Facility readiness and experience of women and health care providers in receiving and delivering obstetric care in comprehensive health posts in Ethiopia: a mixed method study.

Abstract

Background: Maternal mortality remains a critical public health issue in Ethiopia, with only half of births occurring in health facilities. To address this, the Health Extension Program (HEP) introduced comprehensive health posts (CHPs) to improve maternal and newborn health services in underserved areas. The CHPs are expected to provide essential health services to communities who live in villages that have limited access to a health center or Primary Hospital (more than one-hour walking distance). This study assessed the readiness of CHPs to deliver obstetric care and explored the experiences of women and healthcare providers.

Methods: A mixed-methods approach was used, combining quantitative assessments of eight CHPs using World Health Organization (WHO) service readiness tools and qualitative interviews with 22 postpartum women and 16 healthcare providers in agrarian and pastoral settings. Readiness indicators included staffing, availability of essential equipment, and service provision, while qualitative data focused on care experiences, respect, and interactions with providers.

Results: The CHPs had a mean readiness score of 50% for childbirth services, with agrarian settings scoring higher than pastoral ones. Staffing density averaged 4.3 health professionals per 5,000 population. While 63% of CHPs had access to water and electricity, power outages and water shortages significantly impacted service delivery. Women reported positive experiences, highlighting compassionate care and improved access due to proximity to CHPs. However, they noted infrastructure gaps, limited supplies, and training deficiencies. Healthcare providers identified frequent stockouts, staffing shortages and inadequate capacity-building opportunities as key challenges.

Conclusions: Enhancing CHPs' operational capacity is essential to improving maternal health outcomes in rural Ethiopia. Investments in infrastructure, training, and consistent supply chains are critical to address existing gaps and ensure sustainable progress in maternal and newborn care.