Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia

摘要: Background: Evidence shows that the three delays, delay in 1) deciding to seek medical care, 2) reaching health facilities and 3) receiving adequate obstetric are still contributing maternal deaths low-income countries. Ethiopia is a major contributor worldwide death toll of mothers with mortality ratio 676 per 100,000 live births. The Ethiopian Ministry Health launched community-based health-care system 2003, Extension Programme (HEP), tackle mortality. Despite strong efforts, universal access services remains limited, particularly skilled delivery attendance. With help ‘the delays’ framework, this study explores health-service providers’ perceptions facilitators barriers utilization institutional Tigray, northern region Ethiopia. Methods: Twelve in-depth interviews were carried out eight extension workers (HEWs) four midwives. Each interview lasted between 90 120 minutes. Data analysed through thematic analysis approach. Results: Three themes emerged from analysis: struggle tradition newly acquired knowledge, community willingness deal geographical barriers, striving do good job insufficient resources. These represent steps path towards care at facility. Of themes, ‘increased awareness’, ‘organization community’ ‘hospital specialized staff’ recognized as facilitators. On other hand, ‘delivery natural event’, ‘cultural rituals’, ‘inaccessible transport’, ‘unmet expectation’ ‘shortage human resources’ represented delivery. Conclusions: participants gave emphasis closely connected delays model. initiatives being implemented by Tigray Regional Bureau, much needed enhance humanization approach on broader level region. A quick solution address issue lack transport accessibility. poor capacity HEWs provide services, calls for reconsidering staffing patterns remote posts readdressing downgraded would unmet needs.