Levels of Person Centered Antenatal Care among Pregnant Women in Public and Private Health Facilities in Western Hararghe Zone, Ethiopia: An Institution Based Comparative Mixed Method Study Design

BackgroundPerson-centered Antenatal Care (PCANC) is a component of quality care that is essential to enable maximize health outcomes. It is believed to be one of the reasons why private health facilities have higher quality than public health facilities. However, in Ethiopia, there is a little study that assesses and compares the level of person-centered antenatal care among pregnant women in public and private health facilities. ObjectivesTo assess and compare the level of person-centered antenatal care among pregnant women attending antenatal care in public and private health facilities in the Western Hararghe zone, Oromia region, Ethiopia, 2020. MethodsAn Institution Based Comparative Mixed Method Study Design was conducted among pregnant women in the Western Hararghe zone, Ethiopia from September 01-October 02, 2020. A multistage stage sampling technique was used to obtain 340 pregnant women (170 from public facilities and 170 from private facilities). The data were entered into Epi-data version 4.4 and analyzed using SPSS version 27. A comparison of categorical and continuous variables was done using an independent t-test and Chi-square test respectively. All comparisons were considered to be significant at a p-value of < 0.05. Qualitative data was analyzed by manually. ResultsThe overall PCANC percentage mean score was significantly higher in private health facilities (73.7%; 95% CI: 70.5-77.1%) compared to public facilities (59.7%; 95% CI: 56.05-63.5%) (P<0.001). Private facilities had higher percentage mean score than public ones in effective communication (71.4% vs. 56.3%), respect and dignity (85.2% vs. 71.2%), and supportive care (70.1% vs. 59.2%). Qualitative findings further highlighted better interpersonal communication in private facilities. ConclusionThis study highlights significant disparities in the PCANC between private and public health facilities, with private facilities better in effective communication, respect, dignity, and supportive care. Qualitative findings further underscore better interpersonal communication in private settings. Addressing the disparities in person-centered antenatal care between private and public health facilities is crucial to achieve equity and quality of antenatal care. Key messages of the articleO_ST_ABSWhat is already known on this topicC_ST_ABSPerson Centered Antenatal Care (PCANC) is critical for ensuring the quality maternal health services. However, disparities in the quality of care contribute to inequities in maternal health outcomes. What this study addsThis is the first study to assess and compare the level of PCANC in private and public health facilities in Ethiopia using the WHO Quality Framework on Maternal and Newborn Care. The study reveals significant inequities in PCANC with private facilities scoring substantially higher in effective communication, respect and dignity, and supportive care compared to public facilities. How this study might affect research, practice, or policyThe findings emphasize the urgent need to address inequities in antenatal care by strengthening Person-Centered care in public health facilities. The findings highlight the need for targeted strategies that enhance communication, respect, and supportive care to ensure equitable and quality antenatal care. Policymakers and health system planners should leverage the WHO framework to implement targeted interventions aimed at improving equity and quality in maternal care services.