Abstract:
Background: Bypassing of nearby lower level health care facilities is frequent among women in many
areas, which brings impact for the successful implementation of health sector reform. It seen as a
powerful expression of people’s preference for health care and high rates of bypassing have important
implications for health system efficiency and actual coverage of health services.
Objective: The main objective of this study was to assess bypassing of lower level health care facilities
and associated factors with delivery service in Amhara Region Referral Hospitals, Ethiopia.
Methods: Facility based cross-sectional study employing exit interviews with postpartum women was
conducted. By using single population proportion formula, a total of 422 mothers were proportionally
taken from four referral hospitals. Every other postnatal woman who was receiving delivery care in each
hospital interviewed until sample size met. Data was edited, cleaned, coded, and analyzed using SPSS
version 16.0. Bivariate and multivariate logistic regressions applied to identify the effect of each
explanatory variable on the outcome variable. Explanatory variables whose p-values less than 0.05 in the
bivariate analysis were transferred in the multivariate logistic regression to see the prediction power of
those variables.
Results: A total of 422 women participated in the study. The overall bypass rate was 48.1%. Final
predictors of women bypassing nearby lower level facility were Education status, parity, distance from
referral hospitals, and women perception towards lower level health facilities, diagnostic setup and
health care providers working at lower level health care facilities.
Conclusions: In this study, it was found that nearly half of women who attended delivery services at
referral hospitals are by passers. Therefore, the findings have important implications on the health sector
programs especially on maternal health care services. The current efforts in health system should
consider and prioritize women’s perceptions and expectations of care at different level of facilities in
line with accessibility. It is crucial to know and utilize the limited resources at all level health care
facilities to the improve quality of care.
