Table 4 Some discursive practices that suppress patient rights in health facilities

Normatively, policies designed by the State, provide frameworks, and guide implementation of patient rights at health facilities. The KPME Act, 2007 mandates the display of information regarding the charges for services provided, grievance redressal and a patient rights charter. But a majority (4/5) of the private health facilities visited during this study had not complied with this legal mandate. Of course, the display of patient rights charter alone is not sufficient to assure patient rights implementation at the health facility level. But the matter of concern is that even the minimum requirement of displaying the patient rights charter was not fulfilled by many health facilities

In three private health facilities, unqualified people were practicing as allied health professionals such as nurses, pharmacists, therapists etc. Some care-seeking individuals reported paying informal payments to care-providers in government health facilities. In a milieu of weak health care regulation, relatively powerful actors such as care- providers, public officials, health care administrators are not under sufficient pressure to comply and they tend to overlook the importance of promoting patient rights discourses. In other words, system-level efforts are not sufficient to pro-actively inform the care-seeking individuals about their rights

The standardized health records such as the Mother Card distributed to antenatal mothers in government health facilities provided only technical information about maternal and childcare but did not include information about patient rights. In one public health facility we found that the patient records had only patient responsibilities listed but not patient rights. In another public health facility in a rural setting, we found that the posters depicting the rights of women seeking maternal and childcare were in English only (i.e., in a language that is hardly understood by rural folks who are not able to read and write). Thus, we can conclude that the efforts to institutionalize patient rights at the health facility level have remained largely tokenistic