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Table 2 Comparison of quality of ANC provision and experiences

From: Improvement of Quality of Antenatal Care (ANC) Service Provision at the Public Health Facilities in Lao PDR: Perspective and Experiences of Supply and Demand Sides

Theme Categories Coding/concept/
theory
Description/definition/meaning
Supply side Demand side
Challenges with quality of ANC service provision Provision of care Poor routine care -Poor physical examination (they could not perform their task properly)
-Did not provide medicine sometimes
▪ Not provide medicine
▪ Better not to come if do not get any medicine
▪ Asked to buy at drug store
Experience of care Poor information providing Health providers could not provide sufficient information or provided very little information ▪ Providing too small information
▪ Never asked family member to listen
  Poor communication -Only few minutes of time spending for individual health education and mostly during physical examination
-Young staff were shy to talk during group health education
-Language barrier for ethnic group
-No counseling process
-No training
-No guideline/materials
▪ Providers talked very little without explanation
▪ They did not understand
▪ Family member know nothing
▪ Did not ask question
Respect & dignity No privacy and confidentiality -Room needs to be shared with multiple women due to insufficient space
-Overhear of conversation due to crowded area, open window, no closed wall
-Providers did not ask permission before examination
-Only few staff considered these issues as medical ethic problem).
▪ Often sharing the room
▪ Do not like other people to see their body and hear about their in formation
▪ Feel very ashamed
▪ Do not want to come if not necessary
Treat unequally Not mentioned/not perceived ▪ Providers paid more attention and treated better to the richer, relative, and or those who paid extra/additional money
▪ The poor hesitate to go to visit ANC afraid that no extra money to provide
Inappropriate behaviour Angry and aggressive ▪ Angry, aggressive, act as investigator, ordering advice, speak too load and very rude
Negative attitude -Bad mood due to work load, high pressure due to many clients with small staff, multiple duties, time limitation, very tiered, home stress
-shy to talk very nice/soft voice, and do not want to be the only person who greeted to the women and family
-Norm
▪ Unwelcome to patients
▪ Not friendly
▪ Not smile
▪ Bad mod sometimes
▪ Not polite
Competent Lack of qualified staff
Lack of Skill
MCH trained staff were assigned to move to other wards
-No training for new and young staff to provide care
-Without training, some providers could not perform examination and providing information properly
▪ Not satisfy/happy with providers’ performance (eg. Performed very fast for physical examination, and did not tell anything
Motivation No intensive -Low salary consideration
-Designed by themselves to work at other wards where working based financing
-No policy to support for motivation increment
▪ Not mention
Essential physical resources Insufficient space -Not enough room, it needs to be shared during physical examination and providing information
-Waiting area is very crowed
▪ Small room and not enough room, very crowded waiting areas
Lack of staff -Increasing number of visitors.
-Not enough staff to provide care due to be assigned to move to work for other wards
-Some decided by themselves to work for other wards where they can get incentive
▪ Sometimes could not see service providers at health facilities (in the community)
▪ Waiting very long time because of few staff perform their duties
Lack of material -Insufficient health education materials
-due to distribution problem and lack of budget at the lower level)
-No specific IEC material to bring home
▪ Not use material for providing information
▪ No specific materials to bring home
Lack of guideline -No specific guideline to provide care at health facilities ▪ Not mentioned
Lack of medicine Not enough basic medicine in the routine care ▪ Not provide medicine, but also asked to buy at drug store