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Referral Systems - A Summary of Key Processes To Guide Health Services Managers
Referral Systems - A Summary of Key Processes To Guide Health Services Managers
Definition of terms
A referral can be defined as a process in which a health worker at a one level of the health system, having
insufficient resources (drugs, equipment, skills) to manage a clinical condition, seeks the assistance of a
better or differently resourced facility at the same or higher level to assist in, or take over the management of,
the client’s case. Key reasons for deciding to refer either an emergency or routine case include:
to seek expert opinion regarding the client
to seek additional or different services for the client
to seek admission and management of the client
Results of this analysis can be covered at meetings with hospital and clinic staff together. As the issues
are discussed, staff will identify what is needed to improve things - this might include clinical training or
strengthening of particular parts of the referral system or its procedures. Facility managers and
supervisors need to ensure that such items are followed-up and acted on. In-service education and
capacity strengthening can be reinforced by good supervision.
Long-term treatment of chronic illnesses such as diabetes, hypertension, epilepsy and psychiatric illness
can be managed at suitably resourced health centres - this assures not only high quality of care for the
client, but also greater convenience and less burden on the client and the higher levels of the health
system.
Cervantes K, Salgado R, Choi M and Kalter H. 2003 Rapid Assessment of Referral Care Systems: A Guide
for Program Managers, published by the Basic Support for Institutionalizing Child Survival Project (BASICS
II) for the United States Agency for International Development, Arlington, Virginia, available on line at:
http://www.jsi.com/Managed/Docs/Publications/WomensHealth/PNACW615.pdf
Department of Health, Republic of South Africa, 2003, The Clinic Supervisor’s Manual, Version 3, see
Section 6: Referral System Guidelines, available on line at:
http://www.doh.gov.za/docs/factsheets/guidelines/clinical/index.html
Department of Reproductive Health and Research (RHR), World Health Organization, Care of mother and
bay at the health centre: A practical guide, see Section 3 Developing and maintaining a functioning referral
system, available on line at:
http://www.who.int/reproductive-health/publications/msm_94_2/care_mother_baby_health_centre.pdf
Jamison D T, Breman J G, Measham A R, Alleyne G, Claeson M, Evans D B, Jha P, Mills A and Musgrove P,
2006, Disease Control priorities in Developing Countries, A co publication of Oxford University Press and The
World Bank, see Chapter 66: Referral Hospitals, available on line at:: http://files.dcp2.org/pdf/DCP/DCP.pdf
Saunders D, Kravitz J, Lewin S and McKee M, 1998, Zimbabwe’s hospital referral system: does it work? In
Health Policy and Planning: 13(4): 359-370, available on line at:
http://heapol.oxfordjournals.org/cgi/reprint/13/4/359.pdf
Stuart L, Harkins J, and Wigley M, 2005, Establishing Referral Networks for Comprehensive HIV Care in
Low-Resource Settings, Family Health International, Impact and USAID, available on line at:
http://www.fhi.org/NR/rdonlyres/ewym4k3dirreee3fwj43u2wt47o5gctbnrvichtethbx5uwl3tglsewndqxvwfhoqvb
5agzccsce6k/RefNetsGuide.pdf
Tawfik A.M. Khoja, Ali M. Al Shehri, Abdul-Aziz F. Abdul-Aziz and Khwaja M.S. Aziz, 1997, Patterns of referral
from health centres to hospitals in Riyadh region, in Eastern Mediterranean Health Journal, Volume 3, Issue
2, 1997, Page 236-243, available on line at: http://www.emro.who.int/publications/EMHJ/0302/05.htm
WHO Regional Office for South East Asia, 2004, Voluntary HIV Counselling and Testing: Manual for
Training of Trainers, see Module 5 sub module 3: Referral and network development, available on line at:
http://www.searo.who.int/LinkFiles/Training_Materials_voluntary-module5-3.pdf
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Client address
Clinical history
Findings
Treatment given
To Initiating Facility:
(enter name and address)
Client Name
Client address
Treatment / operation
Medication prescribed
Please continue with:
(meds, Rx, follow-up, care)
Refer back to: on date:
Register of Referrals IN
Appropriate Date Back
Date referral Client Name (M or F) Identity No. Referred from Referred for Summary of treatment
referral referral
received (name of facility / specialty) provided
YES / NO sent