Service provision assessment (SPA) is a survey of health facilities formulated to providerninformation on the general functioning of outpatient services related to basic maternal, child,rnand reproductive health. It measures the presence and functioning of components that arernconsidered essential for the provision and maintenance of good quality health services.rnQuality of health care is a useful reference in the formulation of practical approaches tornquality assessment and improvement.rnThe study was conducted in Tikur Anbess General Specialized Hospital on Maternal andrnChild health care, in child health care, family planning and antenatal care clinics.rnObjective of the study was to describe strengths and weaknesses, adherence to standards, andrnclient-provider satisfaction in child health, family planning, and antenatal care health services.rnThis study was a descriptive cross-sectional study undertaken using quantitative method.rnThe study used four different data collection instruments, such as: Exit Interview, ProviderrnInterview, and Observation, and Inventory.rnA total of 450 clients and 130 service providers were involved in the study.rnOne of the most important components to assess the quality of MCH Service Provision wasrnClient exit interview conducted among sick child caretakers, family planning, and antenatalrncare clients.rnThrough the exit interview it is revealed that elements of quality of care such as importantrnprocedures during the hospital visit were made. Majority of the clients, through exit interviewrnbelieved that the providers perform most of the tasks and procedures during their visit. Thernclient's response was also proved to be similar with the findings of performance observation.rnviiirnImportant procedure such as reviewing record before starting the session and check aboutrnprevious history measuring pulse rate, blood pressure and temperature.rnMore than 75% of the clients in all the three clinics rate the service they got in the hospital asrnvery satisfactory and this showed their positive opinion on the usefulness of informationrngiven by providers, and degree of satisfaction the way both health workers treated them.rnHowever, the interview indicated gaps in the provision of health education to clients such asrnproviding materials and take home messages. The caretaker's interviews supported thernobservation findings that provision of education materials to the clients is not commonrnpractice.rnThe four most common suggestions made by clients to improve quality of services accountedrnfor more than 50% of total suggestions. In all the three-study area and the suggestions wererndirected towards increasing space, regularly available doctors, increasing motivation ofrnproviders and increasing number of providers.rnThe other areas, which were given or strongly addressed by most clients, were improvementsrnto the physical environment of the hospital, which are hygiene/cleanliness increasing numberrnof hours, improve supply of drugs.rnIn all the three clinics only very few providers were observed thanking caretakers forrncooperation or thanks ANC or FP client for coming to the hospital and for her time.rnThe other weakness observed and needs due consideration by the management of the hospitalrnis the extreme shortage of washing facilities. Thus none of the health providers in the sickrnchild and ANC clinics were observed washing hands and dries them. This elementary andrnbasic hygienic practice must be dully addressed. Unlike the contemporary and increasinglyrnaccepted practice such as in IMCI service only 4.8%, were observed giving the first dose ofrnixrnthe oral treatment they prescribed and less than 20% discussed the childâ€™s growth chart withrncaretakers.rnDespite the strength of carrying out procedures such as telling the caretakers what illnessesrnthe child has and ask about normal feeding when the child is not ill and check for pallor, inrnmore than 90% of the observations the providers were not observed discussing and givingrnadvice on the childâ€™s health. Thus there is a need for also for communication skill.rnA very important practice which should be taken as a strength and that has to be encouraged isrnprocedures such as checking BP, weight, tempreture are well carried out. All observationsrnrevealed that in the sick child clinic the weight of all children were taken and above all thernmeasurement was plotted on the growth chart and recorded on the child chart.rnThe observation showed that the FP and ANC clinics adequately ensured visual and auditoryrnprivacy.rnDespite the strengths important elements of a family planning clinic need considerations.rnImportant procedures such as discussing partner attitude toward family planning andrndiscussing using condoms as dual method for preventing STI and pregnancy are carried outrnby few.rnThe study also identified the lack of clear job description, standards and guidelines and alsornthe presence of a lot of resentment about the lack of Motivation and Incentives such asrntraining opportunity and promotion.rnDespite the strengths of the OPD services it is clear from the study results that providers werernnot performing the range of tasks in a comprehensive health service care. In particularrnprovision of health education, pertinent advises on family planning pregnancy care andrngrowth monitoring.rnOn the basis of this study recommendations are forwarded to Improve or enhance therntechnical supervision of the health service delivery system, clarify job expectations of thernhealth service providers through creating and disseminating job descriptions, seekingrnmechanisms and strategies that enhance community's positive influence on health workersrnand designing mechanisms for increasing provider motivation through monetary and nonmonetaryrnincentives.