A Systematic Review of the Adoption and Utilisation of the Safe Delivery App by Skilled Birth Attendants in Primary Healthcare Facilities in the Amhara Region, Ethiopia

Maternal mortality remains a significant public health challenge in Ethiopia. Mobile health (mHealth) interventions, such as the Safe Delivery App (SDA), have been introduced to support skilled birth attendants (SBAs) in primary healthcare facilities. The Amhara Region has been a focus for such initiatives, but a synthesis of evidence on the app's adoption and use in practice is lacking. This systematic review aimed to synthesise existing literature on the adoption and utilisation of the Safe Delivery App by skilled birth attendants working in primary healthcare facilities within the Amhara Region of Ethiopia. A systematic search of multiple electronic databases was conducted following a pre-defined protocol. Peer-reviewed qualitative and quantitative studies were included. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Data were analysed using narrative synthesis. Five studies met the inclusion criteria. Findings indicate a positive reception of the app, with reported improvements in knowledge and confidence among SBAs. However, adoption was hindered by inconsistent smartphone access, insufficient training, and infrastructural challenges such as unreliable electricity. A key theme was the app's primary use as a job aid for emergency scenarios rather than for routine care. The Safe Delivery App shows potential as a supportive tool for SBAs in the Amhara Region, but its full integration into clinical practice is constrained by systemic and resource barriers. Sustainable adoption requires addressing these foundational challenges alongside digital tool deployment. Future implementation should prioritise reliable provision of hardware and charging facilities, structured and ongoing training programmes for SBAs, and further research on the app's impact on clinical outcomes and its integration into routine workflows. mHealth, Safe Delivery App, skilled birth attendant, maternal health, Ethiopia, primary healthcare, implementation science This review consolidates current evidence on the adoption of the Safe Delivery App in a key Ethiopian region, providing insights for policymakers and practitioners aiming to scale up digital health interventions in low-resource settings.