Midwifery Led Continuum Care Model Cost Effectiveness, Implementation Effect and Challenges in East Gojjam Zone, Northwest Ethiopia: Mega Research Protocol

Introduction The midwife-led continuum care model is an approach backed by research, suggesting that midwives should take the lead in providing primary maternal care. This model has been shown to improve maternity care and reduce complications during childbirth. While various organizations have recognized its value and recommended its adoption, there is still limited research on how this model works in practice, especially in Ethiopia. This study aims to explore the cost-effectiveness, the impact of implementation, and the challenges faced when applying the midwifery-led continuum care model in East Gojjam Zone, Northwest Ethiopia.MethodsThis study will take place in the East Gojjam Zone from April 2025 to March 2026, with a focus on pregnant women, healthcare providers, and health institutions. To gather comprehensive insights, we’ll use a mixed-methods approach. We plan to include 841 participants, with consecutive sampling for the quantitative part of the study.Data collection will involve pre-tested interview questionnaires and chart reviews to ensure accuracy and reliability. We’ll use Epi Info 7 for data entry and Stata 18 for statistical analysis. We'll apply a range of statistical tests such as descriptive statistics, t-tests, Mann-Whitney U tests, and Chi-square tests to explore differences between the intervention and control groups, with a p-value of less than 0.05 being considered statistically significant. Additionally, an activity-based costing analysis will be employed to assess the outcomes and costs.For themes 5, 6, and 7, the sample size will be determined based on when we reach information saturation, and we’ll use purposive sampling to carefully select participants. The qualitative data will be analyzed using thematic analysis to identify key patterns and insights.