Assessment of Health System Readiness for Pregnancy-Related Maternal Health Issues in Low- and Middle-Income Countries: The Case of Ethiopia and Selected Sub-Saharan African Nations – A Systematic Review

Background Maternal mortality in Sub-Saharan Africa (SSA) accounts for nearly 70% of global maternal deaths. Health system readiness to manage pregnancy-related complications remains inadequate in most low- and middle-income countries (LMICs). Objective This systematic review assesses health system readiness for maternal health services, with Ethiopia as the primary case study and comparisons with Kenya, Nigeria, and Tanzania. Methods Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, African Journals Online and grey literature (2015–2025). Thirty-five studies were included after screening 1,500 records. Readiness was evaluated using WHO Service Availability and Readiness Assessment (SARA) and emergency obstetric care (EmOC) indicators. Results Only 7–52% of designated facilities provide full basic or comprehensive EmOC. Oxytocin stock-outs affect 28–42% of facilities. Skilled birth attendance averages 65.6% but quality-adjusted coverage drops to 48.9%. Ethiopia has expanded community outreach through its Health Extension Program, yet severe rural–urban and workforce gaps persist. Promising interventions include results-based financing (Tanzania), task-shifting (Kenya), and digital supply-chain tools (Ethiopia). Conclusion Urgent, context-specific investments in human resources, essential medicines, referral systems and equitable financing are required to achieve SDG 3.1 in SSA.