A Meta-Analysis of Partograph Implementation Fidelity for Labour Monitoring in Primary Healthcare Facilities in the Amhara Region, Ethiopia

**Abstract** The partograph is a vital tool for monitoring labour and preventing maternal and neonatal complications. In Ethiopia's Amhara region, primary healthcare facilities are the main providers of obstetric care; however, concerns exist regarding the consistent and correct application of this tool in clinical practice. This meta-analysis aimed to determine the pooled level of implementation fidelity—defined as the degree to which the partograph is used as intended—for labour monitoring in these settings. A systematic search of multiple electronic databases identified relevant observational studies. Inclusion criteria encompassed studies reporting quantitative data on partograph utilisation, completeness, or correct interpretation within Amhara's primary healthcare facilities. Data were extracted, and a random-effects meta-analysis was performed to pool proportions. Heterogeneity was quantified using the I² statistic. The pooled analysis revealed low overall implementation fidelity. The correct completion of all essential partograph parameters was achieved in only 34% of documented cases (95% CI: 26–43%), with significant heterogeneity observed (I² = 92%). This indicates a substantial gap between clinical protocol and actual practice, which undermines the tool's potential to improve labour outcomes. Urgent, multifaceted interventions are required, including enhanced training, supportive supervision, and addressing systemic barriers such as staffing and resource constraints. This synthesis provides a consolidated regional estimate, highlighting a critical quality-of-care issue to inform evidence-based policy and practice. **Keywords:** partograph, implementation fidelity, labour monitoring, maternal health, primary healthcare, meta-analysis, Ethiopia