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Effective coverage of antenatal care service utilisation in Ethiopia using service provision assessment and
Ayal Debie1,2, Molla M Wassie1, Claire T Roberts1
1Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Background:
Globally, maternal deaths due to pregnancy and childbirth-related causes are still high. In response to the high maternal deaths, countries committed to achieving universal health coverage (UHC) by 2030. Effective coverage (EC) is a key metric for tracking the progress in the service coverage component of UHC.
Objectives:
This study aimed to assess the magnitude of EC of four or more antenatal care (ANC4+) in Ethiopia.
Design:
Ethiopian Mini-Demography and Health Survey (EMDHS) 2019 and Ethiopian Service Provision Assessment (ESPA) 2021-2022 cross-sectional surveys were used for analysis.
Methods:
EC of ANC4+ was estimated using the EMDHS 2019 with a weighted sample of 3617 women with their most recent live birth and ESPA 2021-2022 data with a sample of 659 health facilities. Accordingly, crude coverage (CC) was calculated from the EMDHS 2019, while a quality score was calculated from the ESPA 2021-2022 data. ArcGIS Pro software was used to display EC of ANC4+ across the administrative regions of Ethiopia.
Results:
In this study, the overall CC and EC of ANC4+ were 41.5% (95% CI: 38.9, 44.0) and 21.6% (95% CI: 20.0, 23.2), respectively with the lowest in Somali region and the highest in Addis Ababa. The overall facility-weighted quality of ANC was 52.1% (95% CI: 51.3, 52.8) with the lowest in Gambela and the highest in Benishangul-Gumuz region.
Conclusion:
This study revealed that the EC of ANC4+ was low due to low achievement in the CC of ANC4+ and quality of care with high regional disparities. Without urgent action, Ethiopia is unlikely to meet Sustainable Development Goal-3 (SDG-3) targets for maternal health. Therefore, administrative region-specific intervention strategies should be designed to improve community engagement, infrastructure, access, and quality of ANC in Ethiopia.
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