Structural Quality of Institutional Delivery Services at Public Health Facilities in North‐West Ethiopia: A Mixed Study

ABSTRACT Background and Aims Improving the quality of care is essential for enhancing utilization and compliance with interventions, ultimately reducing preventable mortality and morbidity among women and newborns during childbirth. However, little is known about the structural quality of institutional delivery services in Ethiopia, particularly in public health facilities in North‐West Ethiopia, which prompted this study. Methods A facility‐based cross‐sectional study with a qualitative approach was conducted in 2018 in North‐West Ethiopia (Amhara region) to assess the structural quality of delivery care services using the Donabedian model. Twenty‐four participants from eight randomly selected hospitals were chosen using purposive sampling, including hospital heads, maternity ward heads, laboratory technicians, pharmacists, and MHIS experts. Data were collected through facility inventory checklists, interviews, and observations. Items were coded as “yes” (1) or “no” (0), and facilities were categorized as “good quality” if they met ≥ 75% of resources. Thematic analysis was applied to qualitative data. Results Out of eight hospitals, only three (37.5%) scored ≥ 75% on structural quality, indicating excellent quality. Most hospitals lacked basic equipment for women's safety and privacy in delivery rooms. Only one hospital (12.5%) had adequate privacy screens, and just two (25%) had proper first‐stage beds. None had clean, ready beds for the next patient. Of 73 structural quality items, only 20 were met by all hospitals, and none met four specific items. Key barriers to quality care included poor infrastructure, a shortage of skilled providers, and insufficient experience among staff. Conclusion The structural quality of facility delivery care was poor, with most hospitals failing to meet national MNH standards. Issues included inadequate infrastructure, equipment, supplies, and skilled providers. Improving infrastructure, supplies, and staffing could enhance delivery care quality.