A comparison of referrals among primary health-care workers in urban and rural local government areas in North-Western Nigeria

Abstract

Introduction: In Nigeria, the three tiers of health-care service are linked through the referral system and primary health care (PHCs) are an entry point into this health-care service. Effectiveness of referral system is a strong determinant of the strength of health-care service delivery. This study was conducted to assess and compare knowledge and practice of referral among PHC workers in urban and rural health facilities in two local government areas (LGAs) in Kaduna State. Methodology: The study was comparative cross-sectional. It enrolled all eligible PHC workers in the study areas; seventy in urban and 69 in rural LGAs. Data were collected using a structured interviewer-administered questionnaire containing close-ended questions. Results: Majority of the health workers in both LGAs were in the age range 25-34 years. Only 16 (22.9%) of those in urban and 13 (21.0%) in rural PHCs had good knowledge of referral (P = 0.594). In addition, only 9 (12.9%) in urban and 7 (11.3%) in rural PHCs had good practice of referral (P = 0.595). Conclusion: Knowledge and practice of referral were poor in both urban and rural PHCs. There is an urgent need for training on referral and other forms of intervention such as instituting a referral focal person to improve practice of referral among the health workers in both rural and urban PHCs.