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Organizational Factors Improving Maternal and Newborn Healthcare Quality: Evidence from Ethiopian Health Facilities

Article scientifique 2025 Autre

Résumé

Abstract Background Poor quality maternal and neonatal healthcare continues to contribute to preventable deaths and long-term disabilities in low-resource settings. Organizational factors within health facilities influence the implementation and uptake of evidence-based interventions, affecting health system performance and policy outcomes. Objective To identify organizational factors that improve the quality of maternal and neonatal healthcare services and examine their implications for evidence-informed decision-making in Ethiopian health facilities. Methods A facility-based pre–post evaluation was conducted across 131 health facilities in three regions of Ethiopia, implementing a phased package of quality improvement interventions. Mixed-effects Poisson regression was used to assess organizational predictors of improvement in clinical bundles and maternal and neonatal health (MNH) quality indicators. Results Improvements were observed in at least one clinical bundle in 103 (78.6%) facilities, and in MNH quality indicators in 117 (89.3%) facilities. Significant organizational predictors for clinical bundle improvements included teamwork (IRR = 1.87; 95% CI 1.06–3.29), regular client satisfaction surveys (IRR = 1.27; 95% CI 1.12–1.44), and the presence of a quality structure with clear terms of reference (IRR = 1.34; 95% CI 1.23–1.47). Facilities implementing all three interventions demonstrated the strongest combined effect (IRR = 3.55; 95% CI 2.53–5.00). For MNH quality indicators, predictors included quality improvement knowledge (IRR = 1.34; 95% CI 1.08–1.67) and hospital-level facilities (IRR = 1.35; 95% CI 1.08–1.67), while resistance to change (IRR = 0.73; 95% CI 0.58–0.92) and staff turnover (IRR = 0.62; 95% CI 0.50–0.76) were negatively associated. Conclusion Teamwork, structured quality systems, and client feedback appear to support improvements in maternal and newborn care. Quality improvement knowledge and hospital-level facilities were associated with MNH quality indicators, while resistance to change and staff turnover showed negative associations. Considering these factors in health system planning may help inform policy, strengthen governance and contribute to better outcomes in low-resource settings.

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Kefale, A., Tamene, G., Alene, A., Adillo, M., Hailemariam, N., Kiflie, A. (2025). Organizational Factors Improving Maternal and Newborn Healthcare Quality: Evidence from Ethiopian Health Facilities. https://doi.org/10.1101/2025.10.22.25338601

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Auteur(s)

Abera Biadgo Kefale Gebremeskel Tamene Abebe Abrha Alene Mehiret Abate Adillo Nebiyou Hailemariam Abiyou Kiflie

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