No shortage of PPE in this HC. But midwives are reluctant the utilization of these PPE for every labor and delivery care service. They usually use them when more than one delivery clients come at a time. This is because of the negligence that midwives have towards using these PP". [late twenty years old male HC head]
Moreover, personal protective equipment (surgical glove, goggle, apron) and national delivery care guidelines were available in all HCs (Table 3). According to the results indicated by key informant interviews, the personal protective equipment was not being utilised well despite their presence in the HCs.  
The overall availability score of the delivery service was 78.5%. Medical equipment items, parenteral IV infusions, and delivery care guidelines were 100.0% available in all HCs, whereas the availability of rooms for laboring, delivery, and postpartum per national standard was only in one-fourths of HCs (Table 4). 
The use of partograph for all mothers admitted in labor is recommended. But midwives do not plot findings on the partograph throughout the labor process. This is because of both the negligence and lack of refreshment training of health workers on partograph utilisation. [male HC head]
In the client's medical record review, a history of present pregnancy like gravida, parity, and ANC visits was recorded for 87.5% of mothers. About abdominal examinations such as fundal height, fetal position, fetal descent, and fetal heartbeat were recorded for 62.5%, 46.9%, 56.3%, and 65.6% of mothers, respectively. Furthermore, vaginal examination at the initial assessment; status of the membrane (68.8%), cervical dilation (81.3%), and fetal presentations (78.1%) were documented. Additionally, some recording files were not safely kept to be easily accessed whenever necessary; they were not also stapled together and had no folders. During the direct observation, monitoring of labor using partograph such as plotting cervical dilation and maternal blood pressure every four hours were observed to be practised for 72.0% and 65.6% of mothers, respectively. 
Washing before and after every L&D care procedure is essential for the mothers and ourselves to prevent infections. But we sometimes attain delivery care without washing hands, simply by wearing gloves. Because we do not have access to water near to the delivery room since there is no hand washing basin in the delivery room [female midwife-nurse delivery service coordinator].
Furthermore, the health-care providers had washed hands during delivery preparation and used sterile gloves for 50% and 96.9% of births, respectively. 
Likewise, health-care providers were observed to be adhered to checking the completeness of the placenta and contraction of the uterus after the delivery of the placenta for 81.3% and 65.6% of delivering mothers, respectively. On the other hand, 71.9% of births were recorded in the medical record and 75.0% of newborn babies have started breastfeeding within an hour. Moreover, 53.0% of delivering mothers were checked for blood pressure every 15 minutes after the complete delivery of the placenta (Table 5). 
The overall score of the compliance dimension was found to be 70.6%. Moreover, the proportion of clients who were checked for completeness of placenta was 81.3% which was the highest score and the proportion of delivering clients checked for vaginal bleeding every 15 minutes in the first hour after delivery of the placenta were 59.0% rated as the lowest score under the compliance dimension (Table 6). 
A total of 363 mothers participated in this study. One hundred thirty-two (36.4%) of mothers were aged 25-29 years; the mean age was 26.6 (SD: +-4.8) years. Religious preference for 80.4% was Orthodox; 80.4% were urban dwellers. About 88.2% of them were married; 32.2% went to secondary school (Table 7). 
Nearly 12% of mothers' recent pregnancy was unplanned. Fifty-eight percent of mothers had ANC visit four times and above, 59.0% of mothers were multigravida and 56.7% had two or more deliveries. Seven percent of the mothers ever had a history of abortion. On the other hand, 3% of mothers ever had a history of stillbirth. Moreover, 96.4% of mother had spontaneous vaginal delivery (SVD) which was the predominant mode of delivery and 2 (0.6%) of delivery ended with newborn death (Table 8). 
There is only one toilet in the HC. The toilet has no hand washing basin and it doesn't get clean regularly because of shortage of water accessibility in the HC. We have informed the head of the HC to discuss different stake holders on the possibilities of building additional toilets and water accessing full days. [female midwife-nurse]
Out of the respondents, 65.6% were perceived that the waiting area was convenient. Nearly two-thirds of mothers were satisfied with the cleanliness of the delivery room. The majority (93.3%) of delivering mothers were satisfied with the delivery room's light and air condition. About 72.5% of delivering mothers were satisfied with the waiting time; 85.0% were satisfied with the delivery room's silence and 48.6% were satisfied with the appropriateness of proximity of the toilet. 
Further, the level of mothers' satisfaction regarding the accommodation of delivery service structure was 68.8% (Table 9). 
The finding of the evaluation showed that the overall acceptability level of delivery service was 80.2%. Of this, 80.4% of mothers responded that health-care providers answered their questions and concerns during delivery care service, and 67.0% accepted the information given by health-care providers about the benefit and side effects of medical treatments and procedures. About 77.7% of mothers accepted the courtesy of health-care providers. The evaluation also showed that 83.8% of mothers were informed about the procedures of the L&D care. Moreover, 94.2% of mothers were responded to recommend the HC's delivery service for friends and families (Table 10). 
In our analysis, residence and having ANC during the recent pregnancy were the factors that affect the delivery services. Accordingly, the odds of acceptance of delivery services by rural dweller mothers is significantly lower compared to mothers from urban areas (AOR: 0.13; 95% CI: 0.06-0.30). Mothers who had ANC visits of 1 to 3 compared to mothers who never had any ANC visit (AOR: 2.65; 95% CI: 1.05-6.74) and mothers who had ANC4 or more visits compared to who never had any ANC visit (AOR: 5.57; 95% CI: 2.09-14.84) had significantly higher odds to acceptance delivery services (Table 11).