Impact of Human Resources for Health flooding Strategy on Quality of ANC and Intrapartum care service in Ethiopia: A quasi-experimental pre-post study
DOI:
https://doi.org/10.20372/ejhbs.1175Keywords:
Human Resources for Health, Maternal Health Service, Quality of Health Care, Propensity Score MatchingAbstract
Background: Ethiopia has implemented a Human Resources for Health (HRH) flooding strategy since 2011 to rapidly expand the availability of health professionals nationwide. Although this approach is expected to strengthen the healthcare workforce, its effects on healthcare quality and service delivery outcomes have not been comprehensively evaluated.
Objective: This study assessed the association between the HRH flooding strategy and maternal healthcare quality, with a focus on antenatal and intrapartum care, to inform strategies for optimizing the effectiveness of workforce investment.
Methods: A quasi-experimental pre-post design with propensity score matching was employed to evaluate changes in care quality following implementation of the HRH flooding strategy. Data were pooled from two rounds of the Ethiopian Demographic and Health Survey (EDHS), using the 2011 EDHS as the pre-intervention control group and the 2016 EDHS as the post-intervention group. The primary outcomes were the quality of antenatal care (ANC) and intrapartum care provided.
Results: The quality of ANC was 27.1% (95% CI: 25.7–28.6) in the treatment group compared to 8.5% (95% CI: 7.5–9.6) in the control group. Similarly, the quality of intrapartum care was 44.0% (95% CI: 42.4–45.6) and 20.8% (95% CI: 19.3–22.5) in the treatment group and control group, respectively. The average treatment effect of the HRH flooding strategy was associated with a 13.5 percentage-point improvement in the quality of ANC and a 23.3 percentage-point improvement in the quality of intrapartum care. Using a 0.01 caliper, radius matching achieved a strong balance between treatment and control groups.
Conclusion: Implementing the HRH flooding strategy is positively associated with improvements in the quality of ANC and intrapartum care services in Ethiopia. However, these findings should be interpreted with caution, as unmeasured confounding factors, including concurrent health system programs, may have contributed to the observed effect.
Downloads
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Adane Kebede, Endalkachew Dellie, Melak Jejaw, Misganaw Guadie Tiruneh, Getachew Teshale, Demiss Mulatu Gebru, Kaleb Assegid Demissie
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright & Licensing © The Author(s) Year. This is an open-access article is distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, sharing (copying and redistributing the material in any medium or format), and adaptation (remixing, transforming, and building upon the material for any purpose), provided the original author(s) and the source are properly cited/credited, and provide a link to the license. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
How to Cite
