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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