Representative quotations on organisational and administrative barriers in the health system experienced by patients
| Health system barrier | Representative quotation |
| Complexity of navigation within tertiary facilities | Q10. For all tests, the patient has to wander here and there; otherwise they won’t collect the test. (Family member of a man with a prior treatment history). |
| Challenges of repeatedly returning to the same facility | Q11. Many patients are not able to come to the hospital several times, especially old people. It will be very helpful if the number of required visits is reduced. (Woman without a prior treatment history). |
| Complexity of navigation between facilities | Q12. (The HCW) told me to go to Old General Hospital. I thought that by ‘Old General Hospital’ she meant Madras Medical College, which is very far from where I live. So I went back home… I later found out that Old General Hospital meant (a local hospital), which is nearby, just opposite this clinic. (Man without a prior treatment history). |
| Q13. Yes, madam, I visited (a TB speciality hospital); they referred me to (a secondary hospital) and then they referred me to (a tertiary hospital). (Man without a prior treatment history). | |
| Failure to notify patient of diagnosis or to provide general TB information | Q14. They referred me to a hospital for treatment… But they did not say anything about my health condition and my disease. (Man without a prior treatment history). |
| Healthcare worker demanded documents | Q15. (After the patient reached the rural DOT centre, the HCW said): “Go back to (tertiary hospital where the patient was diagnosed in the city) and bring a referral slip—only then can we start treatment.” (Man without a prior treatment history). |
| Infrastructure failures | Q16. Thrice I came to (a tertiary hospital) to receive my test report but… (t)hey said, “…(Y)ou have to wait for some days… We can prepare your report only when the power supply is available.” (Woman without a prior treatment history). |
| Healthcare worker absenteeism | Q17. The X-ray technician said that he… can only give the result tomorrow. I pleaded with him. I told him I felt too ill. He asked me to come after 1 hour… At that time the doctor had left the hospital. The Sister (nurse) asked me to come back on Wednesday. (Man with a prior treatment history). |
| Rigidity of facility-based DOT | Q18. (HCWs who perform DOT) come at 11 a.m. Patients will be standing in the queue; they call us one by one to give the tablets. We need to take tablets in front of them and sign. It almost takes until 12 p.m. Then how can I go to work? (Man with a prior treatment history). |
DOT, directly observed therapy; HCW, healthcare worker; TB, tuberculosis.