Table 3.
Limited negotiation power: case overload, limited resources, and poor reputation
| District hospital doctor, Kinh | We do not have enough doctors, which is a shortage of quantity. About quality, we are only first medical degree (master’s degree), but we have to perform many types of operations, such as appendix, gastric perforation, bone setting, and casting |
| Tho mother, farmer | Drugs here at my CHC are limited and equipment is poor. Patients have to refer to higher level and it is difficult since we are poor. A normal birth with narrow pelvic, for example, has to be referred because this CHC cannot manage it. But, we do have the doctor and midwife here. If they could only have more equipment, they could manage these births. It would be more convenient for us, the patients. Or … they could have doctors who come regularly to CHC and do caesarean sections. This alone would greatly reduce the expenses for us, the patients |
| Thai mother, farmer | [The neighbourhood grocer] is quite popular. She sells many kinds of medicine. People buy medicine from her, and, in fact, they get well after taking her medicine. The medicine provided by the CHC does not work |
| CHC nurse, Kinh | The healthcare system and healthcare conditions at highest levels appear really invested by [the Government] in drugs and working mechanisms …. But the local health system has a lot of difficulties [in addition to] limited training or re-training of health providers, limited equipment, and impracticalities related to referring a patient to a higher level …. We have a shortage of [everything] so we cannot provide best service. It takes all of our efforts to become a national standardized station [and to meet governmental guidelines] …. It is quite the same problem at other CHCs in our district |
| District hospital doctor, Thai | Some women cannot afford the referral [to our district hospital] so they stay at home and deliver. When they cannot do that, they go to CHC. But then the CHC refers them here, and by then they are very difficult cases. In fact, cases that are referred from communal level to the district level are usually the severest. We usually have to do emergency treatment |