Table 5. Policy setting and decision making expressions in meeting women reproductive preferences.

Theme 4	Women	Health Staff	Policymakers
Policy setting and decision making processes on reproductive care preferences	“people come to the community to meet us and ask us question on how satisfied we are with services, but we never see any differences in what they provide now from the old”-w1 “some of us do not really care of who takes part in the decision making to deliver us services, all we want to see is more friendlier support from health staff, and our ability to use our health insurance to benefit from available services provided”-w2 “We have health committees at each community facility, just few members are often informed of the clinic facilities concerns for ore services”-w3 “onetime health staff and people from the district came and held a meeting with men on allowing us use facilities for childbirth, we were never involved although the aim of the meeting was to benefit us”-w4 “Our chiefs and opinion leaders play active role in passing information from health center to all of us, but that is not enough since we expect some more engagements from frontline services providers like nurses who attend to us”-w5 “Decisions on services and our expected roles as women when receiving these should be well disseminated using our women leaders to help us”-w6 “We see and recognize health staff as immediate providers of care, what happens in terms of how satisfied we are, relationship building and mutual trust affects decision making on meeting our reproductive preferences”-w7 “Although we do not determine what services facilities should provide, our decisions and choices based on certain service demands should drive providers and policy managers to take steps to make these services friendly and available even to the few women who need them”-w8	“At the facility, we don’t procure or singly adopt an intervention without prior authorization from the district or regional level”-hs1 “We are often called to the regional level for refresher trainings on reproductive health, something I don’t think can be considered as inclusive on how these interventions are designed”-hs2 “Most policies just come from the Ministry level, what is women pressing needs in Bongo here does not matter”-hs3 “most services are rendered based on health staff training received whiles in school, this is difficult to capture and meet changing needs of reproductive users”-hs4 “When women complain of preferences not met, we just tell them we are working on it… however that decision does not depend on us when the policy actors determine what service should be provided based on its availability to us”-hs5 “we just provide the services made available to us, if its counseling services, we provide what information is on the protocol”-hs6 “Some staff incorporates context need by engaging facility committees, but the challenge is these are not always supported in budget lines from district or facility level”-hs7 “Standards of services to provide are sent from the district level without prior sensitization and health providers inputs, we are only called for trainings when we complain of understanding and applying these standards in relation to the settings we work”-hs8 “Women have visited for services not present. we advocated for our capacities to be improved to provide these such as infertility, post-abortion care and building awareness on aspects of female genital mutilation, but these are not viewed important at the top people”-hs9	“Our priorities sometimes are largely defined by what donor money is available and what needs can be met at any particular time”–p1 “One major concern is so many private providers are active players in the reproductive health industry, but there appear to be little synergy between the public and private sector. Most of them are not fully captured, and involved in providing strategic services”-p2 “we sometimes prioritize, other times, funds are already allocated based on prioritized areas for the region”-p3 “activities that we often have the ability to prioritize are very few, so we do not determine which major reproductive activities in the district”-p4 “most of what we prioritize at this level has to do with education and sensitization activities”-p5 “Policy processes include health staff when they have to disseminate/apply skills for service improvements”-p6 “Reproductive, maternal and child health unit at district hospital levels was created to meet reproductive priorities. The challenge has always been too much focus on few streams of reproductive care.”-p7 “We should start the debate on how to fund these services, donors’ funds is been withdrawn in some service need…”-p8 “The Sector Wide Approaches (SWAp) MDGs, and now SDGs goals drive most approaches we do since funding comes along these lines”-p9 “The economic value of most interventions are lacking, so what should guide future policy decision processes…”-p10 “As private providers, we think the reproductive policy must set clear guidelines on reproductive policy settings standards, something currently lacking”-p11 “We have a monitoring and evaluation team at the regional level that ensures targets budgeted activities are undertaken”-p12 “I admit sometimes our activities are too ad hoc and sometimes we taking decisions at the district level do not understand them before we start implementing”-p14

Wⁿ, hsⁿ, pⁿ denotes women, health staff and policymaker’s expressions.Superscript n denotes the number of view counts expressed by participants.