Evaluation of comprehensive abortion care service in University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia: mixed case study design.

Abstract

Despite Ethiopia's substantial progress in comprehensive abortion care, the consequences of abortion remain a major public health challenge. This study aimed to assess the implementation status and its determinants of comprehensive abortion care service at University of Gondar Comprehensive Specialized Hospital. A facility-based single case study with convergent parallel mixed-method evaluation was conducted from March 28 to April 28, 2023. Availability, patient-centered care, timeliness, and compliance dimensions with 35 indicators were used. A total of 379 exit interviews, five key informant interviews, six in-depth interviews, 411 medical charts reviewed, and 17 observations were done. Stata version 17 was used. Binary logistic regression analysis was computed to identify eligible variables for the multivariable logistic regression, and a variable with p-value < 0.05 at adjusted odds ratio with a 95% confidence interval was declared as statistically significant. The qualitative data were recorded through a tape recorder, transcribed in Amharic and translated to English, and analyzed thematically.The overall implementation status of comprehensive abortion care (CAC) was found to be 65.1%, which is considered fair according to judgment parameters. Availability of CAC resources, compliance of service providers, timeliness, and patient-centered care contributed scores of 85.7% (very good), 72.6% (fair), 40.6% (poor), and 61.3% (fair), respectively. Urban dwellers, married women, had family support, privacy to access abortion care, and those who communicated on medication were positive predictors of patient-centered care. There were stock outs of essential emergency drugs, shortages of equipment and trained manpower, and poor infrastructure. Besides, none of the providers comply with hand washing protocols and used personal protective equipment, and there were delays in providing abortion services. The overall CAC program service implementation needs urgent improvements, especially in timeliness, which was notably poor and needs major enhancements. Thus, to improve CAC services, the hospital should ensure the availability of essential drugs, equipment, and infrastructure. The Ministry of health should improver providers' compliance with CAC guidelines by providing training and enhancing continuous professional development programs. Moreover, policymakers and planners should focus on enhancing providers' communication skills and family involvement in care decisions, and warranting patient privacy and confidentiality according to established protocols.