Background: The Ethiopian health care system since 2005 has encouraged safe enhanced obstetrical care. However, hospital delivery has remained expensive for poor households due to hidden costs. Hidden costs are the costs that are not accounted for in direct hospital costs. The aim of this study was to estimate the hidden costs of institutional delivery and to identify its associated factors. Methods: A health facility–based cross-sectional study was conducted in the Bale zone from August 13 to September 2, 2018. Exit interviews were conducted among women who gave birth at the selected hospitals. A total of 390 women from 1 referral hospital and 2 general hospitals were included into the study. Systematic sampling technique was used to select study participants. Multiple linear regression analysis was done to identify the predictors of the hidden cost of institutional delivery. Result: The median hidden cost of institutional delivery was 877.5 ETB (32.03 USD). The median of the direct medical cost of normal delivery was 280 ETB (10.21 USD) while the direct nonmedical cost was 230 ETB (8.40 USD). For cesarean section, the median direct medical cost was 292 ETB (10.66 USD) while indirect costs were 591 ETB (21.60 USD). For forceps delivery, the direct medical cost was 362 ETB (13.21 USD) while the direct medical cost was 360 (13.14 USD). Distance of household from the hospital (β = 0.165), length of stay at the hospital (β = 0.050), mode of delivery (β = −0.067), and family monthly income (β = 0.201) were the explanatory variables significantly associated with the hidden cost. Conclusion: This study showed hidden cost of facility-based delivery was high. Distance, length of stay, income, and mode of delivery were the predictor of hidden cost. Ethiopian health care system should consider the hidden costs for pregnant women and their families.

BACKGROUND: In response to the 2005 World Health Assembly, many low income countries developed different healthcare financing mechanisms with risk pooling stategy to ensure universal coverage of health services. Accordingly, service availability and readiness of the health system to bear the responsibility of providing service have critical importance. The objective of this study was to assess service availability and readiness of health centers and primary hospitals to bear the responsibility of providing service for the members of health insurance schemes. METHODS AND MATERIALS: A facility based cross sectional study design with quantitative data collection methods was employed. Of the total 18 districts in Jimma Zone, 6(33.3%) districts were selected randomly. In the selected districts, there were 21 functional public health facilities (health centers and primary hospitals) which were included in the study. Data were collected by interviewer administered questionnaire. Descriptive statistics were calculated by using SPSS version 20.0. Prior to data collection, ethical clearance was obtained. RESULTS: Among the total 21 public health facilities surveyed, only 38.1% had all the categories of health professionals as compared to the national standards. The majority, 85.2%, of the facilities fulfilled the criteria for basic equipment, but 47.7% of the facilities did not fulfill the criteria for infection prevention supplies. Moreover, only two facilities fulfilled the criteria for laboratory services, and 95.2% of the facilities had no units/departmenst to coordinate the health insurance schemes. CONCLUSIONS: More than nine out of ten facilities did not fulfill the criteria for providing healthcare services for insurance beneficiaries and are not ready to provide general services according to the standard. Hence, policy makers and implementers should devise strategies to fill the identified gaps for successful and sustainable implementation of the proposed insurance scheme.

BACKGROUND: Access to and use of electronic information sources for clinical decision is the key to the attainment of health related sustainable goals. Therefore, this study was to assess Electronic Information Sources (EIS) access and use for healthcare service among hospitals of Western Oromia, Ethiopia, 2013. MATERIALS AND METHODS: A descriptive study design with quantitative and qualitative data collection methods was employed. Study subjects were selected by using simple random sampling technique. Quantitative data were entered and analyzed using SPSS version 16.0. Moreover, multiple logistic regression was fitted to identify independent predictors, and qualitative data were transcribed and analyzed thematically. RESULTS: A total of 590 health professionals were participated in the study with response rate of 95%. Forty-two percent of health professionals had used Electronic Information Sources (EIS). Out of them, more than half used to get latest health information. About three-fourth of health professionals had no formal training on how to use EIS. Moreover, there is a significant association between use of electronic information source and information literacy training, computer literacy level, access to internet connection and access to computers. CONCLUSIONS: In this study, it was determined that more than half of health professionals in the study area were not using EIS. Information literacy training, self-stated computer literacy level, access to internet connection and access to computers with in hospitals were found to be statistically significant factors affecting use of EIS.

Background: The Ethiopian Health Management Information System (HMIS) has been implemented since 2008 to improve the provision of health services, and ultimately, to improve health status of the population. Currently, information revolution is one of the transformation agenda in Ethiopia. Ironically, as in many low-income countries, lack of reliable data and grossly inadequate appreciation and use of available information for planning and management of health services were also true for the HMIS of Ethiopia. This, therefore, to assess the level of implementation HMIS program and utilization of data generated in governmental hospitals of western Oromia, Ethiopia. Methods and Material: The study was conducted in seven randomly selected Western Oromia Hospitals. A descriptive facility based cross-sectional study design with quantitative and qualitative data collection method was employed. The final sample size was calculated to be 620. The samples were selected by simple random sampling technique. The collected data was checked for any inconsistencies and analyzed by fitting multivariate logistic regression in SPSS version 17.0 statistical package. Result: Of the total 620 sampled population, 569 participated with an overall response rate of 91.8%. Of the total respondents, 504 (88.6%) were ever implemented HMIS tools to collect patients data in their respective hospital. Of which, only 85 (16.9%) perceived that they regularly analyze the collected data into meaningful information. Despite the inspiring message by H. E. Dr. Kesetebirhan Admasu former Minister, Federal Ministry of Health, Ethiopia "….health information is much more than collecting figures. Data have no value in themselves; value and relevance come after data management and analysis…the process whereby data are transformed into information and knowledge for action." In this study, only 221 (43.8%) reported they used HMIS generated information for a different actions in their respective hospitals. This study revealed that the major challenges for consistent implementation and use of HMIS were incomplete data filling 174 (34.5%) followed by a shortage of trained human power 158 (31.3%) in HMIS. Furthermore, there was statistically significant association between consistent implementation of HMIS program with presence of HMIS reporting format, regular monitoring and evaluation, trained staffs and having regular feedback. Conclusions: In this study, more than three-fourths of participants perceived they were ever implemented HMIS to generate information. But, less than half of participants reported they used the output of HMIS generated information for reporting, planning and decision making at local level.

BackgroundQuality of service provision in health facilities is fundamental to ensure effective care. However, women’s actual experience of care is often neglected.ObjectiveTo assess perceived quality of institutional delivery services and associated factors among women who delivered in public health facilities of Southwest Ethiopia.MethodCommunity based cross-sectional study was conducted in three districts of Jimma zone, Southwestern Ethiopia, from February 29 to March 20, 2016. A total of 423 mothers who delivered in public health facilities during the last 12 months were selected to participate in the study. Study participants were identified using simple random sampling procedure. Principal component analysis was used to generate scores for three sub-dimensions of perceived quality. Multiple linear regression analysis was performed to identify predictors of these sub-dimensions.ResultsPerceived quality of institutional delivery services was measured with three dimensions: perceived interpersonal interaction, health care delivery and health facility/structure. We found that perceived quality of interpersonal interaction was negatively affected by educational level (read and write) (β: -0.331, 95% CI: -0.523, -0.140), urban residence (β: -0.485, 95% CI: -0.696, -0.275), antenatal care (less than three visits) (β: -0.238, 95% CI: -0.419,-0.056) and delivery service attended by male provider (β: -1.286, 95% CI: -1.463,-1.109). Perceived quality of health care delivery was negatively associated with still birth (β: -0.642, 95% CI: -1.092,-0.193) and delivery services attended by male provider (β: -0.689, 95% CI: -0.907,-0.472). Urban residence (β: -0.260, 95% CI: -0.515,-0.005), and antenatal care (less than three visits) (β: -0.394, 95% CI: -0.628,-0.161) were negatively associated with perceived quality of health facility/structure.ConclusionOverall, the perceived quality of institutional delivery services was low. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.