Health care workers usually want to do a good job and provide good care for patients. However, they are often unable to provide as good care as they would like, particularly in facilities with an overload of clients [17, 18] . Results of a survey among women who had been pregnant in Hanoi revealed that they attended and paid for ANC services at higher-level health facilities (provincial and district hospitals) rather than go to commune health stations where ANC services are free of charge [4] . High workloads were observed at provincial hospitals, while district hospitals and commune health stations appeared to have more time and space for pregnant women. Studies of ANC services in Vietnam have identified a number of weaknesses. Staff shortages and staff motivation can significantly affect the quality of service, especially for counselling, which takes a long time to do well [12, [19] [20] [21] [22] .