality care (a quality score≥75%). All the health centreshad the physical resources (100%) to deliver obstetric and newborn care. The majority of the health centreshad a system for actionable information (92%), functional referral (80%) and providingdignified care (80%). On the other hand, only a few of the health centresmet the quality threshold for effective communication (24%), evidence-based practice of routine obstetric and newborn care (36%),and availability of mechanismsto support and motivate skilled birth attendants (24%). None of the health centresmet the quality threshold for emotional support during labourand delivery. Obstetric care givers’high workloadand job dissatisfaction were barriers toquality care. Finally, astrategy to improve the quality of obstetric and newborn care was developed,informed bythe study.