A total of 265 participants with a response rate of 100%, 309 patient and stock cards for document review, 13 key informant interviews, and 49 client-provider interaction observations had been included for this evaluation.
Availability
The hospital had a 24 hours electric power in Operation Theater room with backup generator, autoclaves, functional labor and maternity ward, latrine and blood bank. The hospital had two operational tables, six delivery couches, nine labor beds and fifty-seven maternity beds. The labor and maternity beds were not proportional with number of delivery cases in the hospital. Significant number of mothers were laboring on the chairs and gave birth on the floor due the shortage of delivery couch and laboring beds. There were a total of 294 health professionals at Gynecology and Obstetrics (Gyn/Obs) department in University of Gondar comprehensive specialized hospital. Of these, about 8.3%, 23.3%, 65.2%, and 3.2% were Gynecology and Obstetricians, Gynecology and Obstetrician resident students, midwives, and anesthetist nurses, respectively. Only 8.7% of the care providers were received CEmONC training and there was no specific radiology, medical laboratory and environmental professionals assigned for Gyn/Obs department alone. Trained human power is the key to deliver CEmONC service to users. Absence of clear, standardized selecting mechanism and regular availability of CEmONC training were the barriers of implementation in the hospital. The Current clinical practice is based on evidence-based medicine approach that needs continuous and an intensive training of health professionals to harmonize with up-to-date guidelines. Key informant interview revealed that all health care providers were not taking in service CEmONC training.
“Not only unavailability of regular comprehensive emergency obstetric service training; but there is also absence of clear and consistent process for selecting health professionals for CEmONC training. In addition, there is also problems of documentation and attaching of a letter stating that the health professions have been trained for CEmONC training with their personal profile, this gives another chance for the health professional to be trained for the second time. There are 165 midwifery professional staffs, but only 15 of them trained for CEmONC, this is scarcely surprising.” (29 years male midwife)
“It is obvious that there is continuous updating of guide lines thanks to advancement of science and research. It is difficult to fully believe that a mother should not die in childbirth without trained health care providers about CEmONC. I think it is better to train every health care provider to update their knowledge and skills as to fully deliver CEmONC service and to minimize the obstetric complications. Most health care providers including me did not take the pre-service and in-service CEmONC training.” (30 years male midwife)
“University of Gondar comprehensive specialized hospital has partnership with abroad country universities and few obstetricians were took short term trainings in those universities. Although there is training gaps especially for midwifery health professionals in this hospital, we have plan to use most of the working budget for obstetric care by trained the providers and to practice based on contentious health professional development approach to train the providers, to harmonize with up-to-date guide lines via refreshment trainings.” (a 33 years male hospital manager)
The resource inventory assessment indicates that the University of Gondar comprehensive specialized hospital had basic functional equipment and drugs needed for emergency obstetric care with full electric power supplied operational theater with back-up generator. However; there were non-functional water pip and no incinerator during our observation. The key informant interview showed that there were intermittent shortage of disposable glove and gauze, and stocked-out of some emergency drugs like methyldopa, Nifidipine and gentamycin.
“In our hospital most basic emergency drugs and supplies are stocked-in due to the existence of pharmacist drug information system. Each service unit coordinators reported to pharmacy department before two weeks of stock-out of drugs. The pharmacist also reports to Gondar branch Ethiopian Drug and Supply Agency (EDSA) before three months of stocked-out. In addition, we received some emergency drugs and supplies directly that found from central supply agency. After essential drugs reach to the hospital quality assurance committee check the quality, quantity and expire date of drugs before storage. Even though drugs are available continuously, there were stocked-out of some emergency drugs in the hospital due to missing during reporting, shortage of drugs in the central drug and supply agency.” (33 years male hospital manager)
There were stocked-out of disposable and surgical glove in our hospital since Covid-19 pandemic rise. Even if there is an access currently, still there is on and off availability of disposable gloves overall the country due to the effect of global covid-19 pandemic. Even though maternity service is an exempted service sometimes clients may purchase gloves in private pharmacy by out of pocket due to shortage of gloves.
(33 years male maternity coordinator)
“Even though there were continuous availability and functionalities of necessary emergency drugs in maternity drug store, there were stock out of essential drugs such as methyldopa, nifidipine and gentamycin from March to April 2021.” (30 years female third year resident)
Availability of medical instruments and equipment in obstetric ward such as sterilized delivery sets, delivery couch, labor and maternity beds, gowns, vacuum extractor and forceps, suction tube, oxygen cylinder, antiseptic, sterilized linens, different stitches and disposable container. Vital sign measuring equipment such as blood pressure apparatus, clinical thermometer, stethoscope, and gynecological examination spot light source were not available. The KIIs reported that shortage of delivery couch, operational table, maternity and labor beds, clean towels, sterilized delivery sets and gowns were the challenges of the ward.
“University of Gondar comprehensive specialized hospital is the only public referral hospital in the town and there is over case flow in the hospital. Even though there is 24 hour running operational theater and delivery services, availability of delivery couch and beds was not proportional with patient flows. As result, sometimes mothers may stay on delivery couch until they are discharge and may sit on chairs during laboring and give birth on the floor.” (31 years male third year Gyn/Obs resident)
“Since the hospital is referral and teaching hospital, many clients came from all directions to this hospital for delivery service. As a result, the hospital is overcrowded and we faced shortage of delivery couch, beds and operational table. To alleviate this burden, the hospital and the regional health bureau, in particular, should collaborate to reduce the number of direct and referral patient flow to this hospital by enhancing the capacity of the health center and primary hospital with human power and resource.” (33 years male hospital manager)
“Even though the hospital is run by federal government and we did not have any regular supportive supervision, we are provided CEmONC service beyond our working capacity. We are still working to scale up the affiliation health center site to be well equipped to provide blood transfusion and cesarean section delivery service in order to reduce direct and referral case to the hospital. The possible reasons to increase patient flow to this hospital, which cause work overload, were lack of trained health care provider at health center and primary hospitals, lack of resource in the facility, most mothers want to delivery at the referral hospital than health center and lack of delivery room at health center.” (40 years female maternal and child officer)
Based on resource inventory, the hospital had laboratory room for CEmONC service and fully functional central supply blood bank which has a capacity to store too much blood unit. The laboratory capacity had available and functional equipment and supplies such as blood type and cross matching reagent, centrifuges, refrigerator, blood unit and register materials, but there were shortage of reagents like syphilis and hepatitis (Table 1). The key informant interview showed that there were interruptions of CBC reagent, blood collection tube, blood and mal-functionality of CBC and chemistry machine in the hospital for one month.
“There was shortage CBC reagent, blood collection tube and mal-functionality of CBC and chemistry machine for one month from March to April. Physicians were unable to done complete blood count cell and organ function tests. Due to this, the physicians were forced to prescribe antibiotic medications based on physical examination finding without knowing blood cell count status” (35 years male midwife)
“The hospital has a common laboratory service which was located far from the obstetric ward. Due to absence of independent laboratory service room at the maternity ward, health care providers took blood samples to the laboratory room and return to get the results. This was very tedious for professionals and sometimes it may delay the procedures, for example during blood transfusion and cesarean section for blood grouping and compatibility. Still, we are repeatedly requesting to have laboratory service room at the obstetric ward like maternity drug store.” (30 years male third year Gyn/Obs resident).
Table 1
Overall judgment of availability of resources for comprehensive emergency obstetric care in University of Gondar comprehensive specialized hospital, 2021
Dimensions with indicator | E* | O* | W* | S* | A* | JP* |
Proportion of gynecologist available in the hospital | 6 | 12 | 2.5 | 5 | 100% | Very good |
Proportion of health workers received training on CEmONC program | 100 | 22 | 3.3 | 0.73 | 22.1% | Poor |
Proportion of Ambo-bag available in delivery room | 5 | 5 | 2.5 | 2.5 | 100% | Very good |
Percentage of essential drugs available for comprehensive obstetric care | 21 | 20 | 3 | 2.9 | 96.7% | Very good |
Proportion of delivery coach in delivery room | 10 | 6 | 3.3 | 2 | 60.6% | Fair |
Proportion of blood unit available in the hospital for mothers | 11000 | 9700 | 2.8 | 2.5 | 89.3% | Very good |
Proportion of available operation table in the hospital | 8 | 2 | 3 | 0.8 | 26.7% | Poor |
Proportion of available suction machine in operation room | 2 | 3 | 2.3 | 3.5 | 100% | Very good |
Proportion of available sterilized cesarean delivery sets | 12 | 12 | 2.5 | 2.5 | 100% | Very good |
Overall availability CEmONC program resource | | | 25.2 | 22.4 | 88.9% | V. good |
Note: E: expected, W: weight, O: observed, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) * 100), JP: Judgment Parameter |
Compliance Of Cemonc
The total of 49 direct observations (25 in operation room and 24 in the labor and delivery) were conducted (to assess their level how they provide CEmONC services as per the national guideline and WHO surgical safety standards. More than three-fourths (76%) of health care providers introduced themselves and call the clients by their name. Two-thirds (68%) attended the labor and delivery through partograph and measured their vital sign and Forty percent (40%) of them reviewed the women’s chart about their previous history of pregnancy and birth outcome before any procedure. Eighty percent (80%) of the clients were informed about any pregnancy related complication and their managements. Only one-thirds (34%) of the operation theater team introduced their name and role to the clients during cesarean section. Over ninety five percent (95.8%) of cesarean section delivery had been done based on indication. Moreover 92% of women received prophylaxis antibiotic an hour before the cesarean section. All clients’ blood group and Rh factor were done, but X-match was performed only for 40% of them. Only half (50%) of the healthcare providers were strictly followed WHO surgical safety checklist standards during performing operation (Table 2). The key informant interviews (KIIs) revealed that caesarean section delivery without clear indications becomes common in this hospital.
“Performing caesarean section delivery without clear indication due to fear of complication becomes common in this hospital. It is my fear that no mother will give birth vaginally in the future if caesarean section delivery without clear indication continued in this manner.” (29 years male midwife)
“I had working in this hospital for many years. I had notice that conducting cesarean section delivery increase time to time. Occasionally, I do believe there are some problems of regarding to the indication of cesarean section in this hospital. Even if the reasons were not clearly well known, in my experience the reason may be due to fear of complication by residents. If complications happen the duty resident might think they will lag or suspend from resident ship promotion so they may create false indication and underwent cesarean section even the case might have a chance to be managed by other options. Other reasons may be due to low senior consultation involvement and cesarean section becomes fashion now a day.” ( 35 years male midwife)
Table 2
Direct observation result of delivery service by health care providers in University of Gondar comprehensive specialized hospital, 2021
Tasks for pregnant mother performed in labor ward (n = 25) | Performed by care providers Frequency (%) |
Check for the availability of washing facilities (water, soap, towel) | 3(12) |
Greets and calls client by her name and introduce herself /himself/ | 19(76) |
Reviews patients record before the procedure and check previous obstetric history | 10(40) |
Provider used partograph to follow labor | 17(68) |
Take pulse rate, blood pressure, temperature, respiratory rate | 17(68) |
Provider document information on partograph and registers | 18(72) |
Do neonatal resuscitation performed based on algorithm | 11(100) |
informs mothers about her and fetus’s health condition | 24(96) |
Informs mothers about any complication and management | 20(80) |
Records all findings, assessments, diagnosis, and care with clients | 23(92) |
Laboratory investigation requested for mothers | |
Coagulopathy test (platelet counts) | 9(36) |
Urine analysis | 16(64) |
Serum blood sugar test | 6(24) |
HGB/HC | 19(76) |
X-match | 16(64) |
Blood group and RH factor | 25(100) |
HIV test | 12(48) |
Tasks performed by operation teams in operation room theatre (n = 24) | |
Mother whose surgical safety check list filled during caesarean section | 12(50) |
Has the patient confirmed his/her identity, site, procedure, and consent? | 23(95.8) |
Is the site marked? | 10(42) |
Is the anesthesia machine and medication checked complete? | 24(100) |
Is the pulse oximetery on the patient and functioning? | 21(88) |
Does the patient have a known allergy? | 4(17) |
Difficult airway or aspiration risk | 8(34) |
If yes, equipment/assistance available | 8(100) |
Confirm the patient’s name, procedure, and where the incision will be made. | 14(59) |
Has antibiotic prophylaxis been given with in the last 60 minutes? | 22(92) |
Anticipated blood loss | 17(71) |
Has sterility been confirmed? | 23(96) |
Are there equipment issues or any concerns? | 9(38) |
Nurse verbally confirms the procedure, completion of instrument, sponge and needle counts, specimen labeling addressed any equipment problems. | 18(75) |
Are there any key concerns for recovery and management of this patient? | 10(42) |
Confirm all team members have introduced themselves by name and role | 8(34) |
Performance of CEmONC signal functions
The past two-month documents were reviewed and the results showed that all signal functions were presented. The most frequently performed signal functions were administration of parenteral uterotonic (40.4%), administration of parenteral antibiotic (17.14%) and cesarean section delivery (12.1%). However, neonatal resuscitation (8.3%), parenteral anticonvulsant (6%), manual removal of placenta (5%), blood transfusion (4%) and removal of retained product (2%) were the least implemented signal functions. The key informant interview results showed that the nine signal functions were performed within the past two months even though there were on and off existence of supplies and medicines. HIV test of mothers came for CEmONC service was neglected.
“The signal functions of CEmONC were performed with the resource that we had. It is difficult to say there were complete availability of all supplies and emergency drugs; but we use different options to deliver the service; however, it is hard to say quality service was provided to the clients” (a 30 years male third year Gyn/Obs resident).
“Nationally one of the Maternal and child health goals was achieving HIV free generation. To achieve this goal every mother should be screening for HIV. Based on the report we received from university of Gondar comprehensive specialized hospital, all clients were not screened for HIV. We tried to communicate with the hospital manager and HMIS focal person because all clients were not screened for HIV. I believe that either the care provider did not screen for HIV or there might be poor recoding and reporting system.” (40 years female maternal and child officer)
Obstetric complications and management
The common obstetric complication encountered in the hospital in the past two months was antepartum hemorrhage (13%) and obstructed labor (11.2%), puerperal sepsis (6.5%), postpartum hemorrhage (6%), Eclampsia (6%), premature rupture of membrane (3.4% and rupture of uterus (1%). All obstetric complication was managed in the hospital and the mother’s life was saved (Table 3).
Table 3
Summary analysis and judgment matrix of compliance for evaluation of comprehensive emergency obstetric care program in University of Gondar comprehensive specialized hospital, 2021.
Dimensions with indicator | E* | O* | W* | S* | A* | JP* |
Proportion of mothers who gave birth by caesarean section based on indication | 25 | 24 | 3.6 | 3.5 | 97.22% | Very good |
Proportion of early birth neonate resuscitated based neonatal resuscitation algorithm | 11 | 11 | 3.2 | 3.2 | 100% | Very good |
Proportion of mothers who informed about any complication and management | 25 | 20 | 3.2 | 2.6 | 81.25% | Good |
Proportion of health professional who greet and call by name mothers | 25 | 19 | 3.6 | 2.7 | 75% | Good |
Proportion of mothers whose vital sign measured | 25 | 17 | 4 | 2.7 | 67.5% | Fair |
Proportion of pregnant mothers whose partograph filled | 25 | 17 | 5.2 | 3.5 | 67.3% | Fair |
Proportion of mothers whose surgical safety checklist filled during C/S | 24 | 12 | 3.6 | 1.8 | 50% | Poor |
Proportion of pregnant mothers whose previous pregnancy history and birth outcome checked before procedure | 25 | 10 | 4 | 1.6 | 40% | Poor |
Proportion of pregnant mothers whose X-match is done | 25 | 16 | 2.8 | 1.8 | 64.3% | Fair |
Proportion of pregnant mothers whose blood group and Rh factor done | 25 | 25 | 3.2 | 3.2 | 100% | Very good |
Proportion of pregnant mothers who received antibiotic prophylaxis within the last 60 minutes before c/s done | 24 | 22 | 3.6 | 3.3 | 91.7% | Very good |
Overall compliance of CEmONC service provider | | 24 | 40 | 29.9 | 74.8% | Fair |
Note: E: expected, W: weight, O: observed, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) * 100), JP: Judgment Parameter |
Acceptability Of Cemonc Services
Socio-demographic characteristics
Half (52.8%) of the respondents were under the age of 20 years and the mean age was 28.5 years (± 5.54 SD). Most respondents (89.1%) were married and 50.2% of them were house wives. More than half (57.4%) of the respondents were attended secondary education and above, and 66% of the respondents had average household monthly income more than ETB 1000.00. Two-thirds (67.9%) of the participants were urban dwellers and 79.2% of them were Orthodox Christian followers.
Obstetric characteristics of participants
More than half (58.5%) of the clients had history of multigravida and 60.8% were primipara. The major mode of deliveries for the current pregnancy in this hospital were spontaneous vaginal delivery (57.3%) and ninety percent of (90.9%) of the birth outcomes were live births. Nearly one-fourth (26.8%) of clients gave births at hospital before current pregnancy. More than ninety percent (95.8%) of the clients were also willing to receive blood if she had indication (Table 4).
Table 4
Obstetric characteristics of the participants in University of Gondar comprehensive specialized hospital, 2021 (N = 265)
Obstetric history | Category | Frequency (n = 265) | % |
Gravidity | Prime-gravid | 110 | 41.5 |
Multi-gravid | 155 | 58.5 |
Parity | Prime Para | 161 | 60.8 |
Multi Para | 104 | 39.2 |
Mode of delivery | Spontaneous vaginal delivery | 153 | 57.7 |
Cesarean section delivery | 98 | 37 |
Instrumental delivery | 14 | 5.3 |
Birth outcome | Alive | 241 | 90.9 |
Still birth | 5 | 1.9 |
Other | 19 | 7.2 |
Frequency of hospital visit | One times | 42 | 15.8 |
Two times | 52 | 19.6 |
Three times | 80 | 30.2 |
Four times | 43 | 16.2 |
More than four | 48 | 18.1 |
Reasons for hospital visit | Pregnancy test | 13 | 4.9 |
ANC follow up | 25 | 9.4 |
HIV testing | 14 | 5.3 |
To give birth | 66 | 24.9 |
Facility for ANC follow-up the recent pregnancy | At this hospital | 91 | 34.3 |
At another hospital | 37 | 14 |
At health center | 96 | 36.2 |
At health post | 34 | 12.8 |
No ANC visit | 7 | 2.6 |
Number of ANC visits for recent pregnancy | One times | 26 | 9.8 |
Two times | 50 | 18.9 |
Three times | 82 | 30.9 |
Four times | 82 | 30.9 |
More than four | 25 | 9.4 |
Previous delivery before current pregnancy | At hospital | 71 | 26.8 |
At health center | 63 | 23.8 |
At home | 27 | 10.2 |
Willing to receive blood | Yes | 254 | 95.8 |
No | 11 | 4.2 |
Health facility related characteristics
More than one-third (39.6%) of clients were travelled for half an hour to receive the CEmONC services. Nearly two-thirds (61.9%) travelled by public transport and 9.8% went to the hospital on foot. About 60% of women were spent more than an hour with the health care provider during service provision.
Acceptability of CEmONC
The overall acceptability of CEmONC services was 81%. Almost all (98.9%) mothers were accepted the healthcare providers explanation about the treatment they received. More than 95% of participants also accepted the discussion and understand about pregnancy related danger sign and pain management during delivery care, ANC, and consultation time. Over 85% of women accepted the waiting time to receive the CEomNC services at the hospital. Nearly 65% of women reported the visual privacy during examination were acceptable and half (52.8%) of them also accepted the auditory privacy (Table 5). The key informants revealed that clients were complained in related to waiting space, physical abuse, humiliation, absence of family support during labor and visual privacy. “Most mothers were complained to waiting space or area cleanness and absence of family support, visual privacy during vaginal examinations disrespect of maternal care and humiliation by care provider.” (a 30 years female third year resident student)
Table 5
Overall performance of maternal acceptability for comprehensive emergency obstetric care program in University of Gondar comprehensive specialized hospital, 2021
Dimensions with indicator | E* | O* | W* | S* | A* | JP* |
Proportion of pregnant mothers satisfied to explanation provided or treatment given | 265 | 262 | 2.8 | 2.76 | 98.9% | Very good |
Proportion of pregnant mothers satisfied to waiting time | 265 | 230 | 3.5 | 3.04 | 86.9% | Very good |
Proportion of mothers satisfied to health care provider open mindedness or greeting them while treating them | 265 | 252 | 3.2 | 3.04 | 95.1% | Very good |
Proportion pregnant mothers satisfied to visual privacy during examination | 265 | 171 | 2.8 | 1.8 | 64.3% | Fair |
Proportion pregnant mothers who satisfied to the cleanliness of the delivery room | 265 | 249 | 3.2 | 3 | 85.7% | Good |
Proportion pregnant mothers satisfied to auditory privacy during discussion | 265 | 140 | 2.8 | 1.5 | 53.6% | Poor |
Proportion of mothers satisfied to pain management | 265 | 260 | 3.2 | 3.14 | 98.1% | Very good |
Proportion of mothers satisfied for consultation time | 265 | 260 | 3.2 | 3.14 | 98.1% | Very good |
Proportion of mothers satisfied to the confidentiality of health care provider | 265 | 258 | 2.5 | 2.4 | 96% | Very good |
Proportion of mothers satisfied for the waiting area safety and cleanses | 265 | 27 | 3.5 | 0.4 | 11.4% | Poor |
Proportion of mothers satisfied with discussion about pregnancy related danger sign | 265 | 261 | 2.1 | 2.06 | 98.5% | Very good |
Proportion of mothers satisfied to ANC follow up service | 265 | 260 | 2.5 | 2.4 | 96% | Very good |
Overall acceptability of CEmOC service | | | 35.3 | 28.68 | 81% | Good |
Note: E: expected, W: weight, O: observed, S: Score ((observed X weight)/Expected), A: Achievement in percentage ((S/W) * 100), JP: Judgment Parameter |
Factors associated with acceptability of CEmONC
Women who had shorter waiting time to receive the CEmONC services were 2.40 times (AOR = 2.40; 95%CI: 1.16, 4.90) more likely accepted the services compared with women who waited longer to receive the services. Non-educated mothers were 5.5o times (AOR = 5.50; 95%CI: 1.95, 15.60) more likely accepted the CEmONC services compared with the educated women (Table 6).
Table 6
Factors associated with acceptability of CEmONC service in University of Gondar comprehensive specialized hospital, 2021
Variables | Category | Acceptability | COR | 95% CI | AOR | 95% CI | p-value |
Yes | No | | | | |
Maternal education | Unable to read and write | 40 | 22 | 0.28 | 0.12 | 0.56 | 5.5 | 1.95 | 15.6 | 0.002 |
Read and write | 10 | 4 | 0.38 | 0.11 | 1.32 | 2.8 | 0.6 | 13.2 | 0.21 |
Primary | 33 | 4 | 1.25 | 0.4 | 3.90 | 0.8 | 0.22 | 2.6 | 0.64 |
Secondary and above | 132 | 20 | 1 | | | 1 | | | |
Waiting time | < 60 minutes | 76 | 30 | 0.37 | 0.19 | 0.69 | 2.4 | 1.16 | 4.9 | 0.02 |
≥ 60 minutes | 139 | 20 | 1 | | | 1 | | | |
No. of ANC visits | One | 24 | 1 | 5.65 | 0.72 | 44.25 | 0.15 | 0.17 | 1.34 | 0.09 |
Two | 39 | 8 | 1.15 | 0.47 | 2.83 | 0.57 | 0.19 | 1.68 | 0.31 |
Three | 63 | 18 | 0.82 | 0.4 | 1.68 | 1.12 | 0.5 | 2.5 | 0.79 |
Four and above | 85 | 20 | 1 | | | 1 | | | |
Parity | Prime Para | 137 | 24 | 1.90 | 1.02 | 3.54 | 0.74 | 0.29 | 1.9 | 0.53 |
Multi Para | 78 | 26 | 1 | | | 1 | | | |
Time taken to the hospital | < 30 minutes | 63 | 13 | 1.67 | 0.77 | 3.6 | 0.61 | 0.24 | 1.56 | 0.3 |
30–60 minutes | 90 | 15 | 2.10 | 1.01 | 4.35 | 0.66 | 0.27 | 1.6 | 0.35 |
> 60 minutes | 63 | 22 | 1 | | | 1 | | | |
Gravidity | Primigravida | 94 | 16 | 1.65 | | | 1.05 | 0.39 | 2.8 | 0.92 |
Multigravida | 121 | 34 | 1 | | | 1 | | | |
Note: Significant at p-value < 0.05 |
Overall judgment matrix
The overall implementation status of CEmONC was 81.6% and judged as good. Availability, compliance and acceptability of CEmONC services were 88.9, 74.8 and 81% and judged as very good, fair and good as per the preset judgment parameter, respectively (Table 7).
Table 7
Overall judgment matrix and analysis of dimension for CEmONC program in University of Gondar comprehensive specialized hospital, 2021
Dimensions | Weight | Achievement | Judgment parameter |
Availability | 25% | 88.9% | Very good |
Compliance | 40% | 74.8% | Fair |
Acceptability | 35% | 81% | Good |
Overall dimensions | 100% | 81.6% | Good |