Evaluating the implementation fidelity of basic emergency obstetrics and neonatal care services in Beyeda District, Northwest Ethiopia: a case study evaluation

TL;DR

This study evaluates how well emergency obstetric and neonatal care services are implemented in a district in Ethiopia, finding that they are delivered with medium fidelity.

Contribution

The study provides a detailed evaluation of BEmONC implementation fidelity in Beyeda District, Northwest Ethiopia, using a mixed-method case study design.

Findings

The overall implementation fidelity of BEmONC services was 74.5%, classified as medium fidelity.

Uterotonic drugs were not administered as per protocol, and healthcare providers showed insufficient respect to clients.

Women over 30, government employment, and four or more ANC visits were positively associated with service quality.

Abstract

Worldwide, nearly 830 women die from complications of pregnancy and childbirth daily. Ninety-nine per cent of these maternal deaths take place in low and middle-income countries. Basic Emergency Obstetric Care (BEmONC) is one method of reducing maternal mortality related to pregnancy and childbirth complications. However, the status of its implementation fidelity has not been investigated. Therefore, this study sought to evaluate the implementation fidelity of BEmONC services in Beyeda District, Northwest Ethiopia.

A single case study design with mixed method was employed from June 01 to July 30, 2022. 415 client exit interviews, 14 key informants’ interviews and 423 retrospective document reviews were conducted. Adherence, participant responsiveness and quality of delivery dimensions from Carroll's conceptual framework, with a total of 21 indicators were used in this evaluation. The overall implementation fidelity status of BEmONC service was judged based on the pre-seated judgmental criteria as; low, medium, and high fidelity.

The overall degree of implementation fidelity of the BEmONC services was 74.5%. Moreover, the implementation fidelity status of adherence, quality of delivery, and participant responsiveness dimensions were 74.7%, 77.2%, and 71.5% respectively. Uterotonic drugs were not administered as per the recommended protocol. Participants’ engagement towards the neonatal resuscitation service delivery was inadequate. Likewise, healthcare providers’ respect for the clients was not sufficient. Furthermore, women aged >30 years, being government employed and ANC visits four and above were variables positively associated with the quality of delivery of BEmONC services.

The overall implementation fidelity of the BEmONC services was judged as implemented in medium fidelity. Moreover, the adherence, participant responsiveness and quality of delivery dimensions were found to be implemented in medium fidelity. Therefore, public health sectors at all levels should strive to enhance the implementation fidelity of BEmONC services. Moreover, healthcare providers should adhere to the BEmONC implementation protocol guideline during service delivery. Healthcare managers should facilitate a continuous awareness creation for mothers regarding the merit of neonatal resuscitation for neonatal complications. Furthermore, healthcare providers should give due respect to mothers while delivering the services.

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