Implementation And Challenges Of Referral System In Public Health Centers Of Addis Ababa Ethiopia 2019

Background: A referral can be defined as a dynamic process, in which a health worker at one rnlevel of the health system, having insufficient resources (drugs, equipment, skills, etc.) to manage rna clinical condition, seeks the help of a better or differently resourced facility at the same or higher rnlevel to assist patients. In Ethiopia, studies indicated that numerous factors could affect the rnimplementation of the referral system. rnObjective: This study was aimed at assessing the implementation and identify the challenges of rnthe referral system in public health centers of Addis Ababa, Ethiopia, 2019. rnMethods: Mixed method study design, based on institutional analysis and community perspective rnwas conducted at Addis Ababa, Ethiopia. Documents of the referral system and 125 referred rnpatients’ folders 2019 G.C. were reviewed at 25 health centers and analyzed descriptively. rnQualitative data were collected by an in-depth-interview using an interview guide and analyzed rnthematically to identify the possible challenges of the referral system. rnResults: This study showed that the implementation status of structure and inputs among health rncenters was low (69.1%). Referral paper content analysis showed that 58% of the referral format rncomplies with the national standards. The proportion of patients reached and got health care at rnhospitals according to a referral from the health centers was 92%, while the proportion of referral rnfeedback was 22.4%. Five major themes about the implementation challenges of referral system rnhave emerged: a) Lack of information and inadequate consultation; b) unnecessary referral for rndrug/ laboratory examination outside the institution; c) incomplete referral form; d) poor rncoordination and communication between health centers and the receiving hospital; and e) rnreluctance and poor staff motivation. rnConclusion: Implementation status of referral among health centers was low and the referral rnpapers sent to hospitals did not mostly comply with the national implementation standard, and rnsending feedbacks from hospitals to health centers was very low. Health centers should establish rnconsultation mechanisms and conduct situational analysis periodically. while health professionals rnare expected to communicate patient’s information at the time of referral as it is essential to high rnquality and safe patient care and they should value the information exchange for a shared patient.

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