Most maternal and newborn deaths can be averted through improving access and quality of care around the time of birth, immediate postpartum, and the postnatal period in a well-functioning facility.  Between March 2016 and October 2017, four rounds of cross‐sectional surveys of 40 health centers were conducted bi‐annually to monitor the access to and utilization of high-impact maternal and newborn health interventions. Data were collected through interviews with providers, client exit interviews, observation of consultations, and a review of patient records and service statistics. 
The survey showed that health centers were well‐staffed and had the basic infrastructure, equipment, and supplies. About half of the health centers were ready to provide the seven BEmONC functions. However, only a few (15%) provided all seven BEmONC functions in the three months prior to the surveys. Most health centers lacked readiness and/or had no provision of most newborn signal functions. Performance of BEmONC signal functions was higher during the dryer seasons (January to April), observed in March 2016 and April 2017 surveys, compared to that in the rainy seasons (July to October), observed in October 2016 and 2017 surveys. The access to and utilization of most maternal and newborn interventions improved over time: between March 2016 and October 2017, the syphilis testing rate increased from 27% to 33%; facility delivery rate increased from 42% to 47%; the proportion of asphyxiated newborns managed with Ambu‐bag and mask increased from 46% to 96%; and proportion of preterm/low birth weight babies initiated kangaroo‐mother care increased from 39% to 48%. Regarding women's experiences of the services and their interactions with the provider, most clients reported that providers are knowledgeable, responsive to their needs, and treat them respectfully. Likewise, during consultations with clients, we observed that most providers used the appropriate tone of voice, asked women's concerns, listened attentively, and assured privacy and confidentiality. 
Most health centers were not functioning as BEmONC facilities. As such, health centers need to be strengthened to provide basic emergency obstetric and newborn care functions. Further investigation is required to understand the seasonal pattern of the provision of BEmONC services in health centers. It is important to include the women’s experiences of the services and client-provider interactions as components of quality of care and routinely monitor facilities' provision of respectful care at primary level facilities. Moreover, program managers should devise strategies and tools for monitoring the compassionate and respectful care (CRC) provision at the primary care level in Ethiopia.  

• Health center
• Assessment
• Four rounds
• Survey
• Cross-sectional
• Bi-annually
• BEmONC
• Family planing
• ANC
• Delivery
• Abortion
• PNC
• PMTCT
• Staffing
• Training

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The four rounds of health facility assessment surveys were conducted bi‐annually to monitor the access to and utilization of high-impact maternal and newborn health interventions. In that regard, the data were collected through interviews with providers, client exit interviews, observation of consultations, and a review of patient records and service statistics, and the study was conducted among 40 health centers between March 2016 and October 2017. This dataset captures information on staffing, availability of training providers, availability of facility infrastructure, equipment, and supplies. Along with that, the performance of BEmONC signal functions was measured to assess health centers' readiness. Regarding maternal and newborn health service delivery, indicators including partograph use rate, active management of the third stage of labor (AMTSL), syphilis testing rate, facility delivery rate, met the need for BEmONC, neonatal sepsis treated, neonatal asphyxia managed, and preterm/low birth weight (LBW) babies given kangaroo-mother care (KMC) were measured. In addition, client-provider interactions and observations of consultations were measured to examine women’s experiences of the services. The table below describes the list of indicators measured and their definitions.
Seven maternity clients, one each from the following client categories–antenatal care (ANC), post‐abortion care, delivery, postnatal care (PNC), childcare/immunization, PMTCT, and family planning clients, in each health center were selected for exit interviews. Likewise, three maternity clients from ANC, abortion, delivery, and PNC in each facility were selected to observe consultations. Interviewers were instructed to select new clients for every category. However, during the absence of the eligible clients, they were asked to interview or observe more clients from a category. As a result, the data were collected using an Android mobile application SurveyCTO collect. The platform allowed data quality assurance through appropriate skip patterns during the interview enabling the entry of only logical values.

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