Quality antenatal care services delivery at health facilities of Ethiopia, assessment of the structure/input of care setting

Abstract

Background: According to the Donabedian model, the assessment for the quality of care includes three dimensions. These are structure, process, and outcome. Therefore, the present study aimed at assessing the structural quality of Antenatal care (ANC) service provision in Ethiopian health facilities. Methods: Data were obtained from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. The SARA was a cross-sectional facility-based assessment conducted to capture health facility service availability and readiness in Ethiopia. A total of 764 health facilities were sampled in the 9 regions and 2 city administrations of the country. The availability of equipment, supplies, medicine, health worker's training and availability of guidelines were assessed. Data were collected from October-December 2017. We run a multiple linear regression model to identify predictors of health facility readiness for Antenatal care service. The level of significance was determined at a p-value < 0.05. Result: Among the selected health facilities, 80.5% of them offered Antenatal care service. However, the availability of specific services was very low. The availability of tetanus toxoid vaccination, folic acid, iron supplementation, and monitoring of hypertension disorder was, 67.7, 65.6, 68.6, and 75.1%, respectively. The overall mean availability among the ten tracer items that are necessary to provide quality Antenatal care services was 50%. In the multiple linear regression model, health centers, health posts and clinics scored lower Antenatal care service readiness compared to hospitals. The overall readiness index score was lower for private health facilities (β = − 0.047, 95% CI: (− 0.1, − 0.004). The readiness score had no association with the facility settings (Urban/Rural) (p-value > 0.05). Facilities in six regions except Dire Dawa had (β = 0.067, 95% CI: (0.004, 0.129) lower readiness score than facilities in Tigray region (p-value < 0.015). Conclusion: This analysis provides evidence of the gaps in structural readiness of health facilities to provide quality Antenatal care services. Key and essential supplies for quality Antenatal care service provision were missed in many of the health facilities. Guaranteeing properly equipped and staffed facilities shall be a target to improve the quality of Antenatal care services provision.

Prevalence and Determinants of Readiness of Health Facilities for Quality Antenatal Care Services in Bangladesh

“…Nevertheless, the equipment (blood pressure apparatus) and drugs (iron or folic acid tablets) for ANC are now in a better position in terms of availability in Bangladesh than other proposed requirements. Findings related to the readiness of health facilities for quality ANC services are consistent with the studies in Nepal and Ethiopia that the health facilities did not meet the requirements set by WHO guidelines [8,17]. Again, another study conducted in India also measured the low quality of ANC services, although the study defined the quality of ANC services based on clinical quality, interpersonal quality of care and utilization of ANC measures [39].…”

“…The readiness index was created by WHO approach, where equal weights were given to each domain of indicators/ items and also to each item at each weighted domain for providing antenatal care services. The above six items are considered for each facility and summed up to generate weighted mean readiness score [8,28,30,31]. Finally, mean score was multiplied by 100 to obtain the results of readiness score in percentage.…”

“…Therefore, negative pregnancy outcomes can be impeded by identifying and treating maternal health compilations during pregnancy through ANC [2] . Better quality antenatal care can promote a woman to choose skilled care for herself and her child at and after birth of the child [5][6][7][8].…”

“…According to new guidelines, a minimum of eight ANC visits in the absence of complications is recommended throughout pregnancy period, which will be challenging for developing countries to achieve this target due to many barriers [15]. Moreover, in order to meet this challenge, health facilities need to be well prepared with trained staffs, medicines, equipment, and infrastructure [8]. The availability and readiness to offer the services are important determinants of health care service utilization [8].…”

“…Moreover, in order to meet this challenge, health facilities need to be well prepared with trained staffs, medicines, equipment, and infrastructure [8]. The availability and readiness to offer the services are important determinants of health care service utilization [8]. Increasing ANC utilization is essential to improve maternal and newborn health outcomes, but it fails to meet the targets of SDG 3 if quality ANC offered by health facilities is poor [16,17].…”