Speaker
Description
Background: Ethiopia has been in conflict complicating the delivery of essential services in the region. The health system responsiveness (HSR) of the healthcare facilities in conflict-affected areas remains unclear. Therefore, we assessed the health system responsiveness for intrapartum care in three conflict-affected districts of Amhara region, Ethiopia.
Methods: Community-based cross-sectional study among four hundred nineteen women who delivered recently were randomly selected form Wadla, Meket and Gynt districts. We used the eight domains of health system responsiveness to identify 30 measurement items for intrapartum care responsiveness; dignity (4), autonomy (4), confidentiality (2), communication (5), prompt attention (5), social support (3), choice (3), and basic amenities (4). A multiple linear regression model was fitted and in the final model, an unstandardized β coefficient with 95% Confidence Interval and a P-value of < 0.05 was used to declare significantly associated factors with health system responsiveness.
Results: The findings of our study revealed that the overall proportion of health system responsiveness in intrapartum care was 45.11% (95% CI: 40.38 - 49.92). The performance of responsiveness was the lowest in the autonomy, choice, and prompt attention domains at 35.5%, 49.4%, and 52.0%, respectively. Mothers living in urban areas (β=4.28; 95% CI: 2.06, 6.50), government employees (β=4.99; 95% CI: 0.51, 9.48), those mothers stayed at the health facilities before delivery/during conflict (β= 0.22; 95% CI: 0.09, 0.35), those who were satisfied with the health care service (β=0.69; 95% CI: 0.08, 1.30), and those who perceived the quality of health care favorable (β=0.96; 95% CI: 0.72, 1.19) were more likely to rate health system responsiveness positively. On the other hand, joint decision-making for health (β= -2.46; 95% CI: -4.81, - 0.10), and hospital delivery (β= -3.62; 95% CI: -5.60, -1.63) were found out be negatively associated with health system responsiveness.
Conclusion and recommendations: In the Amhara region of Ethiopia, over 50% of mothers living in areas affected by conflict reported that health systems were not responsive with respect to intrapartum care. Therefore, it is crucial for all stakeholders to work together to ensure that intrapartum care is responsive to conflict-affected areas, with a focus on providing women autonomy and choice.
