Background: According to Donabedian, assessment of quality of care includes three dimensions: structure, process, and outcome. The present study focused on to identify and measure structural quality of Ethiopian Health facilities to provide Antenatal care (ANC) service.

Methods: Data from Ethiopian Service Availability and Readiness Assessment (SARA) survey were used. It was a cross-sectional facility-based assessment conducted to capture health facility service availability and readiness in Ethiopia. The assessment involved representative health facilities across the country and data were collected from October- December, 2017. The assessment has focused on availability of equipment, supplies, and medications, and health worker’s training and availability of guideline in 764 selected facilities. Health facilities were selected from 9 regional and 2 city administrations. We ran multiple linear regression models to identify predictors of Antennal care service readiness at all surveyed facilities. Statistical tests were done at a level of significance of p < 0.05.

Result: Among the selected facilities, 80.5% reported availability of ANC services. However, the service availability for tetanus toxoid vaccination, folic acid and iron supplementation, and monitoring of hypertension disorder was low, 67.7%, 65.6%, 68.6%, and 75.1%, respectively. Among the identified ten tracer item that are necessary to provide quality ANC services, the overall mean tracer items availability was 50%. In multilinear regression model, health centers, health posts, and clinics scored lower ANC readiness compared to hospitals. The overall readiness index score was lower for private health facilities (β = -0.047, 95%CI: (-0.100, -0.004). The ANC readiness score had no association with location of facilities (p-value > 0.05). Facilities in six regions except Dire Dawa (β= 0.067, 95% CI: (0.004, 0.129) had lower overall ANC readiness score than facilities in the Tigray region with (p-value < 0.015).

Conclusion: This analysis provides evidence of the gaps at national level for the provision of quality ANC. Key supplies for quality ANC service provision were found to be missing in many of the surveyed health facilities. Guaranteeing properly equipped and staffed facilities in addition to ensuring the presence of trained health workers and equipment availability is a mechanism for continuous effort to improve facility-based care.

Key Words: Antenatal care, Ethiopia, Quality, Structure, Input