Objective: To describe the capacity of primary health care facilities to manage obstetric referrals, the reasons, and processes for managing obstetric referrals, and how an enhanced inter-facility communication system may have influenced these.

Design: Mixed methods comparing data before and during the intervention period.

Setting: Three districts in the Greater Accra region, Ghana from May 2017 to February 2018.

Participants: Referred pregnant women and their relatives, health workers at referring and referral facilities, facility and district health managers.

Intervention: An enhanced inter-facility communication system for obstetric referrals.

Results: Twenty-two facilities and 673 referrals were assessed over the period. The major reason for referrals was pregnancy complications (85.5%). Emergency obstetric medicines - oxytocin and magnesium sulfate (MgSO) were available in 81.8% and 54.5% facilities, respectively, and a health worker accompanied 110(16.3%) women to the referral centre. Inter-facility communication about the referral occurred for 240 (35.7%) patients. During the intervention period, referrals joining queues at the referral facility decreased (7.8% to 0.0%; p=0.01), referrals coming in with referral notes improved (78.4% to 91.2%) and referrals with inter-facility communication improved (43.1% to 52.9%). Health workers and managers reported improvement in feedback to lower-level facilities and better filling of referral forms.

Conclusion: Facilities had varying levels of availability of infrastructure, protocols, guidelines, services, equipment, and logistics for managing obstetric referrals. Enhanced inter-facility communication for obstetric referrals which engages health workers and provides requisite tools, can facilitate an efficient referral process for desired outcomes.

Funding: This study was funded by the WHO/TDR Postdoctoral grant number B40347 to the NMIMR.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630038PMC
http://dx.doi.org/10.4314/gmj.v56i3s.7DOI Listing

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