title: Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis.
abstract: Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services.
  
  
  
  Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15-49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs.
  
  
  
  The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery.
  
  
  
  Supply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural-urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care.
authors.affiliation: Department of Global Community Health and Behavioral Sciences, Tulane University, 1440 Canal Street, Suite 2200-22 Mail code: 8319, New Orleans, LA, 70112-2824, USA.
authors.forename: Anastasia J
authors.initials: AJ
authors.lastname: Gage
authors.affiliation: Independent Researcher, 212 Loyola Avenue, Apartment 1105, New Orleans, LA, 70112, USA.
authors.forename: Onyebuchi
authors.initials: O
authors.lastname: Ilombu
authors.affiliation: Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Nigeria. akakanni@yahoo.ca.
authors.forename: Akanni Ibukun
authors.initials: AI
authors.lastname: Akinyemi
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D036861:Delivery, Obstetric / Q000592:standards / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D058016:Health Facility Administration; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D009549:Nigeria; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards / Q000639:trends; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards* / Q000639:trends; D019037:Urban Health Services / Q000592:standards* / Q000639:trends; D055815:Young Adult
keywords: Health facility delivery; Health services quality and management; Maternity services; Nigeria