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Article History

Received: 9 August 2025

Accepted: 31 August 2026

First Online: 1 September 2026

Declarations

Ethics approval and consent to participate: Ethical approval was obtained from the Ethiopian Public Health Association Institutional Review Board with IRB number EPHA-IRB-EPHA/06/583/23 and the Johns Hopkins School of Public Health Institutional Review Board (JHSPH IRB number 24523. The Ethical approvals and consents to participate included in the statement that ‘ experiments on humans/human data and/or the use of human tissue samples must confirm that all experiments were performed in accordance with relevant guidelines and regulations’ . Verbal consent was obtained from each study participant as approved by JHSPH IRB and EPHI IRB. All study participants received information on the study objectives and recruitment process. To protect participants from risks, the study did not record participants’ names, identification numbers and names of health facilities where he or she worked. Data collectors interviewed study participants in a private room without disrupting patient care and other health service activities. After the interview, data collectors put questionnaires in a sealed envelope to keep all answers confidential to anyone at the sample health facility or any other health facility. Data were also entered in a computer with unique randomly generated ID numbers given for each study participant.

Consent for publication: Not applicable.

Authors’ information: JMA: MA, MPH, Senior Human Resources for health management (HRHM) and leadership, management and governance (LMG) Advisor, Jhpiego Ethiopia. ZA: MPH, Jhpiego Ethiopia. SS: MD, MPH HRH Advisor USAID Ethiopia, TT PhD, Research Officer, TY: MD, MPH, PhD, Chief of Party, Jhpiego Ethiopia, FA, M.Sc. PhD Research Director Jhpiego Ethiopia, JS: Professor, Department of Obstetrics and Gynecology, Leeuwarden Medical Centre and Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, the Netherlands, FA Advisor, Jhpiego Ethiopia, MY PhD Professor Bahir Dar University Ethiopia.

Competing interests: The authors declare no competing interests.