Background: Increasing women’s access to and use of facilities for childbirth is a critical national strategy to improve
maternal health outcomes in Ethiopia; however coverage alone is not enough as the quality of emergency obstetric
services affects maternal mortality and morbidity. Addis Ababa has a much higher proportion of facility-based births
(82%) than the national average (11%), but timely provision of quality emergency obstetric care remains a significant
challenge for reducing maternal mortality and improving maternal health. The purpose of this study was to assess
barriers to the provision of emergency obstetric care in Addis Ababa from the perspective of healthcare providers
by analyzing three factors: implementation of national referral guidelines, staff training, and staff supervision.
Methods: A mixed methods approach was used to assess barriers to quality emergency obstetric care. Qualitative
analyses included twenty-nine, semi-structured, key informant interviews with providers from an urban referral network
consisting of a hospital and seven health centers. Quantitative survey data were collected from 111 providers, 80%
(111/138) of those providing maternal health services in the same referral network.
Results: Respondents identified a lack of transportation and communication infrastructure, overcrowding at the referral
hospital, insufficient pre-service and in-service training, and absence of supportive supervision as key barriers to provision
of quality emergency obstetric care.
Conclusions: Dedicated transportation and communication infrastructure, improvements in pre-service and in-service
training, and supportive supervision are needed to maximize the effective use of existing human resources and
infrastructure, thus increasing access to and the provision of timely, high quality emergency obstetric care in
Addis Ababa, Ethiopia.