Evaluation of the implementation fidelity of comprehensive emergency obstetric and newborn care at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a mixed-method evaluation.

Background: Approximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia.

Method: A case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll's conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria.

Results: Overall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively. Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers' respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services.

Conclusions: The overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines.