Dissertation on Adapting and Piloting Respectful Maternity Care Study

This dissertation focuses on adapting and piloting respectful maternity care (RMC) within the context of Ravalpindi, Pakistan, utilizing a qualitative methodology grounded in grounded theory. The research involved in-depth interviews with 64 participants, including gynaecologists, nurses, health workers, hospital managers, and pregnant women, to gather insights into maternity care experiences in public sector hospitals. Data collection methods included focus group discussions and personal interviews, conducted in languages other than English and subsequently translated. The study explores themes related to the level of care, barriers to RMC implementation, patient privacy, differences between public and private services, and challenges faced by patients accessing RMC. The findings aim to inform improvements in maternity care practices and address issues such as mistreatment and lack of respect during childbirth.

Dissertation Adapting and
piloting respectful maternity
care

Table of Contents
Chapter 3 – Qualitative Methodology..............................................................................................3
Study Area...................................................................................................................................3
Study Design & Participants........................................................................................................3
Data Collection Activities............................................................................................................4
Data Analysis...............................................................................................................................7
CHAPTER 4 – RESULTS...............................................................................................................8
Themes associated with level, sub-themes and the categories..................................................8
Analysis of in-depth interview.......................................................................................................14
Theme1- In-depth Interview (IDI2) at managerial level................................................................14
Theme 2-Analysis of In-depth interview.......................................................................................17
2.1 Barriers associated with the implementation of RMC.............................................................17
2.2 Privacy of the patient in RMC.................................................................................................18
2.3 Difference in the public and private services in relation to RMC...........................................19
2.4 Issues faced by patient in visiting RMC..................................................................................24
REFERENCES..............................................................................................................................29

Chapter 3 – Qualitative Methodology
Study Area
The study was regulated in Ravalpindi, it is situated in Punjab, Pakistan. The area of
district Ravalpindi is divided within 7 Tehsils, the government is 3rd tier which is below the
provincial and federal levels. Ravalpindi have 223 hospitals in total which is situated in the
district areas.
The conducted study has come into contact with the public sector hospitals. These
hospitals were chosen because they can provide accurate information which is necessary for
analysing the way maternity care is carried out. These hospitals provided insights related to the
experience of the women who were visiting those hospitals as well as various worker of the
hospitals. The manager, gynaecologist, health care staff and various other people who are
involved in the hospitals were providing the necessary information for the study. The child birth
rate is more than the death rate, also this contains various females who are suffered from bad
maternity care which lead to death of child or the mother.
Study Design & Participants
The approach used in the study is Grounded Theory. Grounded theory is a type of
research method which allow the researcher for developing a theory that helps them to provide
an explanation about the issue (Chun Tie, Birks, and Francis, 2019). The important concern
related to the population is of substantive area and the manner in which it is concerned to
resolving or processing. This theory is mostly used during qualitative research as it helps to
understand the criteria in better manner. One of the main benefit of using grounded theory is that
it include Ecological Validity. Ecological validity is defined as the limit till which research
findings is represented accurately in the real world (Lambert, 2019). The research type is said so
because it is closely connected to the participants from real world.
This is a type of theory which is not connected to any previous theory, it is often new and
fresh. It provides various new potential for the discoveries of novel in science as well as various
new areas. This type of research provides various guidelines which are explicit as well as
sequential which helps in regulating the qualitative research. The grounded theory present
strategies which are specific for operating phases of inquiry which are analytical. Grounded

theory offers methods which help to streamline and integration of data collection as well as
analysis. The theory is suitable for the current research as it is related to the qualitative research.
Sometimes it happens that the researcher using grounded theory put their focus on
preparing hypothesis, replicability, reliability and variables. This will affect the findings of the
research as the focus will be distracted. It is also not acceptable to ignore the existing theories as
sometimes they provide insights which the author is not able to provide. The researcher should
provide importance to the existing literature. The theory provides various complex methodology
as well as terminology which will have confused the researcher. It will not provide any practical
orientation related to the area of research as well as data analysis.
There were around 64 participants who were interviewed. The Participants in the
qualitative survey were gynaecologist who were working at private clinic and Tehsil Head
quarter. There were various lady health worker and staff nurses working at Tehsil Head quarter
& District Head Quarter as well as pregnant females who were visiting the private hospitals.
Also, there were health worker, civil society member, health worker at lady health visitor,
hospital and participant at Tehsil Head quarter. These people were interviewed for gaining the
insights of various questions related to the care for maternity. These people are those who are
responsible for the care of the pregnant females either visiting or admitted.
Data Collection Activities
It is a process which helps the researcher to gather as well as measure the information
which is related to the variables of interest (Snyder, 2019). It is in established systematic fashion
which help to enable an answer which is mentioned in the research question. The study is
conducted on qualitative data which is collected through various focus groups discussion as well
as personal interviews. This data was collected by forming the questions which is relevant to the
information required (Pandey, and Pandey, 2021). It is because it will help us find the answer to
the research question related to the topic.
Study Population
The study populations consist of various health care workers as well as staff members.
This people were working in the Tehsil head quarter as well as district head quarter. This people
are the ones who can provide accurate information which is necessary for the research to get
complete. The population of the research also consist of various managers as well as females

who were visiting the hospitals for check up. This people were asked to provide their experience
in the hospitals so that they can grab the knowledge which is related to the public sector
hospitals. The people interviewed were informed that the privacy of their data will be
maintained, and various other information which was necessary for them to know before
providing information to the other person. The interview questions were providing various
information which will help while making the decision which will help to find the answers to the
question of which is necessary for the research. This people interviewed were the ones who came
into contact with the hospitals and know the necessary information which will help the others
while making any sort of decision. The population studied will be providing information which
is reliable for the researcher.
The study also include focus group discussion. In focus group researcher takes
participation in the people who are assembled for discussing on a particular topic (Zangirolami-
Raimundo, Echeimberg, and Leone, 2018). Here the researcher is able to get the necessary
feedbacks from various people who have been through the same situation. In this researcher gets
various sort of ideas which is beneficial for its final result. The data gathered from the focus
groups will provide both side of the maternity care facility which is good and bad. The people
will provide their experiences during the maternity care period or when they visit the hospitals.
There are various focus groups which will be attended by the researcher for collecting the
required data for the research. This will eventually help the researcher to compare the data which
is gathered from the interview as it will help to analyse the reliability of the data. Focus group
has answered various questions for the author which will eventually help him to complete the
report. There were various key informations which was gathered with the help of Interview as
well as focus groups (Mukherjee, 2019). These are the type which is suitable for the researcher
as it provides information which is necessary for the research.
Sampling Techniques
Sampling techniques helps the researcher for selecting the participants necessary in the
research or any set of population which can help to make statistical inferences (Bairagi, and
Munot, 2019). This helps the researcher to while estimating the characteristics of the necessary
population. The study has chosen 64 participants who are health care providers and working in
the maternity care hospitals. These participants also include the pregnant females who are

visiting the public hospitals for check up. This sample is chosen because they will be providing
the information which is accurate and will help in the research. Health care provider are situated
in the Tehsil Head Quarter as well as District Head Quarter. Among the participants there are 2
managers who are Human resource manager as well as hospital manager. This people will be
providing the information which is useful for conducting the research as the data gathered by
them will be reliable.
This people are working in the maternity care hospitals, so they can easily provide the
required information. Maternity care is important for the females as their lives are dependent on
the nursing staff. The information of these participants is not being disclosed because of the
privacy issue of those people. This people who are involved with the health care are the ones
who will be providing the information which is necessary for the research. This people will be
answering the questions which is fixed by the researcher suitable for answering the research
questions. Females who were interviewed were visiting the hospitals for their regular check up
and the information provided by them will help the researcher while making the decision which
is suitable for the research. This will eventually provide the insights which will help the
researcher for analysing the quality of care which is provided to the pregnant females.
Researcher has chosen this participant because the information collected from this participant
will be important for the accuracy of the research as they are providing. The data on which the
researcher can depend upon while arriving at the conclusion. The data will have various factors
which will provide the information regarding the quality of care undertaken by the researcher
(Kumar, 2018).
Data Collection
Information in the study is collected with the help of attending focus groups and
undertaking interview of various people who are responsible for the health care of pregnant
ladies. The data was also collected with the help of reviewing various previous studies which
helped in gaining more information about the study. The study was conducted on various levels
and analysed the abuse which the women are facing during their routine check up when they are
pregnant. This eventually show the things which they are facing during the process of giving
birth to a child.

The focus group discussion was conducted in language other than English. The
discussion was recorded by the interviewer and then it was written in the document in English
language to understand the responses of the patients in better manner. There were various
participants who had different point of view on certain topics. The discussion was conducted
with privacy to ensure that the feedback of those patients and their information was not disclosed
to anyone. It provided relief to the patient to ensure that there information will not be disclosed
to anyone. The personal interview was also conducted in language other than English, which was
also converted in document to understand their viewpoint. This interview was conducted
privately of various people such as health care staff, nurses, patients and various other. The
interview was recorded to understand the viewpoint in better manner after the interview is
conducted.
The study was conducted fact to face with the participants and their consent was taken in
written. After the approval the discussion was recorded to have the knowledge which will help in
the future. The responses of the participant were confidential and voluntary to ensure their safety.
The participants were informed that they can back out from answering the question and sharing
their viewpoint. This ensured that the participants will be comfortable while talking about their
issues. They were not obliged to provide answer to their question as there was no repercussions.
The interview recording was converted into a document and then it was stored safely to ensure
no one can get the information collected.
Data Analysis
For analysing the qualitative data inductive approach is used in which grounded theory is
used on the information collected with the interview during the process. Initially the responses
were recorded and then documented in English language then it was analysed with the help of
the theory. Some of the responses which were collected with the help of interview and focus
group discussion were quoted in the document to understand the concept in better manner. The
themes which were analysed with the help of focus group discussion and interview were guiding
the researcher in developing an initial code framework. After the coding it was compared with
the document made from the recording to compare the area which lack in the research. The
themes of the research is providing various information which is necessary to understand to the
things which pregnant women face in the hospitals.

CHAPTER 4 – RESULTS
Themes associated with level, sub-themes and the categories
Level-theme Perspectives
of service
user\
service
provider/
civil society
member
Sub-themes Categories Description
reference to
themes
Reference
to theme
Interview at
managerial level
Managers  Barriers in
implementation of
RMC
 Status of patient
 Difference in
public and private
services
 Policies of RMC
 Deficit reason for
policy
 Grievances
Redress
mechanisms in
 Negative
experience
 Emotions
 Responsibilities
 Judgemental
 Lack of
responsibilities.
Problems
associated with
the patient.
9

RMC and its
effects
 Demand status at
community level
 Strategies for
promoting RMC
 Staff training.
Barriers
associated with
the
implementation
of RMC
Service
provider
civil society
member.
 Privilege to
politician
 Physician not
assure proper time
 Lack of policies
 Lack of
responsibility
 Lack of support
Major barrier in
the
implementation of
RMC from
service user
perception.
3
Privacy of
patient in RMC
Service
provider
civil society
member.
 Physical
examination of
patient
 Abusive language
to staff
 Self-worth of
patient
 Unethical
behaviour
 Lack of ethics
 Discrimination
 Dignity
 Morals
Disturbance in the
privacy of patient.
4

Difference in
public and
private sectors
services
Service
user, service
provider
civil society
member.
 Extent of
difference.
 Issues faced by
patient
 Status of the
patient matters in
RMC
 Scenario at the
time of delivery
care
 Issues faced while
experiencing
public services
 Workload over
staff
 RMC and
government
policy
 Lack of RMC
initiatives
 Lack of
accessibility.
 Lack of strategies.
 Lack of
management
 Lack of
accountability
 Discrimination
Difference exist
among public and
private sector
services
8
Issues faced by Service  Practices of RMC  Lack of privacy Hurdles faced in 9

patient in visiting
RMC
user\
service
provider
 Privacy concern
 Behaviour of
doctors
 Deficit policy
 Pattern of
workload
 Financial crisis
 Unethical
practices
 Lack of care
 Abuse
 Lack of
accessibility
 Lack of availability
 Lack of
knowledge.
visiting RMC.
Right of patient Service
user\
service
provider
civil society
member.
 Selection of
doctor
 Cleanliness
 Post period care
 Proper
information
 Privacy protection
No motivation
Emotional fluctuation
Need for integration
The major rights
of the patient
5
Experience of
patient
Service user
civil society
 Experience after
delivery
Worst experience
Physical and mental

member.  Waiting time at
maternity care
services
 Lack of option
impact
Lack of interaction
Need for evolving
Suggestion Service
provider
 Proper monitoring
 Government
policies
 Accountability
 Proper procedure
in relation of
registering
complaints
 Focus on privacy
 More policies in
this context
 Creating
awareness
 Behaviour of
nurses
 Training practices
 Ethical behaviour
 Role of media
Need for strategies
Need for provision
Support towards patient
Creating awareness
Practices can be
improved in
RMC.
14

Analysis of in-depth interview
Theme1- In-depth Interview (IDI2) at managerial level
Barrier in implementing RMC in the hospitals
From the interview it was analysed that, RMC is not being practised properly in the
country. Mainly because it is facing various sort of issues while implementing the RMC in the
hospitals. This is affecting the quality of health care received by the pregnant females. As they
face various issues during the birth process. The view regarding the barrier faced during the
implementation of participant is that “There are countless barriers. Abuse and disrespect are one
of the major barriers. Our hospital staff usually do not respect their patients. Staff abuse the
patients who scream or make noise.”. This is not good for the health of the patients as they are
not able to get the respect they need in during the time of their pregnancy. Information of the
patients does not remain confidential by the staff of the hospitals. This is against the right which
a patient have while visiting the hospital. They are also not shown sympathy which is not good
for their mental health. As it affect they peace of mind during the crucial time of pregnancy.
Their privacy is not respected in the hospitals as they are being examined in the presence of other
patients. Doctors in the hospital does not take consent of the patients in any decision such as
conducting C-Section or examining their progress. This is not good for the patients as they feel
like they are not being cared properly as they should have been treated.
Does status of Patient matter during delivery and issues faced by patients while visiting
From the interview it was analysed that, status of the patient definitely matter when it
comes to the post pregnancy care of the female. The participant said that “VVIP culture and
bribery that were assumed to push doctors to compromise the quality of care for general care
seekers. The MNAs and MPAs have disrupted the system.”. This will eventually affect the health
of the other females patients as they are not being treated properly during they need the care of a
doctor. The people who do not have any reference or are not able to pay bribe, they are not being
taken to the operation theatre. This is depicting that the hospitals are not able to fulfil their duties
of keeping their patients safe from any sort of problem.
There are various issues which are faced by the patients who are poor as they are not
being treated properly. As per the response of the participant the patients are not being asked
about their problems instead they are being handed various test which are to be completed. The

doctor in the hospital does not even examine the patient to analyse that there is any problem or
not. This is affecting the health of those patients either mental health or physical health. This is
against the ethics of the doctor as they should provide support to their customers and provide
respect to their problems.
Difference in services of Private and Public Hospitals
As per the response of the participant there is definitely difference between the services
of private as well as public hospitals. The public hospitals have those patients who are poor, does
not have proper information, are illiterate, and their background is rural. This is leading to the
staff taking the patient for granted and does not provide the services which are important for a
person to have. Their behaviour towards those patients is not appropriate as they use abusive
words or take help of violence when the patient is not behaving as per their wish. Whereas in
private hospitals the patients are educated as well as maintain a good social status of their family.
They are able to pay the higher fee of the private doctors, so they are getting the good quality
care in the private hospitals. The difference is vast as both the patients are getting different sort
of treatment which is affecting the health of the pregnant females.
Policy regarding RMC and its implementation
It is analysed from his response that government is not taking any actions regarding the
policies which are important for the pregnant females to have as well as in any other type of care.
The response of the participant is that “As per my knowledge, I don't think so that anything has
been done at policy level in my province.”. It is analysed from his response that government is
not taking any actions regarding the policies which are important for the pregnant females to
have as well as in any other type of care. It is beneficial for the patients to have support from the
government which they are not getting and facing the issues which is not suitable for their mental
and physical health. The HR manger thinks that there is no such criteria where the policies will
be made and implemented in the health care hospitals to ensure the safety of the females and
other patients in the hospital.
As per the analysis of the response it is analysed that there is no such thing mentioned in
the policies regarding the behaviour which the nurses should provide to their patients. The
system does not have any type of checks and balances, the services provided by the healthcare
15

professional is based upon the trainings they receive. This is not good for the implementation of
the services which is necessary for the person to have during their visit to the hospitals.
The reasons RMC is lacking in the hospital is that the stakeholders does not have any
interest in the policy for the patients. The services which are discussed by the politicians are not
more than a slogan which is affecting the working of the health care staff. The staff behave
rudely to their patients which is leaving a negative effect on their viewpoint.
The participant does say that the makers of the policy does not take the matter seriously
as they are not affected personally which leads to lack in the sympathies for the general public.
Even the social workers and media are not able to support the patients which they have
knowledge about the issues which are faced by the females.
Reasons for deficit in policy
As per the analysis there are various reasons which arise from both the parties. As patient
does not have any awareness regarding their rights, whereas the health care staff does not have
proper training which can ensure proper care for the patients. The public take it as their fate
while the health care workers does not focus on public health. The deficit is created because of
both the sides.
Grievances Redress mechanisms in RMC and its effects
As the analysis conducted it is noticed that there are no grievances redress system. The
participant said that “In tertiary hospitals, there are complaint boxes but no one bothers to check
it and consider the grievances”. This is not good for the patients are there are no one to listen
their problems. The grievances redress mechanisms will ensure that the patient know where to go
for their complaint. It will help the patient to improve the quality of services they receive from
the health care staff.
Demand status at community level
From the interview it was analysed that, for improving the demand it is compulsory to
improve the awareness as it will ensure that the public will know the things which are not good
for them. Also, they should know about redress mechanisms to ensure they can express their

concerns. There are various people who are poor and does not know about their rights which is
not good for their quality of care.
Strategies to promote RMC
From the interview it was analysed that, it is important that there are rules and regulations
which are related to RMC. Also, accountability should be there which will motivate them to
work properly. The citizen should be able to provide feedback which will explain the problems
which are faced by them during their visit to the hospital. The manager said to install CCTV
cameras in OPD to improve the accountability.
Staff Training and workload relation with RMC
From the interview it was analysed that, it is important for the staff to have proper
training and maintaining workload. It is because it will directly affect the quality of care the
people provide to their patients. It will ensure that the doctors are allocating proper time to the
patients and the treatment is appropriate for the patients.
Theme 2-Analysis of In-depth interview
2.1 Barriers associated with the implementation of RMC
This theme contains the major sub-themes that links with the barrier that comes in the
implementation of RMC.
2.1.1Privilege to Politician
The service user provided the major information in regards of barrier that are coming in
context of implementation of RMC. They shared that VIP member or MLA'S has been given the
major priority in the maternity care and due to this public do not get the services on time.
However, one of the respondent have shared that often women who have labour pain has to wait
as they do not have special privilege. Thus, this is one of the barrier in implementation of RMC.
RMC is associated within providing major proper treatment to women within performing ethical
consideration. However, privilege to politician are impacting the human rights of other women.
2.1.2Physician do not assure proper time to patient
The service user have shared similar opinion that how it is important to assure proper
time to the patient in order to assure effective care treatment to the pregnant women. However.,
17

it has been analysed from interview that, physician do not provide proper time to the patient and
this is one of the major issue in the implementation of RMC. The major aim of RMC is aligned
with the providing care services to women within assuring proper time. Thus, from service user's
point of view it has been stated that, it highly important to provide time to the patient as proper
time to patient helps in knowing the major issues of the patient.
2.1.3Lack of policies by the higher authority
One of the respondent revealed that, policy makers are not assuring effective focus over
the needs and wants of the patient. Often, they do not bother about the ways in which the patient
has been treated. Furthermore, public is not aware about their rights therefore the major issues
arrives from here that is decreasing the effectiveness of RMC and creating major issues in the
implementation of RMC. From the perspective of service user it has been analysed that, there is
only little focus has been made in context of RMC practices at the policy level. Politicians are do
not much serious about the treatment that has been assured to the patient. From the respondent it
has been revealed that only policies regarding human rights has been developed. However,
medical ethics has been ignored and this is acting as a barrier in the implementation of RMC.
2.2 Privacy of the patient in RMC
From the perspective of all service users it has been cleared that privacy of the patient has
not been maintained in RMC. However, there opinions state that privacy of patient is highly
important in the RMC. The present theme is mainly aligned with the sub-themes that are linked
to the privacy of patient in RMC.
2.2.1Physical examination of patient
From the interview it has been analysed that majority of the doctors perform the physical
examination of the patient in front of other staff that leads to make patient uncomfortable
However, the respondent has shown similar perspective that physical examination of the patient
needs to be done in private as women become uncomfortable when their physical examination
has been done openly. Also, it has been analysed from interview that, majority of patient do not
share their complex issues in front of other that leads to impact their condition. Thus, one of the
respondent said that, effective focus needs to be provide over the privacy of patient.
2.2.2Abusive language in front of staff
From the service user's the harsh truth has been analysed that is, many physician used
abusive language in front of the staff towards the patient and patient are unaware about their

rights therefore, this leads to crate the major issues. Often, patient kept quite and listen to doctor.
The assurance of dignity needs to be given to the patient. However, it has been ignored on
higher note. Abusive language towards patient leads to demotivate the patient and impacts their
privacy as well. One of the respondent said that strict actions needs to be taken towards such
physician who are doing this.
2.2.3Self-worth of patient
From the analysation of interview it has been identified that self worth of the patient has
been ignored and their privacy has been disclosed. Often, the medical history of the patient has
been revealed in front of other staff which is completely against of law. However, patient are not
aware of their rights therefore, their self-worth has been ignored. One of the service user has said
that, strict policies needs to be implemented in this context so the privacy of the patient can be
maintained as maintaining confidentiality of patient is the major part that has to be performed by
the healthcare professionals. Ignoring this aspect is wrong from all perspectives.
2.2.4Unethical behaviour
The outcomes of interview stated that, breaking down privacy of patient depicting the
unethical behaviour towards the patient. Ethical behaviour towards patient mainly includes the
maintaining confidentiality of patient. However, this has not been followed in RMC therefore, it
clearly stated unethical behaviour towards the patient. Thus, service user has showed common
response and said that not maintaining the privacy of patient leads to follow unethical behaviour
that is against the value, dignity and morals of RMC. Also, patients are unaware about their
rights therefore, doctors are taking advantage and not following professional code of conduct.
2.3 Difference in the public and private services in relation to RMC
From the perspective of service user, service provider and focused group the major thing
that has been witnessed is that, there are large number of difference in the services of RMC at
Public and private sectors has been found. The opinions of the interviewees were highly same in
this context that has provided the idea regarding actual scenario of the services that has been
given at the public and private sector in relation of RMC. Various problems have been witnessed
by the opinion of the interviewees. The current theme is concerned with the analysation of
interviewees response in context of public and private services in relation of RMC.
2.3.1Extent of difference
19

From the interviewee it has been identified that the status of the patient has been judged
by the doctor at private hospital and on the basis of that care has been given to them. In context
of public services, it has been reviewed that, patient has been treated in unethical behaviour. One
of the respondent who was service use has said that, “In public hospitals, patients are not treated
in a humane manner. They get scolded for nothing. But in private clinics, the same doctor will
behave so nicely that you will start doubting”. From this it can be said that, patient at public
hospital mainly face the complication in regards to experiencing services. However, at the
private hospital same doctors treats with effective quality. In this context, service user itself said
that, they have seen their fellow mates while providing treatment. They provide effective
services at their clinics. However, at government hospital same doctors does not treat the patient
in human manner. Behaviour with the patient has been done in such drastic way that it may often
impact the mental status of patient. Civil society member over this shared common perception
and that was, status of the patient is being judged and on the basis of that the care has been given
to patient.
2.3.2Issues faced by patient
The outcomes of the interview stated that patient in public sector faces large difficulties
the interview especially service provider themselves in this context have said that it is much
better to visit private hospital if the patient can afford to go at private hospital. The respondent
has shared common response and that was in public sector patient does not get the respect during
treatment. Harsh treatment has been done with patient that directly impacts the situation of the
patient. The major issue that has been revealed is that patient have to wait for so long to get their
turn. The service user itself revealed that they have to stand in long queue till their turn. There is
no facility has been given to patient in terms of providing waiting room where they can wait. The
major barrier have been witnessed from the response of interviewee that has revealed that, poor
people cannot afford the cost of private hospitals therefore, they have to go at public hospital and
they do not have any option. They have to face the harsh behaviour of the doctors.
2.3.3Status of the patient matters in RMC
The status of the patient is public and private sectors in context of providing services has
been used in terms of judging the patient. Respondents has shared that, in public hospital mainly

poor people come to get the treatment and they are not aware about their rights as well.
Therefore, doctors use abusive language towards them and often perform physical examination
in front of everyone. Discrimination has been done with patient and their sentiments have been
hurt. On the other hand, at private hospital those patient come who are financially stable and
therefore, they get effective treatment often doctors provides effective care within using ethical
language towards the patient. Same doctor who was abusing patient at public hospital uses the
ethical language at private hospital. One of the candidate that was service user said that, this
discrimination has been witnessed in the services as well. In public hospital lack of effectiveness
has been shown by the doctors while providing care. Whereas, at private sector effective care has
been provided and the major reason behind this is concerned with the financial stability of the
patient. Thus, with the help of gathered information from interviewees it can be said that status
of the patient has been judged within their approach have been made at public and private
hospital.
2.3.4 Scenario at the time of delivery care
While conducting interview it has been reviewed that, at the time of delivery care patient
with strong background has been treated effectively in the hospital whether it is public or private
hospital. However, it private sector the patient pays for services therefore, all patients have been
treated in well-mannered. But, at the public hospital patient gets the free services therefore, they
have been treated at the time of delivery care on the basis of their background. One of the
respondent who was service provider has said that” I think. Even doctors treat the rich people
with dignity”. Often, it has been reviewed from the collective response of service user that, they
have seen in private hospitals during the time of delivery care, cleanliness of the area where
patient is staying has been done. Whereas, it public hospital no focus has been done over this
context. Blood spot over has been witnessed at the time of delivery and no cleanliness has been
done. However, it is the accountability of hospital that at the time of delivery care proper care
services needs to be given to patient. But, here as well discrimination has been done. It has been
found from responses that, Doctors rarely talks about the possibility of the C-section of the
referral beforehand. They only act is discriminated manner towards the patient.
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2.3.5 Issues faced while experiencing public services
From the analysation it has been found that, as patient gets free services at public hospital
therefore, they face major issues while only experiencing public services. From the response of
interviewees, it has been identified that, during time of labour pain patient does not get the
required services that are needed to them. Doctor often deny to take the case. Also, they treat the
patient in drastic way that leads to impact their delivery. One of the respondent who was
pregnant women has said that, it public hospital there are large number of patient and they pay
nothing to staff and this is the major reason that they take patient for granted. The issue in
regards to care, behaviour, treatment, dignity and so on elements have been faced by the patient
at public department. The major is aligned with the number of patient available at the public and
private hospital. The data that has been gathered from interviewee states that, in public hospital
there are large number of patient therefore, the issues have been faced by them. Whereas, at
private hospitals the majority of patient is less and often they pay for it. Therefore, effective
treatment has been given to them. Patient who visit public hospital are not aware about their
rights and often they do not well-educated. Therefore, numerous issues have been faced by them.
2.3.6 Workload over staff
While conducting interview it has been reviewed that, workload over the staff leads to
create the impact over their behaviour at the public and private hospitals. The major reason
behind the inappropriate services is the workload over the staff. From the respondent it has been
identified that, in private hospitals staff are concerned with less workload and therefore, they can
easily attend each patient within making full focus and care. Whereas, in public sector the
workload over staff is high that it crates pressure over them and they handle the patient in drastic
way. Often, no care has been given to the patient in appropriate manner. The major reason is
aligned with the workload creates over the staff. One of the respondent often said if the workload
has been reduced then, it might help in increasing the effectiveness of the services in the private
hospital as well. The major concern is related to the workload created over the staff. From the
interview, it has been reviewed that majority of respondents whether they are service user,
service provider, manager, civil society member the majority have said that either the staff must

be increase at the public hospital or the burden should be reduced. This helps in assuring
effective treatment of patient.
2.3.7 RMC and government policy
It has been witnessed that, lack of government policy in relation of RMC leads to create
the hurdles in providing the treatment to the patient. One of the interviewee who was service user
who recently have her delivery stated that in public hospital “There are many issues like long
waiting time, lack of cleanliness, congested wards, lack of privacy, disrespectful behaviour by
doctors and other staff etc”. The major reason behind this lack of government policy in
increasing the effectiveness of services at public hospital. When it comes to private hospital the
patient gets effective treatment but when it comes to public hospital patient face numerous issues
and all this because of lack of initiatives taken by government in this regards. Majority of
respondents have shown collective perspectives and that was concerned with that lack of interest
by higher authority in RMC services are the major reason behind the issues that have been faced
at the public hospital by government. In this context one of the service user have said that,
government are the policymakers who develops the policy however, they have never visited at
the public hospital and therefore, they are not aware about the actual situation of hospital. Thus,
they are not aware about the actual situation then, how would initiative will be taken by
government in this context.
2.3.8 Lack of RMC initiatives
While conductive interview the opinion of the respondents has been taken in regards to
lack of RMC initiatives and it has been reviewed that people wants to get treatment in respectful
manner. However, in public hospital they are not getting proper treatment and therefore, this is
impacting their trust over the hospitals. Lack of RMC initiatives by the policy makers created
such situation for patient in which they do not have any option. Thus, this is one of the major
issues behind the hurdles that have been faced by the patient at public hospitals. Due to lack of
RMC initiatives being taken there are difficulties which the women are facing and this addresses
the concerns and aspects how effectively care is being provided to the patients. Hence, from the
interview it has been analysed that Major reason behind the issues of RMC are concerned with
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the lack of RMC initiatives. Therefore, major focus needs to be made over taking effective RMC
initiatives that leads to.
One of the service provider has said in this context that training should be given to staff
members as this is one of the major initiative in RMC. This was quite interesting as according to
the service provider lack of training in terms of dealing with dignity towards patient and lack of
guidance in context of providing services to patient has impacted the RMC in negative manner
therefore, focus needs to be made over training pattern. Also, the interviewee who was mother
said that, initiative in RMC are lacking as the people who should focus over this are not focusing
in effective manner. Thus, strict guidelines and initiatives needs to be designed so the difference
that has been created among public and private organization for providing RMC services can be
vanished. Thus, it can be said that government needs to put effective focus over the working
pattern of public organization in regards to RMC as this leads to solve the major issues of
differences among public and private organizations.
2.4 Issues faced by patient in visiting RMC
While conducting interview the major issue has been made over the issues that has been
experienced by the patient in visiting RMC. Analysing the issues clearly states that the
improvements that are requited therefore, it was important to know the opinion of interviewees
in this context. however, opinion of all candidates (Service user, service provider, focused group,
and healthcare managers) have been taken in this context. However, the major responses have
been taken from service users and focused groups as they were the part of interviewee population
who have experienced the services and issues as well. The present theme as aligned with the sub-
themes that will analyse the response of interviewees in context of issues faced by patient while
Visiting RMC.
2.4.1 Practices of RMC
From the interview it has been identified that, there are some important and basic
practices of RMC which are to be endured and taken care of. These are addressed as how
effectively and in appropriate manner there are concerns which are initiated for taking care of
women in due respect of the maternity and labour care. There are some manual techniques which
are – massage or application of warm packs and these are recommended for creating value of
how effectively the care should be provided to the pregnant women during their delivery of child

or labour conditions. Encouragement of mobility and more upright positions during labour in
women is recommended which initiates that how care is to be taken of the patients. However, the
RMC is lacking in assuring these practices as the major issue starts with the disturbing behaviour
of the doctors. One of the lady healthcare worker said that, “As far as I have observed in during
my service, I have mostly seen the disrespectable behaviour of staff with pregnant women”.
When the respect is not being given to pregnant women then there is no sense for discussing
about the another warm and comfort practices as it all starts with respecting the women
It has been found from the opinion of service user that, Proper bed rest and no stress work
is the best practice which the women should adopt when they are pregnant and are going through
difficult time of labour. It is very important that the doctors and the hospitals treat the pregnant
women in respectful manner so that proper care is being provided to them. However, after
delivery no proper care is being ensure in public organization that leads to create the issue for the
patient health. Proper initiatives and practices should be taken in concern as it effectively
manages the aspects of how there are positive paths which are leading to care and concern of
women who are pregnant.
2.4.2 Privacy Concern
It has been witnessed that, there are some privacy concerns which has been raised in the
process of RMC. The hospitals should take care of the privacy of the patients which helps in
analysing that how effectively and in appropriate manner there are care and treatment is being
provided. While conducting the interview, there were issues and problems which were raised
regarding the privacy as the respondents said that there are privacy concerns which are related to
the documents and details which might be shared by any other unauthorized person who is not in
charge of the process of how the privacy is being concerned. In this context the major issue that
was aligned with the privacy concern was the physical examination of the patient. Member from
the focused group who was mother have said that, doctors performs physical examination in
front of everyone that makes the women uncomfortable. There is no privacy has been given to
patient in context of this and this leads to create issue for patient and makes them highly
uncomfortable.
It is very important that the hospitals and the management staff at the hospitals are taking
care of the documents and data which is being shared with them. The RMC services are the
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major issues and problems with the public hospitals and this creates problems of how the patients
are being treated. It is very important that the hospitals take initiatives and responsibilities
regarding the aspects of how effectively and in appropriate manner the care should be provided
to the patients. The privacy of the patients should be maintained so that the patients relay on the
services which are being provided to them.
2.4.3 Behaviour of Doctors
It has been found while conducting interviewee that there are problems and issues faced
at the hospitals as there is no availability of doctors for providing the treatment to the patients
and those doctors who are available at hospital behaves in drastic manner with the patient that
leads to reduce the morals and values of patient. This creates fuss about how the hospitals and
the care hospitals are not able to provide and make availability of the doctors for treating the
patients. The doctors behave carelessly and are not concerned for the health and well being of the
patients. While conducting the interview, one of the respondents said that the doctors are not
concerned in providing and taking care of the patients. They are also not respecting the patients
specially the pregnant women. One of the candidate who was HR manager has said that
disrespectful behaviour is being observed in public hospital as the private hospitals are not
concerned in providing the services at large scale.
Their is also lack of knowledge to some of the doctors who are working in the hospitals
and are creating problems for not having enough knowledge due to which the patients are not
able to get proper treatments. Therefore, there should be analysis of how effectively and in
appropriate manner the care service to the patients and pregnant women should be provided.
There are concerns which are related to how effectively the care services should be provided to
the patients and doctors should be appointed according to their jobs and qualifications.
2.4.4 Deficit Policy
It has been revealed in interview that, there is deficit in the policy which is being
analysed and this addresses that the policies and procedures are not followed effectively as there
are concerns of how issues and problems are raised at large scale. The deficit in the policy is
analysed which creates an understanding that some policies and procedures are not followed
effectively. This is how there are problems and issues arising in the private hospitals. The deficit

in the policy should be removed so that there is proper structure of policies which are to be
followed. the service user, service provider, manager and focused group have shown common
perception in this regards. One of the participant who was manager at hospital have revealed
that, there are large number of causes that are hindering the development of proper policies in
this regard.
He often said, the major problem is that people are not aware about their rights they are
facing disrespectful behaviour at the hospital. However, they are not raising their voice in this
context and therefore, this is promoting the disrespectful behaviour of doctors. Also, this is the
major reason that have been working as a deficit in policy as patient are not aware about their
rights therefore they are not taking any action and this is working as a policy deficit. One of the
service user said that, if in case something bad happens then patient consider it and remains
silent that provide strengths to doctors to use same kind of practices and behaviour. Majority of
the patient is poor and illiterate therefore, they have fear and they do not raise voice. Thus, thus
us acting as one of the biggest hurdle. Thus, it has been analysed with the opinion of candidates
that patients must raise their voice.
2.4.5 Pattern of workload
In the interview it has been reviewed that issues faced by patient at RMC is due to the
pattern of workload has been given to doctors. One of the candidate who was Gynaecologist
working at Private Clinic has said that “Workload has a great impact on the doctors”. The
workload has been minimised then doctors can do their job in effective manner and often assures
effective treatment to patient. One of the service provider has said that, as there is extreme load
over doctors at private hospital therefore, the physical examination of patient has been done
without providing privacy as the doctors needs to see numerous patient therefore, they do not
invest their much time for an individual patient. Thus, it has been analysed that patients faces
issues due to the workload pattern over doctors. If the workload pattern will be reduced then, it
helps in investing effective time over each patient. As a result, no issue would be face by patient
often, effective service will be experience by them.
From the perceptions of service user it has been reviewed that, somewhere the reason behind
disrespectful behaviour of doctors is the work-load over them. When there is extreme workload
over them they feel exhausted and starts behaving in drastic way with the patients. Therefore, the
27

workload over doctors should be reduced as the issues related to privacy concern, ineffective
services and disrespectful behaviour arises due to workload over doctors. Thus, it has been
reviewed from the candidates that the issues that has been faced by the patient at public hospital
are arising due to the extreme workload over the doctors therefore, extent of workload needs to
be reduced over the doctors as it provides automatically influence over reducing the issues that
has been faced by patient while receiving treatment.
2.4.6 Financial crisis
Financial crisis is the biggest and topmost problem that has been faced by the patient in
RMC. From the interview the truth has been highlighted that, poor people does not get any kind
of respect and values while getting treatment. Often, they are facing financial crisis therefore,
they cannot prefer private hospitals over public hospitals. In public hospital they are judged due
to their financial status. One of the respondent who was member of focused group revealed the
major fact in this context. It has been revealed that as poor people does not have financial
stability also they do not aware about the charges. However, in public hospital free service has
been given. But, doctors often charge check-up fees from poor people as they do not have any
idea regarding this.
Doctors often create threat in them that if check-ups have not been performed then there
is danger to the mother and child as well. Poor people do not have any option rather than
following orders. Already, they have financial issues and they have to face worse situation in
context of RMC services. The lack of financial stability is one of the major reason that promotes
doctor to do anything with poor people. Whether it is about inhuman behaviour or abusing them.
A candidate who was service user has said that if people has effective financial ability then why
would they prefer public hospitals. The major reason behind going to public organizations are
concerned with lack of finance. Therefore, large number of poor people approach public services
in context of RMC and faces another issues that has been described in the current section.
However, all those issues are generating from lack of financial stability as witnessed from
interview.
2.4.7 Unethical practices
While visiting RMC this is the hurdle that haven been experienced by patient. The
service provider in this context have revealed that it unethical practices have become common

practice in public hospitals as the patient are not raising voice against this therefore, extent of
unethical practices has been increased in the public hospitals and that has become the common
practices as well. Unethical practices such as- performing physical examination in front of
everyone, abusing to patient, not involving patient in their treatment, not providing enough
information to patient related to their treatment. All these practice have been considered as
unethical practices that has become common practices. One of the respondent said who was
pregnant lady that visit to private hospital have said that “Well, you know that a woman is
passing through a critical phase of her life during pregnancy. So, it is very important to take
proper care of her”. All confusion of women must be clear so she can be able to take decision in
proper manner. But, even the dignity has not been given to patient while providing services.
2.4.8 Lack of care
2.4.9 Abuse
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