In this study, we investigated the quality of Comprehensive Emergency Obstetric and Neonatal care (CEmONC) in level IV health facility of Ankole region in Western Uganda. Specifically, we looked at the inputs, proxy measures of processes (CEmONC signals), outputs and outcomes of CEmONC care. In this descriptive cross-sectional study, we employed triangulation-mixed-methods research approach. CEmONC service points (level IV health facilities) of Ankole region were the target while level IV health facilities actively providing CEmONC services formed the study population. We purposively selected 11 health workers with presumed experience and “knowledge” on delivery of CEmONC services for interview. We found that human resource for health met the 75% of the staffing norms in most of the health facilities. However, critical cadres like laboratory staff, anesthetic officers, nursing officer-midwifery were lacking in some health facilities. In addition, critical CEmONC staff like doctors and nursing officers-midwifery had a big chunk of their time on administrative duties. The staff did not receive relevant (CEmONC-related) trainings in recent times. The health facilities generally did not meet the equipment and infrastructure standards for provision of CEmON. All the deficiencies in inputs resulted into poor delivery of CEmONC signals – only one health facility of the 11 provided all the nine CEmONC signals. The interaction between poor inputs and processes resulted into either referrals of conditions needing certain procedure or mortality. We concluded that, despite global human resource for health meeting the Uganda Ministry of Health minimum level of 75% in virtually all the health facilities, lack of relevant in-service trainings, poor attitude and non-professional assignments hampered their provision of CEmONC in Ankole. As a result (of inadequate inputs), many CEmONC signals were majorly not provided or of poor quality and these most probably resulted into poor neonatal outcomes though we could not make direct attribution. It is imperative that, district local governments, Uganda Ministry of Health, and health development and implementing partners devise means to provide the required inputs, rationalize the deployment of CEmONC personnel to non-technical work; monitor and respond to occurrence of unwanted events like fresh still births; and maternal and neonatal deaths in real time.

Emergency Obstetric and Neonatal Care, CEmONC, Quality of Care, Level IV Health Centre, Ankole, Uganda