article · The Lancet Regional Health - Africa
Health facility readiness encompassing staffing, supplies, equipment, and infrastructure is vital for delivering high-quality maternal and newborn care. Using data from forty-two health facility surveys and population surveys across Burkina Faso, Ethiopia, Kenya, and Nigeria between 2008 and 2023, geospatial small area models tracked intrapartum care readiness and estimated readiness-adjusted coverage. Public hospitals demonstrated the highest readiness across all four countries in 2023, reaching between 76.9 percent and 93.5 percent. Overall readiness scores improved over the fifteen-year period in Ethiopia, Kenya, and Nigeria, but declined in Burkina Faso. Coverage adjusted for readiness varied considerably across administrative regions and was consistently higher in densely populated areas. Furthermore, the link between facility delivery rates and readiness differed by country, showing positive associations in Kenya and Ethiopia, but negative associations in Burkina Faso and Nigeria.
Encouraging women to give birth in health facilities only improves survival if those clinics have functioning equipment, supplies, and trained personnel. By tracking readiness alongside actual birth locations, this research reveals where critical capacity gaps persist. It demonstrates to health authorities that boosting facility delivery rates must go hand in hand with direct investments into clinic infrastructure, especially outside major urban centres.
The analytical methods and readiness-adjusted coverage models can inform resource allocation tools and health system planning software used by regional health ministries, international donors, and development agencies. This is applied health systems research rather than a commercial product, but the underlying spatial modelling framework is fully tested across multiple countries and could be integrated into operational health surveillance platforms.
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Background Facility readiness, or the staff, supplies, equipment, and infrastructure available and operational in health facilities, is a pre-requisite for high-quality care. We examined facility readiness for maternal and newborn care alongside location of births by facility type in four African countries to track readiness-adjusted coverage and supply and demand dynamics for delivery services. Methods We used 42 health facility surveys in Burkina Faso, Ethiopia, Kenya, and Nigeria to construct maternal and newborn intrapartum care readiness scores. Geospatial small area models estimated readiness trends from 2008 to 2023 by facility type and region. We estimated location of births by facility type from population surveys and multiplied these by readiness scores to estimate readiness-adjusted coverage. Linear regression assessed the association between changes in facility delivery and readiness. Findings In 2023, readiness was highest in public hospitals (76.9%–93.5%) in all four countries. Readiness scores increased from 2008 to 2023 in Ethiopia, Kenya, and Nigeria but declined in Burkina Faso. Readiness-adjusted coverage varied widely across regions and was higher in more densely populated areas on average. Facility delivery was positively associated with readiness in Kenya and Ethiopia but negatively associated in Burkina Faso and Nigeria. Interpretation Facility readiness rose substantially in three of four countries since 2008, though improvement is still needed, particularly outside densely populated areas. The readiness-utilisation relationship is context-dependent. Policies that increase facility delivery should be paired with investments in facility capacity and strategies to ensure women deliver in adequately prepared facilities. Funding The Gates Foundation.
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DOI: 10.1016/j.lanafr.2026.100150
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