Background: Despite reports of universal access to and modest utilization of maternal and newborn health services in Ethiopia, mothers and newborns continue to die from preventable causes. Studies indicate this could be due to poor quality of care provided in health systems. Evidences show that high quality health care prevents more than half of all maternal deaths. In Ethiopia, there is limited knowledge surrounding the status of the quality of maternal and newborn health care in health facilities. This study aims to assess the quality of maternal and neonatal health care provision at the health facility level in four regions in Ethiopia.Methodology: This study employed a facility-based cross-sectional study design. It included 32 health facilities which were part of the facilities for prototyping maternal and neonatal health quality improvement interventions. Data was collected using a structured questionnaire, key informant interviews and record reviews. Data was entered in Microsoft Excel and exported to STATA for analysis. Descriptive analysis results are presented in texts, tables and graphs. Quality of maternal and neonatal health care was measured by input, process and outputs components. The components were developed by computing scores using standards used to measure the three components of the quality of maternal and neonatal health care.Result: The study was done in a total of 32 health facilities: 5 hospitals and 27 health centers in four regions. The study revealed that the average value of the quality of the maternal and neonatal health care input component among health facilities was 62%, while the quality of the process component was 43%. The quality of the maternal and neonatal health output component was 48%. According to the standard cut-off point for MNH quality of care, only 5 (15.6%), 3 (9.3%) and 3 (10.7%) of health facilities met the expected input, process and output maternal and neonatal health care quality standards, respectively.Conclusion: This study revealed that the majority of health facilities did not meet the national MNH quality of care standards. Focus should be directed towards improving the input, process and output standards of the maternal and neonatal health care quality, with the strongest focus on process improvement.

Background: Care bundles are a set of three to five evidence-informed practices which, when performed collectively and reliably, may improve health system performance and patient care. To date, many studies conducted to improve the quality of essential birth care practices (EBPs) have focused primarily on provider- level and have fallen short of the predicted impact on care quality, indicating that a systems approach is needed to improve the delivery of reliable quality care. This study evaluates the effectiveness of integrating the use of the World Health Organization Safe Childbirth Checklist (WHO-SCC) into a district-wide system improvement collaborative program designed to improve and sustain the delivery of EBPs as measured by "clinical bundle" adherence over-time.Methods: The WHO-SCC was introduced in the context of a district-wide Maternal and Newborn Health (MNH) collaborative quality of care improvement program in four agrarian Ethiopia regions. Three "clinical bundles" were created from the WHO-SCC: On Admission, Before Pushing, and Soon After Birth bundles. The outcome of each bundle was measured using all- or- none adherence. Adherence was assessed monthly by reviewing charts of live births.A time-series analysis was employed to assess the effectiveness of system-level interventions on clinical bundle adherence. STATA version 13.1 was used to analyze the trend of each bundle adherence overtime. Autocorrelation was checked to assess if the assumption of independence in observations collected overtime was valid. Prais-Winsten was used to minimize the effect of autocorrelation.Findings: Quality improvement interventions targeting the three clinical bundles resulted in improved adherence over time across the four regions. In Tigray region, adherence to “On Admission” bundle was increased monthly on average by B =1.39 (95% CI; 0.47 - 2.32; P<0.005).Similarly, adherence to the “Before Pushing” bundle in Southern Nations, Nationalities and People’s (SNNP) region increased monthly on average by B = 2.3 (95% CI; 0.89 - 3.74; P<0.005). Conclusion: Use of the WHO-SCC paired with a system-wide quality improvement approach improved and sustained quality of EBPs delivery. Further studies should be conducted to evaluate the impact on patient-level outcomes.

BackgroundDisrespect and abuse (D&A) during childbirth are major violations of human rights and often deter women from accessing skilled delivery in health facilities. In Ethiopia, D&A has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care (RMC) and decrease D&A in three districts in Ethiopia.MethodsAs part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel RMC training module with three core components: testimonial videos, didactic sessions on communication, and onsite coaching. As of February 2017, we implemented the RMC training in three districts within the regions of Oromia; Southern Nations, Nationalities, and People’s; and Tigray. Measures of births with privacy and a birth companion from a 27-month data from 17 health centers and three hospitals were analyzed using STATA version 13 for interrupted time series and a regression analysis was conducted to assess the significance of improvement. Facilitated discussions were conducted among health care providers to gauge the effectiveness of the videos. Facility level solutions applied to enhance RMC were documented. ResultsAn analysis of the effectiveness of integrating RMC using available programmatic data showed significant improvement following the RMC training, which was sustained beyond the project intervention (regression coefficients ranging from 0.18 to 0.77). Several local solutions were devised and implemented in the health facilities to improve the experience of care for mothers. Facilitated discussions with health care providers participating in the RMC training showed improved understanding of patients’ perspectives and the psychosocial needs of their clients. ConclusionThis study suggests that integrating the RMC training into the district-wide quality improvement (QI) collaborative is effective in improving RMC. Use of testimonial videos are especially helpful as they remind providers of the need to treat mothers with dignity and helps them reflect on potential root causes for this type of treatment and develop effective solutions.

Background: Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from accessing skilled delivery in health facilities. In Ethiopia, mistreatment has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care in Ethiopia. Methods: As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel respectful maternity care training module with three core components: testimonial videos, a skills-building session on communication, and onsite coaching. The respectful maternity care training was conducted in February 2017 in three districts within three regions of Ethiopia. Facility level solutions applied to enhance the experience of care for mothers as a result of the training module were documented. Safe Childbirth Checklist data measuring privacy maintained and birth companion offered during labor and delivery were collected over 27 months from 17 health centers and three hospitals in the three districts. Interrupted time series and a regression analysis were conducted to assess the significance of improvement. Results: Data analysis showed significant improvement in the percentage of births with two elements of respectful maternal care—privacy maintained and birth companionship offered—following the respectful maternity care training, which was sustained beyond the project intervention (regression coefficients ranging from 18% to 77% for births with privacy and with birth companion offered). About 23 local solutions were devised and implemented in the health facilities that improved the experience of care for mothers. Conclusion: This study suggests that integrating the respectful maternity care training into a district-wide quality improvement collaborative is effective in improving respectful maternity care. Use of a multi-pronged approach is especially helpful in enhancing respectful maternity care comprehensively. Testimonial videos helped providers to see their services from their clients’ perspective, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions.

Background: Mistreatment during childbirth are major violations of human rights and often deter women from accessing skilled delivery in health facilities. In Ethiopia, mistreatment has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care and decrease mistreatment in three districts in Ethiopia. Methods: As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel respectful maternity care training module with three core components: testimonial videos, didactic sessions on communication, and onsite coaching. As of February 2017, we implemented the respectful maternity care training in three districts within the regions of Oromia; Southern Nations, Nationalities, and People’s; and Tigray. Measures of births with privacy and a birth companion from a 27-month data from 17 health centers and three hospitals were analyzed using interrupted time series and a regression analysis was conducted to assess the significance of improvement. Facility level solutions applied to enhance privacy and birth companion were documented. Results: Analysis of the effectiveness of integrating respectful maternity care using available programmatic data showed significant improvement following the respectful maternity care training, which was sustained beyond the project intervention (regression coefficients ranging from 0.18 to 0.77). Several local solutions were devised and implemented in the health facilities to improve the experience of care for mothers. Conclusion: This study suggests that integrating the respectful maternity care training into the district-wide quality improvement collaborative is effective in improving respectful maternity care. Multi-pronged approach is especially helpful in enhancing respectful maternity care comprehensively. Use of testimonial videos helped providers to see their services from their clients’ perspective, the quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions.