Low effective coverage of family planning and antenatal care services in Ethiopia

Yakob, Bereket; Gage, Anna; Nigatu, Tsinuel Girma; Hurlburt, Sarah; Hagos, Seifu; Dinsa, Girmaye; Bowser, Diana; Berman, Peter; Kruk, Margaret E; Tekle, Ephrem

doi:10.1093/intqhc/mzy251

Cited by 27 publications

(26 citation statements)

References 17 publications

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“…Studies informed by household survey data or direct observations have demonstrated lower effective coverage of ANC than crude service coverage in diverse settings such as Kenya [10], Ethiopia [37] and other countries in sub-Saharan Africa [22]. These studies have assessed the ‘quality’ component of effective coverage using a checklist of services provided during ANC, which would be conceptually equivalent to the outcome ‘coverage of atleast one screening of ANC intervention’ in our study.…”

Section: Discussionmentioning

confidence: 99%

Effective coverage of essential antenatal care interventions: A cross-sectional study of public primary healthcare clinics in the West Bank

et al. 2019

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Background The proportion of women attending four or more antenatal care (ANC) visits is widely used for monitoring, but provides limited information on quality of care. Effective coverage metrics, assessing if ANC interventions are completely delivered, can identify critical gaps in healthcare service delivery. We aimed to measure coverage of at least one screening and effective coverage of ANC interventions in the public health system in the West Bank, Palestine, and to explore associations between infrastructure-related and maternal sociodemographic variables and effective coverage. Methods We used data from paper-based clinical records of 1369 pregnant women attending ANC in 17 primary healthcare clinics. Infrastructure-related variables were derived from a 2014 national inventory assessment of clinics. Sample size calculations were made to detect effective coverage ranging 40–60% with a 2–3% margin of error, clinics were selected by probability sampling. We calculated inverse probability weighted percentages of: effective coverage of appropriate number and timing of screenings of ANC interventions; and coverage of at least one screening. Results Coverage of one screening and effective coverage of ANC interventions were notably different for screening for: hypertension (98% vs. 10%); fetal growth abnormalities (66% vs. 6%); anemia (93% vs. 14%); gestational diabetes (93% vs. 34%), and antenatal ultrasound (74% vs. 24%). Clinics with a laboratory and ultrasound generally performed better in terms of effective coverage, and maternal sociodemographic factors had no associations with effective coverage estimates. Only 13% of the women attended ANC visits according to the recommended national schedule, driving effective coverage down. Conclusion Indicators for ANC monitoring and their definitions can have important consequences for quantifying health system performance and identifying issues with care provision. To achieve more effective coverage in public primary care clinics in the West Bank, efforts should be made to improve care provision according to prescribed guidelines.

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Section: Discussionmentioning

confidence: 99%

Effective coverage of essential antenatal care interventions: A cross-sectional study of public primary healthcare clinics in the West Bank

et al. 2019

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“…Several prior studies have described poor levels of quality of care in Ethiopia and have investigated potential determinants of quality [ 2 – 4 , 6 , 37 – 40 ]. Studies have shown deficiencies in structural quality (lack of equipment, medicine, supplies and human resources) and provider knowledge, lack of adherence to standards of care, poor content of care, and moderate levels of patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…But despite impressive progress in improving health outcomes in the past decade, Ethiopia’s health care system continues to face important challenges. Wide deficits in quality for a range of health services have been documented, revealing poor adherence to evidence-based standards of care [ 2 – 6 ]. Improving the quality of primary care services is crucial to achieving the health-related sustainable development goals.…”

Section: Introductionmentioning

confidence: 99%

Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

Arsenault

Yakob

Tilahun

et al. 2021

BMC Health Serv Res

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Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality. Results Our analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits. Conclusions Health care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts.

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“…38,39 This could be explained by the poor quality of care provided in many of the health facilities as a result of failure of providers to adhere to guidelines and absence of required resources to deliver care. 40 The variations in geographic accessibility of health facilities across residence (urban-rural) can also highly affects maternal health service utilization in Ethiopia. 41 The role of culture and access to information should also be born in mind to fully understand the existing level of inequity.…”

Section: Discussionmentioning

confidence: 99%

<p>Inequities in the Uptake of Reproductive and Maternal Health Services in the Biggest Regional State of Ethiopia: Too Far from “Leaving No One Behind”</p>

Daka¹,

Woldie²,

Ergiba³

et al. 2020

CEOR

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Background: Despite improvement in the coverage of most maternal, newborn, and child health services, inequality in the uptake of services still remains the challenge of health systems in most developing countries. This study was conducted to examine the degree of inequities and potential predictors of inequity in reproductive and maternal health services utilization in the Oromia region, Ethiopia. Methods: The 2016 Ethiopian demographic and health survey data set was used. Utilization rate of four maternal health service categories (family planning, antenatal care, facility based delivery and postnatal care) was considered in the analysis. Equity in each of these indicators was assessed by residence (urban/rural), wealth index, and educational status. Inequality in service utilization was estimated using rate ratios, concentration curve, and concentration indices. Results: Overall data of 5701 women were used in this analysis. The concentration index to all of the maternal health service utilization indicators showed significance. The concentration index of family planning, antenatal care, facility based delivery, and postnatal care was 0.136 (95% CI=0.099-0.173), 0.106 (95% CI=0.035-0.177), 0.348 (95% CI=0.279-0.418), and 0.348 (95% CI=0.279-0.418), respectively. Maternal age and all of the three sociodemographic factors (residence, education, and wealth) showed inequitable distribution of maternal health service utilization in the Oromia region. The majority of women who were in the favored groups utilized the key reproductive and maternal health services. Conclusion: The utilization of maternal health services in the study area is grossly skewed to those who are well off, educated, and live in urban areas. Any action intended to improve utilization of maternal and child health services should aim to reduce the unnecessary and avoidable disparity demonstrated in our analysis. This of course demands multisectoral intervention to impact on the determinants.

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Low effective coverage of family planning and antenatal care services in Ethiopia

Cited by 27 publications

References 17 publications

Effective coverage of essential antenatal care interventions: A cross-sectional study of public primary healthcare clinics in the West Bank

Effective coverage of essential antenatal care interventions: A cross-sectional study of public primary healthcare clinics in the West Bank

Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

<p>Inequities in the Uptake of Reproductive and Maternal Health Services in the Biggest Regional State of Ethiopia: Too Far from “Leaving No One Behind”</p>

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