Implementation and Challenges of Referral System in Public Health Centers of Addis Ababa, Ethiopia, 2019
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Date
2020-06
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Addis Abeba University
Abstract
Background: A referral can be defined as a dynamic process, in which a health worker at one
level of the health system, having insufficient resources (drugs, equipment, skills, etc.) to manage
a clinical condition, seeks the help of a better or differently resourced facility at the same or higher
level to assist patients. In Ethiopia, studies indicated that numerous factors could affect the
implementation of the referral system.
Objective: This study was aimed at assessing the implementation and identify the challenges of
the referral system in public health centers of Addis Ababa, Ethiopia, 2019.
Methods: Mixed method study design, based on institutional analysis and community perspective
was conducted at Addis Ababa, Ethiopia. Documents of the referral system and 125 referred
patients’ folders 2019 G.C. were reviewed at 25 health centers and analyzed descriptively.
Qualitative data were collected by an in-depth-interview using an interview guide and analyzed
thematically to identify the possible challenges of the referral system.
Results: This study showed that the implementation status of structure and inputs among health
centers was low (69.1%). Referral paper content analysis showed that 58% of the referral format
complies with the national standards. The proportion of patients reached and got health care at
hospitals according to a referral from the health centers was 92%, while the proportion of referral
feedback was 22.4%. Five major themes about the implementation challenges of referral system
have emerged: a) Lack of information and inadequate consultation; b) unnecessary referral for
drug/ laboratory examination outside the institution; c) incomplete referral form; d) poor
coordination and communication between health centers and the receiving hospital; and e)
reluctance and poor staff motivation.
Conclusion: Implementation status of referral among health centers was low and the referral
papers sent to hospitals did not mostly comply with the national implementation standard, and
sending feedbacks from hospitals to health centers was very low. Health centers should establish
consultation mechanisms and conduct situational analysis periodically. while health professionals
are expected to communicate patient’s information at the time of referral as it is essential to high
quality and safe patient care and they should value the information exchange for a shared patient.
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Keywords
Referral, Feedback from Referral, Implementation of Referral, Referral System Challenge