Table 2 Comparison of quality of ANC provision and experiences
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 | ||