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As a country with significant resource constraints, a fair and efficient health priority setting should be at the cornerstone of Ethiopia’s commitment to attain universal health coverage by 2035. This paper draws on the current national strategies including the national essential health service package to explore the criteria and processes used to set the existing national health sector priorities. Additionally, it reviews Ethiopia’s experience in comparison with the multi-criteria decision analysis proposed by Baltussen et al. Finally, the paper highlights the importance of strengthening country-led efforts and investing in human capital to shape priority setting in a developing country context.

This study aims to explore the effects of voluntary family planning (FP) utilization on food security in selected districts of Ethiopia. Quantitative research methods were used to conduct a community-based study among a sample of 737 women of reproductive age. The data were analyzed using a hierarchical logistic regression constructed in three models. The findings showed 579 (78.2%) were using FP at the time of the survey. According to the household-level food insecurity access scale, 55.2% of households experienced food insecurity. The likelihood of food security was lower by 64% for women who used FP for less than 21 months (AOR = 0.64: 95%CI: 0.42–0.99) in comparison to mothers who used FP for more than 21 months. Households having positive adaptive behaviors were three times more likely (AOR = 3.60: 95%CI 2.07–6.26) to have food security in comparison to those not having positive adaptive behaviors. This study also revealed that almost half of the mothers (AOR: 0.51: 95%CI: 0.33–0.80) who reported being influenced by other family members to use FP had food security, in comparison to their counterparts. Age, duration of FP use, positive adaptive behaviors, and influence by significant others were found to be independent predictors of food security in the study areas. Culturally sensitive strategies need to be considered to expand awareness and dispel misconceptions that lead to hesitancy around FP utilization. Design strategies should take into account households’ resilience in adaptive skills during shocks, natural disasters, or pandemics which will be invaluable for food security.

The current healthcare system’s efforts to reduce the spread of COVID-19 in Ethiopia and limit its effects on human lives are being hampered by hesitancy toward the COVID-19 vaccine. The aim of this study was to assess the knowledge levels, attitudes, and prevention practices of COVID-19, in the context of the level of vaccine hesitancy with other associated factors in Ethiopia. A community-based cross-sectional design with mixed-method data sources was employed. It comprised 1361 study participants for the quantitative survey, with randomly selected study participants from the studied community. This was triangulated by a purposively selected sample of 47 key informant interviews and 12 focus group discussions. The study showed that 53.9%, 55.3%, and 44.5% of participants had comprehensive knowledge, attitudes, and practices regarding COVID-19 prevention and control, respectively. Similarly, 53.9% and 47.1% of study participants had adequate knowledge and favorable attitudes toward the COVID-19 vaccine. Only 29.0% of the total survey participants had been vaccinated with at least one dose of vaccine. Of the total study participants, 64.4% were hesitant about receiving the COVID-19 vaccination. The most frequently reported reasons were a lack of trust in the vaccine (21%), doubts regarding the long-term side effects (18.1%), and refusal on religious grounds (13.6%). After adjusting for other confounding factors, geographical living arrangements, the practices of COVID-19 prevention methods, attitudes about the vaccine, vaccination status, perceived community benefit, perceived barriers toward vaccination, and self-efficacy about receiving the vaccine were significantly associated with vaccine hesitancy. Therefore, to improve vaccine coverage and reduce this high level of hesitancy, there should be specifically designed, culturally tailored health education materials and a high level of engagement from politicians, religious leaders, and other community members.

Background In collaboration with its partners, the Ethiopian government has been implementing standard Emergency Obstetric and Neonatal Care Services (CEmONC) since 2010. However, limited studies documented the lessons learned from such programs on the availability of CEmONC signal functions. This study investigated the availability of CEmONC signal functions and described lessons learned from Transform Health support in Developing Regional State in Ethiopia. Method At baseline, we conducted a cross-sectional study covering 15 public hospitals in four developing regions of Ethiopia (Somali, Afar, Beneshangul Gumz, and Gambella). Then, clinical mentorship was introduced in ten selected hospitals. This was followed by reviewing the clinical mentorship program report implemented in all regions. We used the tool adapted from an Averting Maternal Death and Disability tools to collect data through face-to-face interviews. We also reviewed maternal and neonatal records. We then descriptively analyzed the data and presented the findings using text, tables, and graphs. Result At baseline, six out of the 15 hospitals performed all the nine CEmONC signal functions, and one-third of the signal functions were performed in all hospitals. Cesarean Section service was available in eleven hospitals, while blood transfusion was available in ten hospitals. The least performed signal functions were blood transfusion, Cesarean Section, manual removal of placenta, removal of retained product of conceptus, and parenteral anticonvulsants. After implementing the clinical mentorship program, all CEmONC signal functions were available in all hospitals selected for the mentorship program except for Abala Hospital; the number of Cesarean Sections increased by 7.25% at the last quarter of 2021compared to the third quarter of 20,219; and the number of women referred for blood transfusions and further management of obstetric complications decreased by 96.67% at the last quarter of 2021 compared to the third quarter of 20,219. However, the number of women with post-cesarean Section surgical site infection, obstetric complications, facility maternal deaths, neonatal deaths, and stillbirths have not been changed. Conclusion The availability of CEmONC signal functions in the supported hospitals did not change the occurrence of maternal death and stillbirth. This indicates the need for investigating underlying and proximal factors that contributed to maternal death and stillbirth in the Developing Regional State of Ethiopia. In addition, there is also the need to assess the quality of the CEmONC services in the supported hospitals, institutionalize reviews, surveillance, and response mechanism for maternal and perinatal or neonatal deaths and near misses.

ObjectiveA dimensional shift in the health service delivery in the primary healthcare setting is required to raise maternal and child well-being. This study aimed to evaluate the effect of US Agency for International Development-funded obstetric ultrasound service on maternal and perinatal health outcomes at Ethiopia’s primary healthcare facilities.DesignWe employed a quasi-experimental study design.SettingThe study was conducted in primary health centres located in four regions of Ethiopia.ParticipantsWe used 2 years’ data of 1568 mothers from 13 intervention and 13 control primary health centres. Data were obtained from Vscan, antenatal care (ANC), delivery and postnatal care registers.InterventionUse of portable obstetric ultrasound service during pregnancy.Outcome measuresThe primary outcome variables include complete four ANC visits, referral during ANC, delivery in a health facility and having postnatal care and continuum of care. The secondary outcome variable was perinatal death.ResultsWith the kernel matching approach, we have found that having four or more ANC visits was decreased after the intervention (average treatment effect (ATE): −0.20; 95% CI: −0.23 to –0.09), and the rest of the indicators, including referral during ANC (ATE: 0.01; 95% CI: 0.15 to 0.34), institutional delivery (ATE: 0.24; 95% CI: 0.15 to 0.34) and postnatal care (ATE: 0.26; 95% CI: 0.10 to 0.37), were significantly raised because of the intervention. Similarly, we have found that perinatal death dropped considerably due to the intervention.ConclusionThe findings show a consistent increase in maternal health service use because of the introduction of obstetric ultrasound services at the primary health centre level. Furthermore, early detection of complications and following referral for specialty care were found to be high. The consistent rise in maternal health service use indicators calls for additional trial to test the effect of obstetric ultrasound service in other locations of the country. Furthermore, evaluating the predictive values, sensitivity and specificity of the obstetric ultrasound service is important.

BackgroundQuality improvement intervention (QI) was implemented from 2018 to 2021 in health facilities of developing regional states of Ethiopia. The main objective of this study was to examine the impact of QI interventions on facility readiness, service availability, quality and usage of health services in these regions.MethodsWe used district health information system data of 56 health facilities (HFs). We also used baseline and endline QI monitoring data from 28 HFs. Data were summarised using descriptive statistics and various tests. Regression analysis was employed to examine the impact of QI interventions on various outcomes.ResultThe QI intervention improved readiness of HFs, service availability and quality of maternal and child health service delivery. The mean availability of basic amenities increased from 1.89 to 2.89; HF cleanliness score increased from 4.43 to 5.96; family planning method availability increased from 4 to 5.75; score for emergency drugs at labour ward increased from 5.32 to 7.00; and the mean score for basic emergency obstetric and newborn care service availability increased from 5.68 to 6.75; intrauterine contraceptive devices removal service increased from 39.3% to 82.1%; and partograph use increased from 53.6% to 92.9%. HFs that use partograph for labour management increased by 39.3%. The QI intervention increased the quality of antenatal care by 29.3%, correct partograph use by 51.7% and correct active third-stage labour management, a 19.6% improvement from the baseline. The interventions also increased the service uptake of maternal health services, but not significantly associated with improvement in contraceptive service uptake.ConclusionThe integrated QI interventions in HFs could have an impact on facility readiness for service delivery, service accessibility and quality of service delivery. The effectiveness of the QI intervention should be evaluated using robust methods, and efforts to enhance contraceptive services through a QI approach requires further study.

BackgroundMobile Health Service (MHS) has been introduced as an alternative strategy to make health care services easily accessible in the Somali and Afar regions of Ethiopia to reach the mobile and hard-to-reach communities. However, the implementation status and effectiveness of the MHS program are not evaluated. Thus, this study aimed at exploring the dynamics and causes of poor health care utilization and implementation barriers and facilitators of MHS in the two regions, i.e. Somali and Afar regions of Ethiopia.MethodsThis study employed the Reachness, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to understand the health care services utilization in pastoralist settings. Furthermore, the study demonstrates the proposed MHS programme components and their challenges encountered during the implementation phase. The researchers collected data from eighteen key informants and eight focused group discussions (FGDs). The data were categorized, coded, entered, and analysed using the NVIVO version 11 software.ResultsThe results of this study revealed that health service coverage increased in the districts of Somali and Afar regions where MHS was implemented. According to the results of this study, MHS provision has also increased access to and utilization of health services in general and RMNCH services in particular. The study indicated that the MHS provided the following main health care services: family planning, nutrition supply, timely referral with free transportation, immunization, and treatment of malnourished children. The MHS programme is considered as an effective health service modality in pastoralist areas compared to other modalities. This is mainly because it provides health services following the footsteps of settlement and movement route of the community in search of grazing land and water. However, the study revealed that the MHS programme lacks guidelines for procedural adoption to implement it both at national and regional levels.ConclusionThe Mobile Health Service has been a useful and effective mechanism to deliver Reproductive, Maternal, Newborn and Child Health (RMNCH) and family planning (FP). Hence, it also facilitates nutrition services to hard-to-reach communities with limited or no health facilities in the targeted woredas of the Somali and Afar regions. Based on the findings, the study recommends the MHS needs to be institutionalized and owned by the government as an alternative health care service delivery modality.