Published in PLOS One on 2026-01-07, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Negeso Gebeyehu Gejo, Daniel Yohannes Bedecha, Solomon Seyife Alemu, Maedot Ariaya Haymete, Milion Reta Regasa, Abraham Endale Geleta, Qorinah Estiningtyas Sakilah Adnani
Source: PLOS One • DOI 10.1371/journal.pone.0340691
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Health System Responsiveness is defined as how well the health system meets the legitimate expectations of the population for the non-health enhancing aspects of the health system. As Ethiopia approaches the conclusion of the Health Sector Transformation Plan-II (HSTP-II), generating evidence on health system responsiveness is critical for evaluating progress and guiding future strategies. However, there remains a scarcity of empirical evidence on health system responsiveness, particularly in the context of delivery care services.
The primary aim of this study was to assess the health system responsiveness and its associated factors for delivery care in public health facilities of West Arsi Zone, Oromia, Ethiopia.
A health facility-based cross-sectional study was conducted among 617 mothers who gave birth in the selected public health facilities of West Arsi Zone, Oromia Region. Data were collected from 24/02/2025–26/04/2025. Systematic random sampling technique was used to approach study participants. Health system responsiveness was measured using eight domains namely dignity, autonomy, confidentiality, communication, prompt attention, social support, choice and basic amenities each item rated on 1–5 scale. Mothers with median score ≥112 were categorized as having good responsiveness performance for delivery care whereas <112 were considered as poor responsiveness for delivery care. Data was entered and analyzed using SPSS version 25. Both bi-variable and multivariable logistic regression analysis were done to identify association between dependent and independent variables. Crude and adjusted odds ratios with respective 95% confidence intervals were computed and statistical significance was declared at p-value <0.05.
The overall level of good health system responsiveness for delivery care was found to be 51.4% (95% CI 47.4–55.4). The highest and least performance score was reported in the social support domain (62.9%) and choice domain (51.7%) respectively. Adverse neonatal outcome (AOR = 0.50, 95% Cl (0.31, 0.82), obstetrics complications (AOR = 0.47, 95% Cl (0.26, 0.85), history of admission during current pregnancy (AOR = 0.58, 95% Cl (0.35, 0.96) were factors significantly associated with health system responsiveness.
More than half of the respondents reported that the overall level of health system responsiveness during delivery was good. Adverse neonatal outcome, obstetrics complications and history of admission during current pregnancy had shown statistically significant association with health system responsiveness for delivery care. Enhancing health system responsiveness during delivery needs targeted investments in infrastructure, continuous training for healthcare providers, and tailored support for women who experience adverse neonatal outcomes or obstetric complications. Strengthening these areas is essential for ensuring respectful, timely, and women centered maternity care.
Introduction
Given the primary purpose of a health system is justice, it is expected to enhance, attain, and distribute health equitably among the entire population in all segments. For this reason, the concept of health system responsiveness was developed and articulated [1]. In addition to equity in the health system’s funding, the World Health Organization’s (WHO) approach for evaluating the effectiveness of health systems includes health and responsiveness as major outcomes; the extent to which the health system satisfies the public’s justifiable expectations regarding its non-health-improving components is known as responsiveness [2,3].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Negeso Gebeyehu Gejo, Daniel Yohannes Bedecha, Solomon Seyife Alemu, Maedot Ariaya Haymete, Milion Reta Regasa, Abraham Endale Geleta, Qorinah Estiningtyas Sakilah Adnani. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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