To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. Before and after evaluation for the BEmONC intervention included, a cross-sectional survey was conducted in April 2013 and July 2015, in 134 rural health centers in 91 districts of four regions: Amhara, Oromia, the Southern National, Nationalities, and Peoples’ Region, and Tigray. A BEmONC implementation strength index was constructed from seven input, and five process indicators were measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. The study estimated the dose-response relationships between outcome and explanatory variables of interest using regression methods. Data were analyzed for both descriptive and inferential statistics using Stata version 14.2. The programmatic outcome variables of interest were the facility delivery rate and the met need for BEmONC. The facility delivery rate was defined as the proportion of deliveries that took place in health facilities out of the total expected number of births in the catchment area. The expected births were calculated based on information from the catchment projected population the population estimate of a health center based on the regional population growth rate estimate and the crude birth rate for the catchment area. Descriptive statistics were used to analyze the inputs and process of service delivery. A paired t-test was used to test the statistical significance of the changes in the indicators of interest between the baseline and follow-up surveys. The BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose-response relationship between the explanatory and outcome variables.

• Basic emergency obstetric and newborn care (BEmONC)
• Emergency obstetric care (EmONC)
• Ethiopia
• Implementation strength
• Life-saving interventions
• Low- and middle-income countries (LMIC)
• Maternal and newbornhealth
• Primary health care
• Rural health centers

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This study was a cross-sectional study conducted on the programs' effectiveness and availability of the BEmONC in Amhara, Oromia, the Southern National, Nationalities, and Peoples’ Region, and Tigray regions of Ethiopia.  The study was conducted among 134 health centers in 91 districts by interviewing the medical directors of health centers. The independent variable of interest was BEmONC implementation strength ( BIS), which was measured during the baseline and follow-up surveys as an index using items measuring programmatic input and process indicators. The critical components necessary for measuring BIS in rural health centers to improve the use of critical maternal and newborn care services are 1) facilities’ emergency readiness in terms of availability of services, human resources, equipment, and drugs; 2) effective referral; 3) the support system; and 4) adherence to basic life-saving interventions and quality of care. Moreover, Descriptive statistics were used to analyze the inputs and process of service delivery. Finally, a paired t-test was used to test the statistical significance of the changes in the indicators of interest between the baseline and follow-up surveys.

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