BackgroundMaternal health remains a major public health problem in Ethiopia. Despite the government’s measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women.ObjectiveThe study aims to identify determinants that sustain home delivery in Ethiopia.MethodsA total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11.ResultsFindings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited availability of supplies and equipment were found to maintain the preference to deliver at home.ConclusionThe government’s endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of women deliver at home and this was found to be the preferred option. Thus, the current form of intervention needs to focus on factors that determine decisions to deliver at home and also focus on investing in improving service delivery at health facilities.

Background Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Even though Ethiopia has endorsed the implementation of ENC, as other many counties, it has been challenged. This study was conducted to measure the level of essential newborn care practice and identify health facility level attributes for consistent delivery of ENC services by health care providers. Methods This study employed a retrospective cross-sectional study design in 425 facilities. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p < 0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders. Results A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors—availability of essential obstetrics drugs in delivery rooms, high community score card (CSC) performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of consistent delivery of essential newborn care (CD-ENC) was consistent partograph use, recording an odds ratio of 2.66 (AOR = 2.66, 95%CI: 1.71, 4.13). Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 (AOR = 1.88, 95%CI: 1.15, 3.08) times higher odds of exhibiting consistent delivery of ENC. Conclusion The delivery of essential newborn care depends on both health provider and facility manager actions and availability of platforms to streamline relationships between the clients and health facility management.

Introduction: The USAID Transform: Primary Health Care project is working on preventing maternal and child deaths in Ethiopia. As part of its effort, the project is supporting the government in its endeavor in improving nutrition service coverage and quality. More than 90% of the communities are accessing nutrition and health services at health posts where trained health extension workers (HEWs) provide services. ‘Workload’ in the HEWs was identified as critical challenge and in response, a small scale task-shifting task-sharing initiative was tested in two selected health posts. Tasks related to monthly acute malnutrition screening, monthly GMP, and cooking demonstration were shifted completely from the HEWs to a voluntary community health workers. The tasks of tracing and linking of targeted children for VAS and deworming were also shared by the CHWs, while the actual provision of the drugs were done by the HEWs. This study focuses on the results of this initiative. Methodology: A quasi-experimental method with pretest-posttest design is used to measure the outcomes of the initiative. The findings of the house-to-house survey done after eight months of the implementation of the initiative are compared with that of the baseline. This is triangulated with the findings of record reviews and in-depth interviews. Result: A total of 243 (116 girls) and 219 (112 girls) under-five children were identified at the baseline and at the second round house-to-house surveys respectively. Monthly screening coverage for acute malnutrition has improved from 8% at baseline to 99%. The percentage of children supplemented with vitamin-A during the six months prior to the survey reached 97% from the baseline status of 23%. Growth monitoring and promotion (GMP) participation rate has also improved from 5–96%. Recounting and comparing the coverages reported by the health facilities from source document was not possible at baseline due to incomplete documentation. After the introduction of the initiative, the documentation has improved and the discrepancy between the reported, the recorded and the survey data for the three services narrowed down to a range of 1% difference for VAS, to 6% for acute malnutrition screening. Conclusion: Nutrition services in Ethiopia heavily depend on the productivity of the health extension program (HEP) which is currently struggling with several challenges with the workload being among the critical bottlenecks. The results of this study shows that coverage and quality of essential nutrition services can be improved if workload challenges are recognized and addressed through carefully designed task-shifting and task-sharing initiatives. The marked discrepancies among the reported, the recorded and the actual coverages shows that monitoring nutrition services through the routine information system could be misleading. Recommendations: Efforts to improve community nutrition services should recognize heavy workload in the HEP as a critical challenge. This initiative should be scaled up with continuous learning including on its impact on the productivity of HEWs and CHWs. Investigating and addressing nutrition data quality should also be among the top priorities as the current status is often seen to be unacceptable.

Background: Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Although a minimum package of proven interventions to reduce newborn mortality have been adopted, countries are still challenged by multiple system related problems. Methods: This study employed a retrospective cross-sectional study design and used program monitoring data collected from 425 facilities between October and December 2019. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p<0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders. Results: A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors - availability of essential obstetrics drugs in delivery rooms, high CSC performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of CD-ENC was consistent partograph use, recording an odds ratio of 2.66. Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 times higher odds of exhibiting consistent delivery of ENC. Conclusion: Health worker commitment to provide ENC is linked to the practices and platforms created by health facility management. Health facility managers should establish a platform or mechanism to enhance providers relationship with their clients as well as comprehensive tools to remind health workers’ responsibilities with regards to ENC. In addition, the health service managers should also consider availing the required supplies and drugs closer to the service delivery rooms and tables.