This study used a community-based cross-sectional design using both quantitative and qualitative approaches aimed to assess the utilization of facility-based health care and associated factors in the Oromia region. In doing so, the level of utilization of facility-based health care was computed.
In this study, during the COVID 19 pandemic about a quarter (25.5%) visited health institutions for seeking essential health care. This is supporting the evidence as novel coronavirus disease (COVID 19) has disrupted healthcare systems around the world and direct health threat to patients and that strained access to healthcare [13, 14]. The study participants have a huge gap in visiting the health institution as mentioned above due to fear of transmission from health institutions and belief in divine intervention as protection. Moreover, dealing with COVID-19 is likely to create imbalances in health care provision, disruption of routine essential services, and require redeployment of scarce health personnel across health services .
The observed significant reduction might be due to various reasons. Given likely challenges to the health system due to the burden of the disease and the government-mandated mitigation strategies, the provision of facility-based health care services was anticipated to be challenged by staff redeployment to provide the intended services, closures of health facilities or services, and supply-chain difficulties limiting provision of care, as well as reductions in outpatient care attendance due to fear, lockdowns and financial difficulties. In recognition of the burden of the pandemic on the health sector, in April 2020, the Ethiopian Federal Ministry of Health (FMoH) developed national guidelines for managing COVID-19. The national guidelines set standards for surveillance, tracing protocols, COVID-19 treatment centers, as well as health center preparedness, community engagement, and maintaining the effectiveness of facility-based essential health care services during the pandemic.
Respondents in the category of the agro-pastoralist cluster were less than half times less likely to utilize facility-based health care during the COVID 19 global pandemic as compared to agrarians. The result was consistent with the study conducted in different parts of Ethiopia, [6, 165-18] which suggests that there is a significant reduction in utilizations of facility-based health care since the COVID-19 pandemics happened in Ethiopia.
The study also showed that the odds of the utilization of facility-based health care lower among participant’s urban areas. This finding is congruent with a study conducted in the Netherlands  that showed high utilization of facility-based health care during the COVID 19 pandemic. This might be due to the fact that because of having more information about COVID 19 urban residents might be having a panacea compared to their counterparts .
Also, Orthodox Christians were less likely to use facility-based health care utilization compared to protestants. This is consistent with the findings of others as most people from Orthodox Christian followers are using spiritual (Tsebel) during the pandemic [6, 16–18].
Being Widowed/Divorced/ separated were less likely to utilize health care during COVID 19 pandemic compared to participants who were never married. This is consistent with the studies done in Ethiopia [6, 16–18]. This might be due to unmarried or single women have autonomy which is positively associated with maternal health service utilization.
The study also showed that the odds of the utilization of facility-based health care services were lower among participants with a poor level of knowledge. As knowledge is the result of awareness based on obtaining appropriate information it is supported by studies conducted elsewhere [12, 20]. This finding is congruent with a study conducted in the Netherlands  that showed high information-seeking behavior was associated with the utilization of facility-based health care services. This might be due to the fact that if the population had prior information about the utilization they are more likely to utilize facility-based health care [4, 21].
In this study, the attitude of the respondents towards COVID-19 preventive measures and utilization of facility-based health care services failed to be significant in the multivariate analysis. However, in several studies, those respondents having favorable attitudes towards COVID-19 preventive measures and utilization of facility-based health care services were more likely to adhere towards the mitigation measures than their counterparts [4, 21]. The possible explanation might be that the respondents who had a favorable attitude towards COVID-19 preventive measures and utilization of facility-based health care services might trust the science of mitigation measures and comply with the instructions of these guidelines .
As to the limitations of the study, due to the cross-sectional nature of the study design, it might be difficult to ascertain the cause-effect relationship between the study variables. Secondly, social desirability bias might be introduced despite their poor actual implementation. Thirdly, the tool used in this study was developed by the research team based on the context and not previously validated and the reliability was checked using Cronbach’s alpha.