Assessing Facilitators and Barriers to Referral of Children Under the Age of Five Years at Ndirande Health Centre in Blantyre, Malawi

Abstract

Patient referrals among health facilities are initiated to maximize receipt of quality care at a proper level within the health system. This study explored the processes, factors that influence, and strategies for referral of children from Ndirande Health Centre to Queen Elizabeth Central Hospital in Blantyre, Malawi. We drew a purposive sample comprising health care workers, mothers, fathers, ambulance drivers, and Health Center Advisory Committee (HCAC) members and held 19 in-depth interviews and 1 focus group discussion in August 2020. The referral process is influenced by the availability of motor and bicycle ambulances that are well equipped with medical equipment, delay in seeking health services, uptake of referral, and community support. Education and communication with the community and parents respectively optimize the process of referral. There is a need to improve the referral system of under-five children by instituting a policy that is functional while addressing the main barriers.

Improving care pathways for children with severe illness through implementation of the ASPIRE mHealth primary ETAT package in Malawi

“…As such, implementation of ETAT within the primary health system led to an increase, from Phase 1 to Phase 2, in the likelihood of those referred reaching tertiary care but rates of successful referral remained less than optimal at 54·7%. Both economic and social barriers to the referral pathway have been identified across sub-Saharan Africa including Malawi[ 33 ] and are likely to have impacted here. While we initially aimed to measure referral times from presentation at PHC to the referral clinician through the data monitoring system, our analysis suggested potential problems with data reliability.…”

Child acute illness presentation and referrals at primary health clinics in Malawi: a secondary analysis of ASPIRE

“…Referral is a critical component of the IMCI strategy, intended to recognise children with severe conditions and ensure appropriate management and optimise quality care at the proper level of the health system 8 9. In Malawi, in 2013–2014, only 3.5% of hospitals were equipped to provide basic paediatric emergency care in a national facility census 10.…”

“…In low-resource settings in sub-Saharan Africa prior to the implementation of IMCI, <2% of children presenting at primary level facilities were referred8 11; after the introduction of IMCI, referral rates for children were 6%–20% 12. Challenges with the referral pathway range from parental education9 13 to communication,9 transport,9 14–16 and cost 14 16. Therefore, for children who have been referred, successful referral (ie, arrival at the referral facility) has been documented to be as low as 28% 16…”