Abstract
A functional referral system for addressing maternal and child health issues requires coordinated efforts by health system stakeholders and community. Using Rural Health Program (RHP) Thatta as platform provided by an academic institution, district health system stakeholders and community of Mirpur Sakro taluka of Thatta were engaged to strengthen the emergency referral system for maternal and child health emergencies through active community engagement. Through combined consultation, referral system plan for maternal and child health emergencies was developed. Community volunteers from each village liaised for transportation, referring patients to health facilities and maintaining referral documentation. An ambulance service under contract with health department and private transporters were taken on-board to facilitate patients’ transportation. Community’s experiences of referral system were assessed through qualitative in-depth interviews. Patients’ experiences of referral system improved but faced structural challenges including out of pocket transport expenses, direct self-referrals, Continuous...
Highlights
A functional referral system is an essential element of primary healthcare (PHC) that serves to connect the community with health facilities
To address the challenges of the dysfunctional referral system, the Community Health Sciences Department, Aga Khan University (AKU) initiated the Rural Health Programme (RHP), an implementation science initiative aimed at health systems strengthening in the rural district of Thatta, Sindh
Referral system improved transport availability: Several cases were referred to health facilities through the referral system with the majority of these ending up at public sector hospitals with successful deliveries, treatment outcomes and/or referrals to the level of care
Summary
A functional referral system is an essential element of primary healthcare (PHC) that serves to connect the community with health facilities. District health stakeholders and the community were brought together to collectively identify and address priority health issues. The lack of an effective referral system to address maternal. Key stakeholders included the district health office (DHO) and the non-state providers (NSPs) working with the health department through public-private partnership (PPP) node and were managing public sector health facilities in the district. Through the mapping of the village and community-based organisations (CBOs), village representatives were approached to organise community meetings for building partnerships and apprise the communities regarding the importance of having a functional referral system. Private transporters of the respective villages were mapped to aid in patient referrals
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