Objective: This study aims to identify the level of Health system responsiveness (HSR) to childbirth care and its predictors using a multi-center study approach in public hospitals of Sidama Region, Ethiopia. Design: A multi-center institution based cross-sectional study was employed . Setting: Sidama Region, Ethiopia Population: A 536 postpartum mothers who gave birth at Public hospitals Methods: An institution-based cross-sectional study was conducted among 536 mothers who gave birth in public hospitals in the Sidama region. Systematic random sampling was employed to select study participants. Data were collected using a structured, pretested questionnaire. The HSR was dichotomized, and binary logistic regression was used. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to determine the independent predictors of HSR to childbirth care. Level of significance determined at p-value of less than 0.05. Main outcome Measures: determining the level of HSR and its influencing factors Results: The study revealed that 47.9% (95% CI: 43.73% to 52.19%) of mothers reported that health facilities provide good HSR to childbirth care. After controlling for potential confounders, being an urban resident [AOR=1.88; 95% CI (1.30, 2.74)], having ANC follow-up [AOR=1.73; 95% CI (1.15, 2.61)], experiencing obstetric complications [AOR=0.61; 95% CI (0.39, 0.95)], and being satisfied with the services provided [AOR=1.60; 95% CI (1.11, 2.31)] were significantly associated with HSR to childbirth care. Conclusions: Nearly half of the mothers reported receiving responsive childbirth care in Sidama Region. The findings of this study highlights that promoting antenatal care, preventing obstetric complications, and enhancing client satisfaction with services provided by improving the quality of childbirth services are critical for achieving a responsive healthcare system to childbirth care. The finding implies that urban-rural disparities need targeted interventions to tackle inequalities and improve the health system responsiveness to childbirth care regardless of where women reside.