Qualitative interviews and focus group transcripts Health worker 1 ? Name of working birthing centre/Position at birthing centre. BC1 working as temporary ANM since Jesta (April/May 2016) from Western Regional Health Directorate. ? Years of experience at this birthing centre and past experience at any organization. It has been eight months since I started working here and before here I used to work at N Health Post for 6 years. ? Number of clients attending birthing centre in a month (approx), checking the records. It varies a lot. In some month it reaches 25, at other time it is 8-10 or 16 per month depending on which month they come. ? Number of staff working at the birthing centre including their position and availability. We are two ANMs working here, I was appointed by government and the other ANM was appointed by the NGO. We are open 24 hours as per the requirement of birthing centre. ? Is the birthing centre open 24 hours? Yes, we are open 24 hours. ? What happens when the ANM has to attend training in the capital or regional headquarter? Is there any alternative solution to keep the birthing centre open 24 hours? We are open 24 hours. One of us is always present here whatever the situation maybe. When there is training for us, we take turns to attend. ? How is the management and funding of the birthing centre done? Is the management done by HFOMC or VDC? The fund received from government is received in the account of our health post in-charge. When we need to distribute money for each delivery and ANC check ups to the cases, our health post in-charge and chairman of the VDC sign the cheque and then we receive money. If there is need of any instruments or necessary materials, then we inform the health post in-charge and he makes it available to us. ? From where does the birthing centre receive its budget (Government, NGO, INGO or other)? We also receive NRs 5,000 from the NGO for purchasing necessary instruments and materials needed for the birthing centre. Materials like maternity pad, cord clamp, gloves are purchased by this money as the District Public Health Office Nawalparasi doesn’t send us everything. ? Does the birthing centre has all essential drugs and equipments required for a normal birth? (Checking the drugs and equipments using observation checklist) Yes, we have all essential equipments required for a normal birth which was provided by the NGO. For the drugs, we receive some from the NGO and some from government. Sometimes when some medicine is deficient we buy it ourselves by the money received from the NGO. ? If any complication arises during labour is there any referal mechanism available? (either ambulance or any transportation) In case if any complication arises we refer them to hospital in Bhairahwa or Butwal. Sometimes we refer them to P hospital but they refer them to Butwal or Bhairahwa, so we directly refer them to these places. ? Is there any other nearest birthing centre or health institution? There is BC2 which is nearest from here. Further questions ? In your view how would you rate the quality of birthing centre in terms of services you are providing, staff, equipments, etc. We try to provide quality service to the public from our side and even the patients have started coming to this birthing centre. Even people from far VDCs like S, G, J and B come here to utilise the services. ? Do you provide adequate information to the labouring woman about her situation? How do you encourage her during labour and delivery? When women come here they are quite nervous but we counsel them not to feel anxious, we tell them it’s very difficult to give birth to a baby but you need not worry, everything will be fine. From time to time we tell her the progress of her labour, it will not take long time. Depending on the stage of her labour we tell her everything needed for her to know. ? Do you allow family members of labouring women inside the birthing centre or do they have to wait outside? Yes, we do allow the family members to enter the delivery bed. It is our policy to deliver the baby in the presence of one family member. Whoever accompanies the laboring women, either her mother-in-law or sister-in-law, we allow one family member inside the delivery bed. ? How do you provide the incentives that a woman who delivers at your birthing centre needs to get? We do provide NRs 900 if they have done four ANC visits according to protocol and delivered here according to provision of government. ? Do all the women who come for ANC attend birthing centre for delivery? If they do not come, which facilities do they visit and what do you think hinders them to visit birthing centre and visit another facility? Not every who come for ANC visit come for delivery. Since I have started working here, I haven’t seen any women from ward 1 of this village coming to this birthing centre for delivery. Some of them even come for four ANC visits but don’t come here for delivery because the health facilities in India is close to them so they go to India. Even some women in ward 1 deliver at home which we found when we went to vaccinate babies in that ward. We even tell them to come here and we run meetings from the NGO where we motivate them to visit this birthing centre but they don’t come here due to distance. ? In your opinion in what way can the births occuring in the birthing centre be increased? It is very difficult to motivate women to come here for delivery. Even women from wards 2 and 3 didn’t use to come here but now they have started to come. For the women who don’t come here (especially from ward 1), we need to counsel more and tell them that all facilities are available here and that they don’t need to go to India for delivery. We need to go to the community and held meetings and promote them to come here for delivery. At the end, finish by asking Is there anything else you need to add? It is very difficult to call ambulance to this birthing centre. Sometimes there is a complication and there is a need to refer then we call ambulance but they don’t come especially at night. We don’t know if it is difficult for them to come here. We faced one such case when we called them they were in Bhairahwa and even disconnected our call but when we called again then only they came. There is one school vehicle which has Indian number plate and sometimes we call them and they help us. They are afraid to take the complicated cases but we provide them a letter from our health post and request them to take the women to hospital. Health worker 2 ? Name of working birthing centre/Position at birthing centre. I am working as Senior ANM in BC2. I am working here as ANM since 2061 BS, before that I was working as Maternal and Child Health Worker (MCHW) since 2050. Birthing centre established here only one year back. ? Years of experience at this birthing centre and past experience at any organization. I am working here since 12 years before that when I was working as MCHW I had experience of delivering baby and taking care of the newborn. ? Number of clients attending birthing centre in a month (approx), checking the records. Almost 10-12 deliveries occur here per month. This is a small VDC and the population is small as well. People from surrounding VDC have started to know about this birthing centre and have started to come here for delivering. ? Number of staff working at the birthing centre including their position and availability. From the NGO there are two ANMs and I am appointed by Government so in total there are three ANMs and there was one temporary ANM working here but she left recently. ? Is the birthing centre open 24 hours? Yes, we do open 24 hours. ? What happens when the ANM has to attend training in the capital or regional headquarter? Is there any alternative solution to keep the birthing centre open 24 hours? In case if there is any training we don’t go all at one time but take turns. We never close the birthing centre. ? How is the management and funding of the birthing centre done? Is the management done by HFOMC or VDC? This building where birthing centre is running was built by government. Other support is done by the NGO. The instruments and even maintenance of building and instruments is done by the NGO. District Development Office and Village Development Office has helped while construction of the birthing centre building. Save the Children only provides posters. District Health Office also provides some medicines which is received by the health post, whenever we need any medicine we also get it from Health post. ? From where does the birthing centre receive its budget (Government, NGO, INGO or other)? The budget comes from Government. ? Does the birthing centre has all essential drugs and equipments required for a normal birth? (Checking the drugs and equipments using observation checklist) Yes, we have all essential equipment which was initially provided by The NGO and also maintenance is done by them. ? If any complication arises during labour is there any referal mechanism available? (either ambulance or any transportation) We refer complicated cases to CEOC centres especially in Butwal, P or Bhairahwa. We don’t really refer to PHC, if there is need for C/S then we usually send to Butwal. We don’t arrange for ambulance, there is facility for ambulance but it takes time to arrive here. We arrange for local transportation like rikshaw, jeep or motorbike to nearest place where ambulance is easily available. ? Is there any other nearest birthing centre or health institution? P2 health post. Initially all cases from this VDC used to go there for delivery as it was our ilaka health post. But now people from this VDC come here first and if there is a need to refer then we suggest them to go to CEOC centre. Further questions ? In your view how would you rate the quality of birthing centre in terms of services you are providing, staff, equipments, etc It is very useful and of good quality. Before when there was a normal case, they needed to go elsewhere but now they come here as this birthing centre is open 24 hours. If the labour has progressed, we admit them but if they are in early labour we ask them to go home and they return home but come again after few hours. Some even return home but some want to get admitted so we take them here. We have two beds so until now there has not been such situation where we had to turn them down. Once it happened that there were three cases together. We referred one and admitted two cases, then delivered both women taking turns. ? Do you provide adequate information to the labouring woman about her situation? How do you encourage her during labour and delivery? We communicate with women in local language and tell them their progress of labour, how much their cervix has opened and they seem to understand well. We console them not to worry, everything will go well, we are there to take care of them. Some get worried if their labour is very long and express their concern about what to do if they can’t deliver here. We tell these women not to worry, if will take too long, we will send them to another health facility. ? Do you allow family members of labouring women inside the birthing centre or do they have to wait outside? We do allow one of the family members of laboring women to the labour bed which makes feel them secure. Before when we used to conduct home delivery we allowed family members as well. ? How do you provide the incentives that a women who delivers at your birthing centre needs to get? Yes, we do provide incentive to the women who has successfully completed four ANC check ups to whom we provide NRs 400 and NRs 500 to those who has delivered here. ? Do all the women who come for ANC attend birthing centre for delivery? If they do not come, which facilities do they visit and what do you think hinders them to visit birthing centre and visit another facility? Almost all women who comes for ANC attend birthing centre for delivery. Some who go their paternal home or those who don’t want normal delivery or want to go to hospitals (where they assume they will get better services) don’t come otherwise most of them attend this birthing centre for delivery. Few others who have complications, we refer and suggest them to visit CEOC centre after seeing their ultrasound. If they don’t come here they mostly visit Butwal. ? In your opinion in what way can the births occuring in the birthing centre be increased? Our VDC has a small population and we take help from FCHVs to increase cases at this birthing centre. I don’t think most women in our VDC go elsewhere for delivery. I think to increase the cases we need to bring cases from surrounding VDCs by promoting and communicating about this service to them. Since almost all women from this VDC know about this service, our only way to increase the cases is by bringing people from other VDC. Women from other VDC have started to come here after knowing the services available from here. At the end, finish by asking Is there anything else you need to add? I want to thank The NGO for helping to establish birthing centre since we really wanted one here. But we are really worried about sustainability of this birthing centre since this project is only for two years. It would have been better if the project continued for two more years. When the project finishes I am worried if health staff will want to stay here or not, and if we will be able to manage for instruments and other support, so we really hope that The NGO will support this birthing centre for few more years. Health worker 3 ? Name of working birthing centre/Position at birthing centre. My name is CC, I live in P2. I am working as ANM in BC2 since one year and am appointed by The NGO. ? Years of experience at this birthing centre and past experience at any organization. Before working here I used to work as ANM in BC1, S2, B2. I used to work as volunteer in S2, in B2 I used to work in D hospital where there were no cases for delivery. While working in BC2 and S2 though I used to conduct deliveries. ? Number of clients attending birthing centre in a month (approx), checking the records. For the ANC check ups there is almost 10-12 cases whereas for deliveries there is around 8-9 (more than 7) cases per month. ? Number of staff working at the birthing centre including their position and availability. We are four ANMs (one recently left), one HA, one CMA (sister) and two sweepers. ? Is the birthing centre open 24 hours? Yes, we do open 24 hours and the birthing centre is never closed. Whenever there is training or anything else, one of us always stay in the birthing centre. ? What happens when the ANM has to attend training in the capital or regional headquarter? Is there any alternative solution to keep the birthing centre open 24 hours? In case if there is any training we don’t go all at one time but take turns. We never close the birthing centre. ? How is the management and funding of the birthing centre done? Is the management done by HFOMC or VDC? When we don’t have any equipments, we make a list and give it to the in-charge of health post and he makes it available to us. For instruments, some are provided by government, and if we need to manage we have funds from government (received after conducting a normal delivery) and also from The NGO. ? From where does the birthing centre receive its budget (Government, NGO, INGO or other)? DHO gives medicines like oxytocin, paracetamol, iron, albendazole etc. Medicines are available from both The NGO and government. ? Does the birthing centre has all essential drugs and equipments required for a normal birth? (Checking the drugs and equipments using observation checklist) Yes, we have all essential equipment which was initially provided by The NGO and also maintenance is done by them. ? If any complication arises during labour is there any referal mechanism available? (either ambulance or any transportation) We refer complicated cases to high centre, first to S3 PHC since there is a doctor. We also ask the patients where they want to go after providing the options – S3 PHC, P hospital or Butwal/Bhairahwa (CEOC centres). After providing them options we leave the decision on them. Mostly we encourage them to go to P since its near and there is government CEOC centre as well but some say they don’t want to go there but want to go to Butwal (there is a zonal hospital and CEOC centre). So its best to leave the decision on them. ? Is there any other nearest birthing centre or health institution? P2 birthing centre and T birthing centre. Initially all cases from this VDC used to go to P2 for delivery but now people from this VDC come here first. Further questions ? In your view how would you rate the quality of birthing centre in terms of services you are providing, staff, equipments, etc This is a remote area and there was no birthing centre before but after opening of this birthing centre it has been very easy for people here since it provides quality service, easily accessible and all medicines are also available. ? Do you provide adequate information to the labouring woman about her situation? How do you encourage her during labour and delivery? We conduct PV first and check the opening of cervix. We check the blood pressure and if the case is normal we check them time to time. If the progress of labour is slow, we tell their relatives to save money and tell them they might have to higher level of health facility. We also tell them about their progress of labour and we try to console them by telling not to be anxious, we need to go through the pain. We are also women like you and can understand your pain but to give birth to baby is very difficult. It is you who will have to give birth and go through the pain, so please keep faith, things will be fine. ? Do you allow family members of labouring women inside the birthing centre or do they have to wait outside? Their family members are present in the waiting room. In the delivery bed we are only present but if they request to bring the family members we allow them inside. If women insist on bringing someone we don’t stop their family members from coming in since they also need emotional support ? How do you provide the incentives that a women who delivers at your birthing centre needs to get? Yes, we do provide incentive to the women who has successfully completed four ANC check ups and delivered here to whom we provide NRs 900 and those who have delivered but not completed 4 ANC visits, we provide NRs 500 only. ? Do all the women who come for ANC attend birthing centre for delivery? If they do not come, which facilities do they visit and what do you think hinders them to visit birthing centre and visit another facility? Almost all women who comes for ANC attend birthing centre for delivery. If they don’t come here they go to P2, P hospital or wherever we refer. If someone wish to go to Butwal then they go there. ? In your opinion in what way can the births occuring in the birthing centre be increased? Our VDC is a small one, the cases here have increased because people from surrounding VDCs com here. It is difficult to increased the number of deliveries here since this is a small VDC but we can recommend women to come here for ANC since B3 and P is far but we provide similar facilities as them for normal delivery. We can counsel them that we have our own building and this is like home so it will be better for delivering baby. At the end, finish by asking Is there anything else you need to add? It is necessary to increase awareness regarding delivering at birthing centre which will help to increase the number of deliveries. We need to go to different ward to increase awareness since sometimes women don’t even listen to the FCHVs. In such case we need to take help from other literate people and ask them to help us in increasing awareness among village women. Health worker 4 ? Name of working birthing centre/Position at birthing centre. I am working as a ANM at BC2 since one year. ? Years of experience at this birthing centre and past experience at any organization. I haven’t worked in other health institutions before this. ? Number of clients attending birthing centre in a month (approx), checking the records. In some month the number of delivery is 5 and some month it reaches even 19. The number of ANC check ups reaches 20-22. ? Number of staff working at the birthing centre including their position and availability. We are 2 ANMs and 2 sweepers working from The NGO and the other ANM is appointed from the government. ? Is the birthing centre open 24 hours? Yes, we are open 24 hours. ? What happens when the ANM has to attend training in the capital or regional headquarter? Is there any alternative solution to keep the birthing centre open 24 hours? We don’t close if there is a training but arrange our schedule if anything comes up. ? How is the management and funding of the birthing centre done? Is the management done by HFOMC or VDC? We depend on our in-charge didi who is appointed from government. Government and The NGO provide for the management and funding. The NGO provides instruments like bed, heater, perilight and at first medicines were also provided but now only government provides medicines. The NGO will support the birthing centre for two years but after that the birthing centre will operate without support from The NGO. ? From where does the birthing centre receive its budget (Government, NGO, INGO or other)? Government provides budget for normal deliveries and even The NGO provides some fund. ? Does the birthing centre has all essential drugs and equipments required for a normal birth? (Checking the drugs and equipments using observation checklist) Yes, we have every essential equipments and drugs required for a normal birth. ? If any complication arises during labour is there any referal mechanism available? (either ambulance or any transportation) We refer them to higher centre depending on the condition of baby and mother. If the health of both mother and baby is delicate we refer them to Bhairahwa but if baby is good in health and mother’s health is delicate we refer them to Butwal. Referral also depends on their financial condition, income and how much they can afford. We explain them what is offered by those hospitals and let them decide where they want to go. ? Is there any other nearest birthing centre or health institution? There is P2, B3 birthing centre which is nearest. Before women used to go there but now they come here when this birthing centre was openend. Further questions ? In your view how would you rate the quality of birthing centre in terms of services you are providing, staff, equipments, etc. The service provided by this birthing centre is good but if there was availability of few equipments, which becomes scarce from time to time, it would have been better. Equipments like lights, perilights, heater is scarce now but we may have to wait for that to receive. There is non-availability of ambulance which makes it difficult to refer. The NGO, VDC must initiate to make ambulance available. ? Do you provide adequate information to the labouring woman about her situation? How do you encourage her during labour and delivery? We provide necessary information to laboring women, we tell them their stage of labour, how much their cervix is open and condition of baby. We ask them if they had something to eat and offer them something their family has brought. They are anxious and get nervous, to whom we counsel not to worry about sex of the baby and counsel them. ? Do you allow family members of labouring women inside the birthing centre or do they have to wait outside? We allow the family members of laboring women to the waiting room. In the delivery bed, we allow one of the family member of the women inside the delivery bed. Some women are shy and don’t want anyone inside the labour bed but those who ask any family member to bring inside we allow them. ? How do you provide the incentives that a women who delivers at your birthing centre needs to get? We provide NRs 500 for delivery and if the women have completed four ANC visits according to the protocol then we provide additional NRs 400. Whenever the health post receives money we provide incentive within three days but in current situation the budget is released bit late so we have not been able to provide the incentive but as soon as we receive the money we will provide it. ? Do all the women who come for ANC attend birthing centre for delivery? If they do not come, which facilities do they visit and what do you think hinders them to visit birthing centre and visit another facility? After the birthing centre opened, most of the women come to deliver here, even women from surrounding area of India come here even they have not done the ANC check up here. Out of 10 women who come for ANC check up, 8 or 9 come here for delivery. Few needs to be referred and some deliver on the way to health post, so obviously the number of women delivering here is less than those who come for ANC visit. Before when the birthing centre was not opened, women in community used to call us and we visited them during delivery but after opening of the birthing centre we encourage women to come here for delivery. Those who don’t come here go wherever they find it better, some goes to P2 or B3, some have done C/S, so they go to Butwal. We also counsel them where to go after listening to their history. ? In your opinion in what way can the births occuring in the birthing centre be increased? To increase the number we can counsel them the advantages of delivering at health centre and risks of delivering at home when they come for ANC visit. We also tell FCHVs to convey these message to whoever is pregnant in the village. At the end, finish by asking Is there anything else you need to add? Because of the support from The NGO, the people from N VDC and even from P3 can utilize the services but when the project finishes it will be difficult for the staff here to manage the cases and even for the people here. Health worker 5 ? Name of working birthing centre/Position at birthing centre. I am working as ANM at BC1 birthing centre and was appointed by The NGO for two years. ? Years of experience at this birthing centre and past experience at any organization. It has almost been two years since I started working here. Before here I used to work as temporary ANM by DHO and also worked for committee. I almost worked for 1-1.5 years. ? Number of clients attending birthing centre in a month (approx), checking the records. In the beginning it started with 5-6 persons but when the awareness regarding this birthing centre increased among women then it went up 8-10, 15, 20 and reached upto 25. Women from five surrounding villages also visit this birthing centre. ? Number of staff working at the birthing centre including their position and availability. The birthing centre is open 24 hours. There were 2 ANMs from The NGO. I was appointed for 2 years but the one who was appointed for 1.5 years already completed her tenure and left. From government one temporary staff work along with me but there is no one who is permanently positioned from government here but soon there will be someone coming to join permanently. ? Is the birthing centre open 24 hours? Yes, it is open 24 hours. ? What happens when the ANM has to attend training in the capital or regional headquarter? Is there any alternative solution to keep the birthing centre open 24 hours? We take turns to attend training and never leave birthing centre unattended. ? How is the management and funding of the birthing centre done? Is the management done by HFOMC or VDC? Whenever there is shortage of any equipments or instruments then we ask with The NGO, if we ask anything from government they neglect it and tell us to ask from The NGO since this birthing centre is supported by The NGO for two years. ? From where does the birthing centre receive its budget (Government, NGO, INGO or other)? We receive budget from the government which is provided after conducting deliveries and The NGO provides NRs 5000 monthly. Free medicines are received from government and if few material needed for ANC are in shortage we obtain it from the money available from VDC committee. VDC committee provides NRs 1,00,000 for purchase of furnitures and other essential equipments. ? Does the birthing centre has all essential drugs and equipments required for a normal birth? (Checking the drugs and equipments using observation checklist) Yes, we have all essential equipments required for conducting a normal delivery. ? If any complication arises during labour is there any referal mechanism available? (either ambulance or any transportation) Women from this VDC but if we need to refer, we send them to Bhairahwa medical college depending on financial condition of family. If some family doesn’t have enough money, we refer them to P since there is facility for C/S, facility for ICU as well and is nearer. The availability of ambulance is not so good here because of bad condition of roads. The ambulance doesn’t want to come during night but during day it’s not a problem. There are three ambulances available in surrounding areas: P, P2, C hospital. As this place doesn’t lie near the highway and during winter there’s thick fog which makes it difficult to drive, so they don’t want to come here. If ambulance was available ? Is there any other nearest birthing centre or health institution? There is a PHC in S2. Further questions ? In your view how would you rate the quality of birthing centre in terms of services you are providing, staff, equipments, etc It is providing quality services to people from this VDC as well as surrounding VDCs. Before there used to be 80-90% home deliveries but as this birthing centre lies in the middle of 4-5 VDCs so it has been very helpful for many people. The NGO staff conduct home visit and encourage for visit to birthing centre. There were some complicated cases in past like bleeding and death of baby, so they have started to visit birthing centres. ? Do you provide adequate information to the labouring woman about her situation? How do you encourage her during labour and delivery? When the women first arrive here, we examine them first and if we find everything is normal, we console them not to worry, the baby will be delivered here. But I tell the family to manage for money in case if emergency arises. We tell them not to worry and also that we have ambulance contact number. If need be we can refer you, you can bring your food and feed the laboring women. We will examine every 4 hours and tell you the situation and tell you how much your cervix has opened (in local language). We also monitor baby’s heartbeat so we tell women not to worry. ? Do you allow family members of labouring women inside the birthing centre or do they have to wait outside? I allow visitors in the waiting room and one of the family member in the labour room. I tell them about the progress of labour so that they can make others understand about the situation. Usually in big hospitals don’t allow anyone inside the labour bed but I allow at least one person inside. Understanding the sentiment of women I allow a family member which makes her feel secure and less anxious. ? How do you provide the incentives that a women who delivers at your birthing centre needs to get? Yes, we provide the money and obtain their signature. Usually we provide incentive in time but only sometimes we get delayed to distribute the incentive because we receive the fund late. However, we have the contact numbers so they get it sooner or later. ? Do all the women who come for ANC attend birthing centre for delivery? If they do not come, which facilities do they visit and what do you think hinders them to visit birthing centre and visit another facility? Not all women who come for ANC attend birthing centre for delivery. Some women whose paternal home is in India, they go for the ANC and delivery in their paternal home in India. We don’t have right to tell them to come here for delivery as they know best where to go, however we suggest them not to deliver at home but attend the health facility wherever they give birth. But we do have increasing number of delivery cases from surrounding places even if they don’t come here for their ANC. Some women who don’t come here for delivery also go to P hospital or S2 PHC. ? In your opinion in what way can the births occuring in the birthing centre be increased? DHO provides two ANC but they don’t provide anyone who can go to field to increase awareness. But we have field staff working from The NGO go for home visit in the community and try to increase awareness among women there. But when the project terminated the women in community might doubt on quality of services provided by the birthing. The FCHV also goes to the community for increasing awareness but no one from ward 1 from K VDC wants to come for delivery here but they prefer to go to India. At the end, finish by asking Is there anything else you need to add? The project is about to finish, so it would have been better if the tenure was extended for few more years. Health worker joint interview ? Name of working birthing centre/Position at birthing centre P3 birthing centre ANM 1 - ANM 2 - ? Years of experience at this birthing centre and past experience at any organization. ANM 1 – .. years ANM 2 – .. years ? Number of clients attending birthing centre in a month (approx), checking the records. ANM 1 & 2– in a month about 20-25 deliveries occur and 8 ANC per month. ? Number of staff working at the birthing centre including their position and availability. ANM 1 & 2 – We are three ANM working here at the moment which includes me as a permanent staff (ANM 1), one temporary ANM appointed by the DHO (ANM 2) and one temporary ANM appointed by WRHD. ? Is the birthing centre open 24 hours? ANM 1 & 2 - Yes, we are open 24 hours. ? What happens when the ANM has to attend training in the capital or regional headquarter? Is there any alternative solution to keep the birthing centre open 24 hours? ANM 1 & 2 - We take turns to attend the training and one of us (ANM 2) lives here. ? How is the management and funding of the birthing centre done? Is the management done by HFOMC or VDC? ANM 1 & 2 – If there is scarcity we receive materials gloves, ringer, cyntosin etc from DHO. We receive a total of NRs 1,000 from Safe Motherhood Programme of which the birthing centre also receives NRs 700 per delivery and if there is money remaining from this fund, we utilize it to buy things which is scarce. We also appoint one cleaner from this money. We receive Rs 255 (after deducting VAT from Rs 300) which is personal. We distribute this money among ourselves. Besides this we don’t have support from anyone. ? From where does the birthing centre receive its budget (Government, NGO, INGO or other)? This birthing centre was established by government, instruments are provided by government, Save the Children, CN, PN and the NGO. If there is shortage of anything, we utilize the fund which is received for birthing centre (Rs 700). Sometime when there is shortage of some material which is needed during delivery we ask the family member of women to buy it from another place and later we reimburse the patient. At other times we also have to take as a loan from another health institution and return it later when it is available to us. ? Does the birthing centre has all essential drugs and equipments required for a normal birth? (Checking the drugs and equipments using observation checklist). Yes, we do have all essential drugs and equipments required for a normal birth. ? If any complication arises during labour is there any referal mechanism available? (either ambulance or any transportation). The patients ask where it would be better to go. We suggest them to go to nearby places like P hospital but they again doubt if they might have to go elsewhere from there, so they want to attend better (meaning tertiary or private medical colleges or hospitals) places. Most of the patients go to Bharahwa medical college, some even go to Devdaha medical college. Some patients tell their experience about attending Lumbini medical college but even if they are examined there, the health personnel refer the patients elsewhere (especially to medical colleges) saying that there are not enough medical personnel present there. Some patients say that they had to pay for delivery even in public hospital. Some claimed that they had to pay Rs 15,000 for C/S but we know that even for C/S, patients don’t have to pay for anything except their food, lodging and transportation cost. Instead they receive money after getting delivered there. ? Is there any other nearest birthing centre or health institution? S3 PHC, BC2, T birthing centre. Further questions ? In your view how would you rate the quality of birthing centre in terms of services you are providing, staff, equipments, etc. It is providing quality service at no cost and we are also giving new clothes for free. It is very helpful for rich and poor both. Few people especially rich ones who want more facilities, they go to hospitals but for the poor this birthing centre has been very helpful. Some poor people don’t even bring a penny for whom this facility has been very useful. Whereas few others who are rich act as poor and come to utilize this service. ? Do you provide adequate information to the labouring woman about her situation? How do you encourage her during labour and delivery? After examining the laboring women it is our duty to provide information of their progress. Some women get curiosity and keep on asking when will the baby come out again and again, can I not get injection? We keep on telling them not to get anxious, it will take time, it will take time. We will keep on examining every four hours. Every women wants their labour to be fast. It is our duty to tell them their progress and if their labour is normal or prolonged. They get anxious but we tell them not be anxious, when time comes everything will be fine. ? Do you allow family members of labouring women inside the birthing centre or do they have to wait outside? We allow one of the family member either mother-in-law or sister-in-law inside the labour room since the laboring women gets anxious and needs moral support. We only allow one female but not male to accompany the women. ? How do you provide the incentives that a women who delivers at your birthing centre needs to get? Yes, we do provide Rs 500 for delivering at health facility as transportation cost and Rs 400 as an incentive to those who have completed four ANC visit according to protocol. We try to provide incentive to the delivery cases as soon as possible. Sometimes government doesn’t release money soon and delay in sending the money but since two quarters we receive the money on time. ? Do all the women who come for ANC attend birthing centre for delivery? If they do not come, which facilities do they visit and what do you think hinders them to visit birthing centre and visit another facility? Not everyone attend this birthing facility but it would have been best if everyone who came for ANC visit came for delivery. We tell everyone who come for ANC visit to manage for clothes, money and keep contact of three people who can provide blood if needed. Some conduct video x-ray and when they come for ANC here they tell us they won’t be coming here but as per doctor’s suggestion they will attend medical colleges. Before women from N and T VDC used to come here but now birthing centre is opened there, so they visit those birthing centre rather than coming here. Also the S3 PHC is nearby and some visit there instead of coming here as S3 PHC has good infrastructure and availability of doctors and staff. Even the number of ANC is less than delivery cases because women visit their own VDC for ANC but when it comes for delivery, many come here as this birthing centre is closer than birthing centre in their own VDC and they also feel the services are better here. For example women from K VDC visit their own health post but time comes for delivery they come here as this birthing centre is nearer to them. ? In your opinion in what way can the births occuring in the birthing centre be increased? In our VDC we have FCHV sisters we tell them to counsel women in community and increase awareness regarding delivery in health facility. Before there used to be many home deliveries but now the number of home deliveries has decreased drastically. Still we can’t help for those who deliver on the way to birthing centre. We need more staff here if we want to increase number of births, at least four ANMs is needed but we are only three. At the end, finish by asking Is there anything else you need to add? We don’t have anything to add as such. Health worker- Public health nurse ? Name of working birthing centre/Position at birthing centre. Working as a Public health nurse working since six years in N. Before working here, I used to work as a PHN in M DHO. I worked as an ANM for a short period of two years in Western Regional Hospital in Pokhara during beginning of my career. ? Years of experience at this birthing centre and past experience at any organization. It has been six years since I started working here as a PHN and before here I worked at M DHO for 15 years. ? Number of clients attending birthing centre in a month (approx), checking the records. In BC1, for ANC checkup there are around 50-80 and over 20 deliveries per month almost 25 in some month. In BC2, there are around 10-12 or even 15 deliveries. ? Number of staff working at the birthing centre including their position and availability. In BC1 there are no ANM from government (we will send one after appointment), from The NGO there is one ANM (there used to be two but one position was phased out), one AHW, one in-charge, one upgraded village health worker and two community worker, in total 7. There are also 7 workers in BC2, two ANM from The NGO, two community workers, from GoN one ANM, one in-charge. ? Is the birthing centre open 24 hours? Yes, we are open 24 hours. ? What happens when the ANM has to attend training in the capital or regional headquarter? Is there any alternative solution to keep the birthing centre open 24 hours? Birthing centres open 24 hours. ANMs take turns to attend training. ? How is the management and funding of the birthing centre done? Is the management done by HFOMC or VDC? FCHV are appointed and mobilized from VDC. VDC also provides One ANM was appointed in T by VDC but now her tenure is finished. There are HFOMC in both birthing centres. ? From where does the birthing centre receive its budget (Government, NGO, INGO or other)? There is financial support from The NGO and government pays the institutional delivery cost to the birthing centre. ? Does the birthing centre has all essential drugs and equipments required for a normal birth? (Checking the drugs and equipments using observation checklist) Yes, these birthing centres have all essential equipments required for a normal birth which was provided by The NGO and government. The NGO has built the building for birthing centre. For the drugs, they receive some from The NGO and some from government. ? If any complication arises during labour is there any referal mechanism available? (either ambulance or any transportation) In case if any complication arises they refer cases to CEOC centre in P. Some also go to Lumbini Zonal hospital in Butwal, or Universal Medical college in Bhairahwa or even in Devdaha medical college. ? Is there any other nearest birthing centre or health institution? P hospital lies nearby. Further questions ? In your view how would you rate the quality of birthing centre in terms of services you are providing, staff, equipments, etc. Yes, they provide good quality services, until now there has not been any deaths or other adverse events in these birthing centres. ? Do you provide adequate information to the labouring woman about her situation? How do you encourage her during labour and delivery? The ANMs are quite helpful since very beginning stages of pregnancy and provide all support and information needed. During delivery they provide all information in a sympathetic way and I don’t see them getting irritated or shouting loudly with the patients. Even partographs are maintained for every delivery. ? Do you allow family members of labouring women inside the birthing centre or do they have to wait outside? Yes, we do allow one family member to enter the delivery bed and also keep them informed about the progress of labour and delivery. It is our policy to deliver the baby in the presence of one family member in all the birthing centres. But family members are not allowed inside the delivery bed in the CEOC centres. ? How do you provide the incentives that a woman who delivers at your birthing centre needs to get? We do provide NRs 900 if they have done four ANC visits according to protocol and delivered at the birthing centres according to provision of government. ? Do all the women who come for ANC attend birthing centre for delivery? If they do not come, which facilities do they visit and what do you think hinders them to visit birthing centre and visit another facility? Not every who come for ANC visit come for delivery in these birthing centres. Some women who live in the peripheral areas attend J PHC for delivery. Some even visit another district for delivery and this has drastically decreased our institutional delivery rate. Last year our institutional delivery rate was 32% but this year it is only 26%. When we surveyed in R and C district, we found 55% women living in the periphery areas go to these districts for delivery. If we could follow and count these women even our institutional delivery rate would have risen over 60%. If we had more CEOC sites then maybe the institutional delivery rate could be increased. ? In your opinion in what way can the births occuring in the birthing centre be increased? In my opinion, if the facilities were increased or if there was more availability of ambulance to refer to hospitals then it would have been better. At the end, finish by asking Is there anything else you need to add? Nyano Jhola is going to be reintroduced which is a good initiative. If there was incentive available to the FCHVs in the form of transportation or refreshment, then it would be motivating for them since they work so hard to bring pregnant women to the birthing centres. Women in community 1 ? How far is your home from this birthing centre? Did you had any difficulty to come to this place? This birthing centre is five minutes far from the place where I live. No I didn’t have any difficulty to go to the birthing centre since it is so near from me. ? Why did you decide to come to the birthing centre for delivery? Did you considered to deliver at some other facilities? My mother-in-law decided that I should go to the birthing centre for delivery. She thought that since there is a birthing centre in our own VDC, I should go there for delivery as it is nearer and convenient to go. ? Where did you have your ANC check up? At the health post in T where birthing centre is also there. ? Who came with you for delivery? Were they allowed to be with you while you were in labour? My mother-in-law came along with me during delivery and she was allowed to accompany me even near the delivery bed. ? How were you treated by the staff here? Were they kind and supportive or rude? I was treated very well by the ANMs at the birthing centre. They were referring me to Butwal hospital because the baby was not responding but my husband requested the ANMs not to refer as we are poor and don’t have enough money, so they delivered my baby at the birthing centre. When my water broke I was given two bottles of saline water. ? Were you provided enough information about progress of your labour? Yes, I was given enough information about progress of labour. The ANMs told me about each and every step during labour and encouraged me while I was laboring. I was very impressed by the behaviour of the ANMs, they were very supportive and helpful. ? Did you receive the service which you expected to receive at this birthing centre? Yes, I received the service I expected from the birthing centre. I was very happy with service ? Did you have to pay for anything or bring anything from home for delivery at this place? No I didn’t have to pay for anything else or bring anything during delivery at the birthing centre. I only had to pay Rs 3,000 for nutritious food after delivery. ? Did you receive the travel and delivery incentives which you should get from government? I received the travel and delivery incentive from the government but my husband received it. Further questions ? Are you happy with the service you received here? If not what things were you not happy about? I am very happy with the service I received at the birthing centre in T. There is nothing I can complain about. ? What are the things that you wish to be changed/ improved at this birthing centre? There’s nothing I wish to change or improve at the birthing centre. ? Based on your experience would you recommend this birthing centre to your relatives or friends? I tell my friends and neighbours to go to the birthing centre for normal delivery. At the end, finish by asking ? Is there anything else you need to add? It was best for me. But I have heard people talking in my community that we should not go to health posts/birthing centres for delivery but go to hospitals in the city since there are doctors. But I told people that we should go to birthing centres as my baby was delivered well and is in good health now. One of my neighbor who first went to birthing centre was referred to P3 PHC, where she spent 3 days and then only delivered the baby. It was her fourth baby, other two died because her family fed them water and sweets. But I didn’t gave my baby anything like that as I have heard of it in the meeting conducted by the NGO. Women in community 2 ? How far is your home from this birthing centre? Did you had any difficulty to come to this place? This birthing centre is very near from my home. It takes only one minute for me to go there. No it is not so difficult to come here as it is very near. ? Why did you decide to come to the birthing centre for delivery? As all of my babies were born normally, so I thought this time also the baby would also be born normally. So I will go to this birthing centre at first, and in case if I need to be referred then I will go to other health facilities which are located far. ? Where did you have your ANC check up? Did you considered to deliver at some other facilities? I had four ANC check up in T health post where the ANMs told me that my baby is normal. I didn’t consider to go to another health facility for delivery as everything was normal. Only if it was difficult to deliver here then I would think of going to hospital in Bhairahwa or Butwal. ? Who came with you for delivery? Were they allowed to be with you while you were in labour? My mother-in-law went with me during labour. She was allowed to be with me while I was in labour. She would come with tea and other snacks while I was in labour bed. ? How were you treated by the staff here? Were they kind and supportive or rude? I found that the beahaviour of ANMs was very supportive. They even come to my house and we have good informal relationship. ? Were you provided enough information about progress of your labour? Yes, I was told everything and provided necessary information during labour. My labour pain started at 8 pm and I went to birthing centre at 9 pm and there they examined me and told me that my cervix has dilated fully, so they gave me saline water. At 12:48 I gave birth to baby. ? Did you receive the service which you expected to receive at this birthing centre? Yes, I received all necessary services necessary as I expected and I didn’t face any difficulty. During delivery of my elder girl I went to S3 PHC but they referred me to Butwal hospital and I faced much difficulty then. Although I had normal pregnancy and the baby was born normally, they insisted that I should go to Butwal. The birthing centre was not established in our village at that time but this time it was much easy and near for me to go to birthing centre in our village. ? Did you have to pay for anything or bring anything from home for delivery at this place? I didn’t have to pay for anything else except NRs 100 for buying maternity pad. I didn’t have to bring anything to the birthing centre except for the clothes I took and the ANMs wrapped the baby with the clothes available from the birthing centre. ? Did you receive the travel and delivery incentives which you should get from government? Yes, I received the money which is meant to be given after delivering baby at this birthing centre. I received NRs 900 in total, 500 as transportation cost and 400 for completing four antenatal check ups. Further questions ? Are you happy with the service you received here? If not what things were you not happy about? I am very happy with the services that I received here. There is nothing as such except for the maternity pad which I had to buy here. If it was available here itself, I wouldn’t have to think about going elsewhere just to buy pad. ? What are the things that you wish to be changed/ improved at this birthing centre? ? If urine and blood test during ANC check ups was available from birthing centre here in T it would have been much easier. We need to go to S3 PHC for these tests which is inconvenient for us. ? Based on your experience would you recommend this birthing centre to your relatives or friends? Yes, I recommend everyone to go to the birthing centre for delivery. At the end, finish by asking Is there anything else you need to add? If there was availability of an ambulance it would have been much easier to go to other health facilities in case if anyone is referred from here. Ambulance is available in S3 PHC and in other places but not available here. Women in community 3 ? How far is your home from this birthing centre? Did you had any difficulty to come to this place? This birthing centre (N) is not so from my home. It takes only five minute for me to go there. No it is not so difficult to come here as it is very near. ? Why did you decide to come to the birthing centre for delivery? Did you considered to deliver at some other facilities? Every facility necessary for a normal delivery is available at this birthing centre and it is very near to my place so I decided to come here. If there is any difficulty, then I can think of going elsewhere. Everything is normal and the ANMs here do good job and because of my past experience as well I wanted to come to this birthing centre. ? Where did you have your ANC check up? I had four ANC check up in N health post. And they told me everything was normal. ? Who came with you for delivery? Were they allowed to be with you while you were in labour? My mother-in-law went with me during labour. She was allowed to be with me during the labour period which helped me a lot. ? How were you treated by the staff here? Were they kind and supportive or rude? I found that the beahaviour of ANMs was very helpful, supportive, kind and very polite. ? Were you provided enough information about progress of your labour? Yes, I was made understand every step during labour which was very informative. They told me about how much my cervix was open and tried to console me that there is nothing to worry about. ? Did you receive the service which you expected to receive at this birthing centre? Yes, I received all necessary services necessary as I expected. I found this birthing centre better than other places. ? Did you have to pay for anything or bring anything from home for delivery at this place? I didn’t have to pay for or bring anything from home for delivery. ? Did you receive the travel and delivery incentives which you should get from government? I haven’t received the money till now but the ANMs told me I will receive soon and they will contact me when I can get the money. Further questions ? Are you happy with the service you received here? If not what things were you not happy about? I am very happy with the services that I received here. ? What are the things that you wish to be changed/ improved at this birthing centre? ? There’s nothing that I see that can be changed or improved at this birthing centre. ? Based on your experience would you recommend this birthing centre to your relatives or friends? Yes, I recommend everyone to go to the birthing centre for delivery. It is very easy to give birth to baby here, so I recommend this place to others as well. At the end, finish by asking Is there anything else you need to add? This place is good for delivery and even the facilities are better here. Even people from surrounding places visit this birthing centre. If more people know about this birthing centre then the number of cases will increase. We are doing from our side, even the health professional can do this in their own way. Women in community 4 ? How far is your home from this birthing centre? Did you had any difficulty to come to this place? This birthing centre (N) is not so from my home. It takes only twenty minute for me to go there. No it is not so difficult to come here. ? Why did you decide to come to the birthing centre for delivery? Did you considered to deliver at some other facilities? This birthing centre is very near from where I live. It is not necessary to go far for delivery. No I didn’t consider to go to other place. ? Where did you have your ANC check up? I had my ANC check up in N health post. ? Who came with you for delivery? Were they allowed to be with you while you were in labour? My sister came with me during labour. She was allowed to be with me during the labour period. ? How were you treated by the staff here? Were they kind and supportive or rude? I found that the beahaviour of ANMs was good, supportive, and helpful. ? Were you provided enough information about progress of your labour? Yes, I was made understand every step during labour which was very informative. They told me about how much my cervix was open. ? Did you receive the service which you expected to receive at this birthing centre? Yes, I received all necessary services necessary as I expected. ? Did you have to pay for anything or bring anything from home for delivery at this place? I didn’t have to pay for or bring anything from home for delivery. I didn’t had to buy anything there. ? Did you receive the travel and delivery incentives which you should get from government? I haven’t received the money till now but the ANMs told me I will receive soon and they will contact me when I can get the money. Further questions ? Are you happy with the service you received here? If not what things were you not happy about? I am very happy with the services that I received here. ? What are the things that you wish to be changed/ improved at this birthing centre? ? There’s nothing that I see that can be changed or improved at this birthing centre. ? Based on your experience would you recommend this birthing centre to your relatives or friends? Yes, I recommend everyone to go to the birthing centre for delivery. But people don’t want to go this birthing centre which is near but they want to go to health facility which are located far from their house and I don’t know why they want to go far when the facility is available in our own village. At the end, finish by asking Is there anything else you need to add? There is nothing I want to say more. Women in community 5 ? How far is your home from this birthing centre? Did you had any difficulty to come to this place? This birthing centre (P2) is near to my home. It takes only ten minute for me to go there. No it is not so difficult to go there. When labour started I went to the birthing centre by motorbike. ? Why did you decide to come to the birthing centre for delivery? Did you considered to deliver at some other facilities? There are necessary facilities available here and is near to my place and if any complications arise then ambulance is available easily. If I had to go to another health facility, I would go the S3 PHC but since every facility is available here I didn’t considered going to S3. ? Where did you have your ANC check up? I had my four ANC check up in P2 health post. ? Who came with you for delivery? Were they allowed to be with you while you were in labour? I went to the birthing centre with my husband but no one came with me in the labour room. I didn’t felt the need as the ANMs are very caring and helpful. ? How were you treated by the staff here? Were they kind and supportive or rude? I found that the beahaviour of ANMs was good, supportive and they communicated in local language so that I can understand. ? Were you provided enough information about progress of your labour? Yes, I was made understand every step during labour which was very informative. They told me what do whenever there was a need. ? Did you receive the service which you expected to receive at this birthing centre? Yes, I received all necessary services necessary as I expected. ? Did you have to pay for anything or bring anything from home for delivery at this place? I didn’t have to pay for or bring anything from home for delivery. I was provided refreshments from my house otherwise there was nothing I spent on. Besides that, I had arranged for all essential amenities required during delivery by myself. ? Did you receive the travel and delivery incentives which you should get from government? Yes I received NRs 900 yesterday. Further questions ? Are you happy with the service you received here? If not what things were you not happy about? I am very happy with the services that I received here as my baby was delivered well. ? What are the things that you wish to be changed/ improved at this birthing centre? As I didn’t face any difficulty while I was there, there I nothing that I see that can be changed or improved at this birthing centre. ? Based on your experience would you recommend this birthing centre to your relatives or friends? Yes, I recommend everyone to go to the birthing centre for delivery. During my first baby there was some complication so I was referred to S3 PHC and arranged ambulance for me but during my second baby there was no difficulty. At the end, finish by asking Is there anything else you need to add? There is nothing I want to say more. Everything was good. Every facilities are available here whichever time we go there. Women in community 6 ? How far is your home from this birthing centre? Did you had any difficulty to come to this place? This birthing centre (T) is near to my home. It takes only ten minute for me to go there. No it is not so difficult to go there, I went there by motocycle. ? Why did you decide to come to the birthing centre for delivery? Did you considered to deliver at some other facilities? There are necessary facilities available here and is near to my place so I didn’t think about going to other health facility. My relatives went to S3 PHC but I didn’t think to go there, I always wanted to go to T birthing centre since its near. I didn’t felt need to go to another health facility. If there was any difficulty, then I would have considered going to another health facility. ? Where did you have your ANC check up? I had my three ANC checkups here in BC1 and one ANC check up in S3 PHC.. I thought since S3 PHC is older and they might know better but then I considered to deliver at BC1. At the birthing centre I was told the importance of delivering in the health facility. Also I used to attend meetings conducted by the NGO where they discussed about importance of delivering at birthing centre. ? Who came with you for delivery? Were they allowed to be with you while you were in labour? Four people came with me during delivery: my mother, my husband and in laws. My mother was present with me in the labour bed during whole period of labour and delivery. ? How were you treated by the staff here? Were they kind and supportive or rude? I found that the behaviour of ANMs was good, helped me understand in a supportive way. They took good care of me, told me what to do and how to do. I went there at 10 am and delivered at 7 pm and returned home at 10 pm. ? Were you provided enough information about progress of your labour? Yes, I was made understand every step during labour which was very informative and told me everything from time to time. ? Did you receive the service which you expected to receive at this birthing centre? Yes, I received all necessary services necessary as I expected. ? Did you have to pay for anything or bring anything from home for delivery at this place? I didn’t have to pay for or bring anything from home for delivery. I didn’t have to buy anything there. I had arranged for all essential requirements by myself and my family arranged for refreshments while I was in the birthing centre. ? Did you receive the travel and delivery incentives which you should get from government? I received NRs 900 after one month of delivery. Further questions ? Are you happy with the service you received here? If not what things were you not happy about? I am very happy with the services that I received here. Everything went well for me. ? What are the things that you wish to be changed/ improved at this birthing centre? ? There’s nothing that I see that can be changed or improved at this birthing centre. ? Based on your experience would you recommend this birthing centre to your relatives or friends? Yes, I recommend everyone to go to the birthing centre for delivery. At the end, finish by asking Is there anything else you need to add? If there is emergency facility available at this birthing centre or nearby or even the ambulance is available in our village then it would be better in case if there is any emergency case. Focus group discussion ? Have any of you or your family members delivered at the birthing centre in your village or nearby village? W1 W2 W3 W4 W5 W6 W7 W8 W2 and W7 delivered at the birthing centre. W2 – There are every facilities available here at N. They provide good service and my home is nearby. W7 – It is easy to deliver here, every facilities are available here and my home is nearby. W6 – When these women were about to deliver, this birthing centre was already established, so they thought it would be better to deliver here since our home is also near to the birthing centre. ? Why did you decide to go to the birthing centre and not to other health facilities?/ Did you consider other health facilities for delivery? W6 - Our home is nearby, there was no birthing centre here. The health professionals at this health post used to do our check up but they suggested us to go to S3 since if any difficulties appear during labour, it is easier to go to Butwal. W8 – We don’t need any vehicle to come here and facilities are very good. ? Where does the women here usually get their ANC check up after they get pregnant? Most of them go to the N health post for their ANC since it is nearby. When we go to health post we are suggested to go to hospital for other check ups either Butwal or some other places. ? Were your family members allowed inside the birthing centre or do they had to wait outside? Yes, they were allowed for whole time during labour and also during delivery. ? How are you treated by the staff at the birthing centre? Do the staff allow family members with the labouring woman? W2 – Their behavior was very good, they talked to us, they asked us questions and suggested us what to do in different stages. W7 – They behaved very well and talked in a good manner and politely. ? Do you get enough information about the labour and delivery from the ANM? W2 - Yes we were informed about every steps during delivery and they also told us what to do next which was very helpful. W6 – Our FCHV sister from this community motivates us to visit birthing centre for delivery. Before when there was no birthing centre, ANMs from this health post used to visit our home when we called them. ? Did you received the service which you expected to receive at this birthing centre? Yes, we did receive the services we expected. ? Did you had to pay for anything or bring anything from home for delivery at this place? W7 - We did not have to pay for anything but we had to buy things like maternity pads from outside. If we could get these things from the birthing centre it would have been much better. There should be facility for essential materials and medicines. W2 – We did not have to pay for anything or buy anything for delivery. We received everything at the birthing centre. We didn’t even have to pay any money. ? Did you receive the travel and delivery incentives which you should get from government? W2- I received Rs 1,000 after three days of delivery. They gave it to my husband after signing into a register. We bought nutritious food to eat. Further questions ? Are you happy with the service you received here? If not what things were you not happy about? W1, W3, W4, W5 - We are all happy with the services. We didn’t deliver at this birthing centre but went for ANC visit and liked the facilities and services there. ? What are the things that you wish to be changed/improved at the birthing centre you attended? W2 - If there was an ambulance available during emergency, it would have been better. Also I think there should be more nurses and even one doctor available at this birthing centre. W1, W3, W4, W5, W6 – There is nothing as such that we want to be changed. ? Based on your experience would you recommend this birthing centre to your relatives or friends? W1, W3, W4, W5, W6 – Yes we will recommend everyone to visit this birthing centre as it is very near and we all are happy about that. W6 – Since the ANMs are from our own village, we don’t feel it uncomfortable or fearful to share our problems. If we go to a far by health facility where we don’t know anyone, it feels uncomfortable to share our problems to them. W8 – I recommend others to go to health facility even if I didn’t go to health facility for delivery while giving birth to my babies. Even if someone is thinking to deliver at home, if there is any complications or difficulty, its better to rush to birthing centre. W1 – It is better to visit birthing centre since nowadays people prefer to go there. In our times we didn’t use to go to birthing centre or hospital since there was not much facility available but as a birthing centre is available to our nearby place others should go there. It is easier to deliver at birthing centre as there is presence of health workers, necessary medicines and other facilities whereas at home there is nothing available as such. I also tell others to go for ANC visit at the health post. W5- When I gave birth to my child this birthing centre was not built so I had to go to S3. It is better to go there since it is nearer, every facility is available similar to S3 here and easier even to take food for the laboring women. Since this birthing centre is very near it is very easy to reach here, if we had to go far, it would be inconvenient and we would need an ambulance. At the end, finish by asking Is there anything else you need to add? If there were all necessary medicines, more nurses and health professionals including doctor and more equipment, we would get all facilities here.