A261 model was implemented. Tally sheets were used to categorize referral recommendations. Satisfaction was defined as reported in survey response as, dissatisfied, neutral and satisfied. RESULTS: On patient satisfaction or dissatisfaction only two hundred and twenty eight respondents answered the questions of whom only 38% (37/117) reported that they were satisfied with the patient referral and counter referral process while 62% (80/117) were neutral. CONCLUSIONS: Two thirds of the respondents were undecided. They were neither satisfied nor dissatisfied with the referral process. This is a significant proportion which in the view of the authors, there is need for further investigation to establish factors that are likely to make patients remain neutral.

A179arthritis/hypertension, adults with diabetes/heart disease and arthritis/heart disease/ hypertension had significantly higher missed work days, while adults with diabetes/hypertension had significantly lower missed work days. ConClusions: Average missed work days was differed by chronic condition combinations. Adults with combinations of diabetes/heart disease, arthritis/heart disease/ hypertension and arthritis/diabetes/heart conditions have high burden of disease in terms of reduced productivity while at work. Workplace health programs that address multiple health conditions at the same time should be implemented to reduce missed work days.

A141beneficial effect and could make significant contribution to a reduction in home deliveries. The study was meant to develop and test a Community Based Referral Model (CBRM) that could be used to improve antenatal, postnatal care visits and hospital deliveries. The study had three outcome measures e.g. Proportion of pregnant women who attended antenatal care clinics, home deliveries who visited postnatal clinic and proportion of women who delivered in the link hospitals. Methods: A quasi -experimental study was carried out in two sub-locations linked to a hospital within the sub location. Secondary data on antenatal, postnatal visits and hospital deliveries on the past 10 months was extracted from registers in the two link hospitals before implementation of the referral system. One hundred community health workers were trained on community based referral and counter referral system and issued with referral tools. They were instructed to regularly visit the households in order to identify pregnant women, counsel and refer them to antenatal clinics in the linked hospitals. Each community health worker was assigned 25 households; hence 2209 households were regularly visited for a period of 10 months. Endline information was extracted from the same hospital registers. The two sets of data were compared. Results: Statistically significant differences were observed in postnatal care visits (p-value 0.007) depicting an increase of 166% and hospital deliveries (p-value 0.001) depicting an increase of 135%. No differences were observed in all the 4 antenatal care visits. ConClusions: In order to get a better understanding of the effectiveness of a community based referral and counter referral system in a rural setting, a larger study with randomly selected intervention and control sites is recommended.

much" to 4 "disagree/dissatisfied very much". Correlation analysis was performed to identify the relationship between working motivation and job satisfaction. Also, multivariate regression analysis with stepwise method was conducted between overall job satisfaction and various working motivation dimensions. Results: 141 out of 150 nurses filled out the questionnaire (RR 94%). The majority of the sample (68.8%) was female and belonged to the 21-30 years old group. Working motivation scoring was ranged from 2.54 to 2.04, meaning positive, except from working relationships (1.8 ±0.7). Also, the mean of overall job satisfaction was 2.3±0.6, meaning satisfied. Positive correlation was found between working motivation and job satisfaction (p≤ 0.01), with the exception of salary and working relationships. Personal development (β = 0.227), job interest (β = 0.254), responsibility (β = 0.149) and recognition (β = 0.154), were significant predictors of overall job satisfaction (p≤ 0.05). Reporting high motivation from work was positively and significantly associated with higher job satisfaction. ConClusions: Working motivation of health professionals contributes to the enhancement of their job satisfaction and consequently to the improvement of health services provision.

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