Quality of Antenatal Care Service in Public Health Facilities in Southern Ethiopia: Retrospective Study

The provision of quality service demands continuous monitoring and evaluation of ongoing service provision and improving organizational processes. Hence, the aims of this study were to assess facility readiness to provide quality of antenatal care and quality of antenatal care in public health facilities in southern Ethiopia.

A health facility-based cross-sectional and retrospective studies were done in 2018. Multi-stage sampling was used to select 131 facilities of different levels and 2237 records. To assess the quality of ANC, all three dimensions (number of visits, early initiation and services provided) were considered. Factors associated with getting ANC components were assessed by using multi-level mixed effects linear regression.

From the total health facilities assessed, only 47.3% had at least one HIV test kit, 30.5% had iron, 23.7% folic acid, and 51.9% had iron and folic acid combined. From hospitals and health centers, 77.1% had syphilis testing kits, and 34.3% could perform hemoglobin level tests. Of 1222 records with gestational period, only 15.5% started ANC at or before 16 weeks of gestation, and only 2.7% started at or before 12 weeks. On average, women in rural areas received 2.5% points lower ANC components than those in urban areas (p = 0.04). Compared to women attending at hospitals, women attending at health centers receive 5% fewer ANC components (p = 0.001) while those attending at health post receive 20% lower (p < 0.001) ANC components.

The readiness of facilities to provide quality ANC was suboptimal, and clients' medical records demonstrated poor performance in all programmatic quality indicators. Women living in rural areas, women attending health centers, and health posts receive lower ANC components. Close monitoring of facility readiness and supporting service provision is vital to ensure the quality of the service.