Health system responsiveness and associated factors for delivery care in public health facilities, Dessie City Administration, South Wollo zone, Ethiopia: Cross-sectional study design

ObjectiveTo assess health system responsiveness (HSR) and associated factors for delivery care in public health facilities, Northeast Ethiopia. DesignInstitutional-based cross-sectional study. SettingSouth Wollo zone, Ethiopia. ParticipantsA total of 430 women who delivered within the study period from 1 June 2022 to 5 July 2022 were included for this analysis. OutcomeHSR. MethodsInstitutional-based cross-sectional study was conducted from 1 June 2022 to 5 July 2022 in nine public health facilities. The data were collected through semistructured interviewer administered questionnaire, reviewing delivery registration books and client charts. HSR for delivery care was assessed by eight domains based on WHO responsiveness assessment framework. Binary logistic regression analyses were employed to check the association of variables with HSR. An adjusted OR (AOR) with 95% CI was determined to show the strength of association, and a pResultsIn this study, the health system was responsive for 45.8% (95% CI 41.1% to 50.6%) of delivered mothers. The highest (74.2%) and lowest (45.8%) rated domains were dignity and basic amenity, respectively. In multivariable logistic regression analysis, caesarian delivery (AOR 3.67, 95% CI 1.91 to 7.06), obstetric complication in current pregnancy (AOR 0.45, 95% CI 0.23 to 0.85), referred during labour (AOR 0.36, 95% CI 0.18 to 0.69), birth within 17:30-8:30 hours (AOR 0.51, 95% CI 0.32 to 0.81) and good satisfaction (AOR 5.77, 95% CI 3.44 to 9.69) were statistically significant associated factors with HSR. ConclusionThe overall responsiveness of delivery care was low. Basic amenities, choice of provider and social support domains were least rated responsiveness domains. If health professionals give emphasis to mothers during spontaneous vaginal delivery, able to prevent obstetric complications, and if health facilities increase the number of professionals to duty time, handover, the referred mothers appropriately; having clean and attractive delivery wards will be important interventions to improve responsiveness for delivery care.

Automated summary

This study assessed health system responsiveness and associated factors for delivery care in public health facilities in Northeast Ethiopia. The overall responsiveness for delivery care was found to be low, with basic amenities, choice of provider, and social support being the least rated domains. Important interventions to improve responsiveness for delivery care include emphasizing mothers during spontaneous vaginal delivery, preventing obstetric complications, increasing the number of healthcare professionals, and ensuring appropriate referrals and clean delivery wards.