Abstract
Over 50% of sick children are treated by private primary-level facilities, but data on patient referral processes from such facilities are limited. We explored the perspectives of healthcare providers and child caretakers on the referral process of children with common childhood infections from private low-level health facilities in Mbarara District. We carried out 43 in-depth interviews with health workers and caretakers of sick children, purposively selected from 30 facilities, until data saturation was achieved. The issues discussed included the process of referral, challenges in referral completion and ways to improve the process. We used thematic analysis, using a combined deductive/inductive approach. The reasons for where and how to refer were shaped by the patients’ clinical characteristics, the caretakers’ ability to pay and health workers’ perceptions. Caretaker non-adherence to referral and inadequate communication between health facilities were the major challenges to the referral process. Suggestions for improving referrals were hinged on procedures to promote caretaker adherence to referral, including reducing waiting time and minimising the expenses incurred by caretakers. We recommend that triage at referral facilities should be improved and that health workers in low-level private health facilities (LLPHFs) should routinely be included in the capacity-building trainings organised by the Ministry of Health (MoH) and in workshops to disseminate health policies and national healthcare guidelines. Further research should be done on the effect of improving communication between LLPHFs and referral health facilities by affordable means, such as telephone, and the impact of community initiatives, such as transport vouchers, on promoting adherence to referral for sick children.
Highlights
We explored the referral process of children below 5 years attending level private health facilities (LLPHFs) in Mbarara District
Health workers in LLPHFs have positive attitudes towards referring sick children, but key challenges exist, which lead to caretaker non-adherence to referral
These include health system issues, such as long waiting times, inadequate medicines and materials for patient care and a large number of patients at public referral health facilities compared to the healthcare workers
Summary
Prompt and appropriate care for children with infectious diseases can contribute to reducing child deaths and to realising the SDG targets. Over 50% of sick children first receive healthcare from private primary health facilities in Uganda; many of these facilities lack the capacity to manage complicated conditions, such as severe pneumonia and severe malaria [7,8]. Such cases should be referred for escalation of care, and a well-streamlined referral system is important. It is important that the healthcare providers have the competence to identify and appropriately refer sick children needing referral
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