Process Evaluation of Health System Responsiveness Level and Associated Factors Among Mothers Gave Birth at Obstetric Ward in a Tertiary Hospital, Southwest of Ethiopia: Mixed Study Methods

Figures & data

Figure 1 Newly developed Conceptual Framework for delivery service Responsiveness.

Table 1 Judgment Matrix Analysis of Resource Availability in Obstetrics Ward of Jimma Medical Center, Jimma, Ethiopia

Indicators	E	O	W	S	A	JC
Number of health care provider in labor ward	61	46	10	7.5	72	Good
Number of health care provider in maternity operation room	27	20	10	7.4	74	Good
Number of health care provider in maternity ward	24	22	10	9.2	92	Excellent
Number of operation theatre tables	2	2	9	9.0	100	Excellent
Number of delivery coaches in delivery unit	5	5	9	9.0	100	Excellent
Number of delivery sets in delivery unit	12	12	9	9.0	100	Excellent
Number of caesarean sections set in maternity operation room	03	03	9	9.0	100	Excellent
Number of laparotomies set in maternity operation room	02	02	9	9.0	100	Excellent
Number of CEmONC guideline in delivery unit	01	0	5	0.0	0	Poor
Percentage of equipment must be available 24 hours and functional in delivery unit	35	29	10	8.3	83	Very good
Percentages of emergency drugs must be available 24 hours in delivery unit cabinet	15	11	10	7.3	73	Good
Overall resources availability			100	84.8	84.8	Very good

Notes: S = (W×O)/E, A = (S/W). Excellent = >90%, very good = > 81–90%, good = > 71–80%, Fair = > 60–70, poor = < 60.

Abbreviations: E, Expected; W, weights; O, observed; S, score; A, achievement (%); JC, judgment criteria.

Table 2 Socio-Demographic and Family Income Characteristics of Participants in the Evaluation of Responsiveness in Obstetrics Ward of JMC, Jimma, Ethiopia

Variables	Frequency (N = 422)	Percent
Age
16–20	1	0.2
21–25	117	27.7
26–30	193	45.7
31 −35	92	21.8
36–40	19	4.5
Religion
Muslim	223	52.8
Orthodox	118	28.0
Protestant	80	19.0
Catholic	1	0.2
Ethnicity
Oromo	252	59.7
Amhara	64	15.2
Gurage	55	13.0
Kafa	30	7.1
Dawro	10	2.4
Others	11	2.6
Residency
City	178	42.2
Partial rural	153	36.3
Rural	91	21.6
Educational level
Not able to read and write	39	9.2
Has informal education	13	3.1
Attended Primary school	140	33.2
Attend secondary school	114	27.0
Attend college and above	116	27.5
Occupation
Government employee	99	23.5
Private employee	40	9.5
Merchant	76	18.0
Housewife	183	43.4
Farmer	24	5.6
Family size
2 −4	290	68.7
5	75	17.8
≥6	57	13.5
Average family monthly income in ETB
601–1650	33	7.8
1651–3200	168	39.8
3201–5250	86	20.4
5251–7800	31	7.3
7801–10,900	61	14.5
≥10,901	43	10.2

Note: N = total number /sample size.

Abbreviation: ETB, Ethiopian birr.

Figure 2 Study participants’ mode of delivery with their age category in evaluation of responsiveness of delivery service in JMC, Jimma, Ethiopia.

Abbreviations: SVD, spontaneous vaginal delivery; C/s, cesarean section.

Table 3 Health System Responsiveness Scores in Obstetrics Ward JMC, Jimma (N = 422)

Sub Dimensions	Description of Sub Dimensions	Categories
		Poor, n (%)	Good, n (%)
Dignity	Treated with respect	68(16.1)	354(83.9)
	Kept safe from communicable diseases	120(28.4)	302(71.6)
	Encouraged to discuss concerns freely	124(29.4)	298(70.6)
	Encouraged to ask about diseases, treatment and care	131(31)	291(69)
	Respected to desire of privacy during examination	28(34.6)	276(65.4)
	Average	94.2(27.9)	304.2(72.1)
Autonomy	Provided information on treatment option	126(29.9)	296(70.1)
	Health care provider ask consent before any procedure	151(35.8)	271(64.2)
	Get consulted on preference over alternative treatment	136(32.3)	286(67.8)
	Get periodic updates on health status and progress	148(35)	274(64.9)
	Average	140.3(33.3)	225.4(66.8)
Confidentiality	Confidentiality protected during consultation	144(34.1)	278(65.9)
	Having conversation where others cannot hear	124(29.7)	297(70.4)
	Getting consultation where others cannot see	104(24.6)	318(75.4)
	Confidentiality of information provided is kept	108(25.6)	314(74.4)
	Confidentiality of medical records is kept	124(29.3)	298(70.7)
	Average	120.8(28.7)	244.4(71.4)
Communication	Provision of clear explanation on delivery service	135(32)	287(68)
	Listening to clients carefully	125(29.7)	297(70.4)
	Points are explained and clients understand easily	125(29.6)	297(70.4)
	Clients get opportunity of asking questions	131(31)	291(69)
	Average	129(24.4)	293(69.45)
Prompt attention	Get service as quick as they want	138(32.7)	284(67.3)
	Not spending unnecessary long time waiting to get service	110(26)	312(73.9)
	Length of time spent waiting for consultation is reasonable	132(31.3)	290(68.7)
	Average	126.7(30)	295.3(70)
Social support	Get opportunity of visitors daily	121(28.7)	301(71.3)
	Get opportunity of personal need care by friend or family	136(32.2)	286(67.8)
	Get opportunity of religious support from religious leader	134(31.8)	288(68.3)
	Average	130(31)	292.7(69)
Choice	Can choose health care provider in the unit	130(30.8)	292(69.2)
	Get opportunity to see specialist at time of want	140(33.2)	282(66.8)
	Average	135(32)	287(68)
Basic amenities	The unit is clean	14(4)	405(96)
	Building of the unit is maintained	25(5.9)	397(94.1)
	Furniture in the unit is adequate	180(42.6)	242(57.4)
	The food in the unit is nutritious and edible	208(49.3)	214(50.7)
	Clean water in the unit is accessible	212(50.2)	210(49.7)
	The toilet in the unit is clean	106(25.1)	316(74.9)
	The shower service in the room is accessible	225(53.3)	197(46.7)
	The linen in the unit is clean	182(43.2)	240(56.8)
	Average	144(34.2)	277.6(65.8)

Abbreviation: n(%), number(percent).

Table 4 Judgment Matrix Analysis of Responsiveness in Delivery Service of Jimma Medical Center, Jimma (N = 422)

Indicators	E	O	W	S	A	JC
Proportion of mothers who respond the healthcare giver is kind and respectful	422	360	5.5	4.7	85	Very good
Proportion of mothers who are respected to their desire for privacy during treatment and examinations	422	276	4.5	2.9	64	Fair
Proportion of women encouraged to discuss their concerns and needs freely, during the process of care	422	298	5	3.5	70	Fair
Proportion of mothers provided information on treatment option	422	296	5	3.5	70	Fair
Proportion of mothers get informed consent before any procedure	422	271	4	2.6	65	Fair
Proportion of mothers get periodic information on her status of health	422	274	3.5	2.3	66	Fair
Proportion of women getting conversation where others cannot hear	422	297	4	2.8	70	Fair
Proportion of women getting consultation where others cannot see	422	318	4	3	75	Good
Proportion of women getting confidentiality of her information	422	286	3.5	2.4	68.6	Fair
Proportion of women getting confidentiality of her medical records	422	298	4	2.8	70	Fair
Proportion of women get clear explanation about delivery service and other treatment	422	287	3.5	2.4	68.6	Fair
Proportion of women getting opportunity of asking question	422	291	4	2.8	70	Fair
Proportion of mothers getting careful listening from their health care provider	422	297	4.5	3.2	70	Fair
Proportion of mothers who understand things easily from health care providers explanation	422	297	4	2.8	70	Fair
Proportion of women getting service as quick as she wanted	422	284	4.5	3	67	Fair
Proportion of women not spending unnecessary long-time for getting consultations	422	312	5	3.7	74	Good
Proportion of women having opportunity of daily visitors	422	301	3.5	2.5	71	Good
Proportion of women getting opportunity of religious support from religious leader in their hospital stay	422	288	3.5	2.4	68.6	Fair
Proportion of mothers who can choose health care provider in delivery services	422	292	3.5	2.4	69	Fair
Proportion of mothers getting opportunity to see specialist at time they want	422	282	3.5	2.3	66	Fair
Proportion of women responding the unit is clean	422	405	5	4.8	96	Excellent
Proportion of women responding that the toilet is clean	422	316	4	3	75	Good
Proportion of women responding that clean water is access able in the unit	422	210	4	1.9	47	Poor
Proportion of women getting shower service in the unit at time they want	422	197	4.5	2	44	Poor
Overall responsiveness			100	69.7	69.7	Fair

Notes: S = (W×O)/E, A = (S/W), Excellent = JC>90%, very good = JC > 81–90%, good = JC> 71–80%, Fair = JC > 60–70, poor = JC <60.

Abbreviations: E, Expected; W, weights; O, observed; S, score; A, achievement (%); JC, judgment criteria.

Table 5 Determinant Factors of HSR at Obstetric Ward of JMC

Variables	β	t	p	Lower Boundary	Upper Boundary
(Constant)	89.8	18.4	0.000	80.3	99.39
Age of respondent	−0.314	−1.80	0.072	−0.66	0.03
Educational level
Elementary education	1	1	1	1	1
Not attend formal education	5.2	2.01	0.039*	0.27	10.13
Has informal education	−1.7	−0.43	0.667	−9.38	6.01
Grade 9–12	−0.9	−0.51	0.608	−4.42	2.59
College and above	−8.6	−3.50	0.001**	−13.54	−3.74
Residency
City	1	1	1	1	1
Out of city	−1.3	−0.87	0.384	−4.27	1.65
Rural	−2.0	−1.1	0.276	−5.72	1.64
Place previous delivery
Home delivery	1	1	1	1	1
Health center	−3.8	−2.3	0.021*	−7.07	−0.59
Private hospital	−4.0	−0.42	0.676	−22.75	14.77
Current mode of delivery
SVD with epitome	0.40	0.23	0.820	−2.95	3.72
Instrumental delivery	−7.2	−2.0	0.048*	−14.350	−0.068
Cesarean delivery	−4.3	−2.51	0.012*	−7.625	−0.935
Occupation
Housewife	1	1	1	1	1
Government employee	−4.4	−1.90	0.065	−9.003	0.271
Private	−3.7	−1.50	0.138	−8.509	1.186
Merchant	−10.0	−5.2	0.000**	−13.758	−6.242
Farmer	−4.2	−1.40	0.162	−10.171	1.706

Notes: *Significant association at p <0.05, **Significant at p<0.01.

Abbreviation: SVD, spontaneous vaginal delivery.

Table 6 Overall Judgment Matrix Analysis of Evaluation of Responsiveness of Delivery Service in Jimma Medical Center

Dimensions	Number of Indicators	Weight Given	Observed value	Achievements in %	Standardized Judgment Criteria
Availability	11	40	33.8	84.5	Very good
Health system Responsiveness	24	60	41.8	69.7	Fair
Overall HSR evaluation	35	100	75.6	75.6	Good

Notes: Key = health system responsiveness, If achievements:> = 90% = excellent, 81–90% = very good, 71–80% = good, 60–70% = fair and < = 60%= poor, % = percent.