9.3  What prevents referrals from happening effectively?

There are many reasons why a referral doesn’t happen at all, or does not happen in time, including the following:

  • Lack of proper counselling to the mother, father and other caregivers, so they don’t realise how serious the problem is.
  • Far distance and lack of means of transportation to the health facility.
  • The family has not saved the financial resources to make the journey.
  • Health facilities are not attractive to some patients. Often they don’t have proper supplies of essential medicines and equipment, or they lack the correctly trained person for the service required. Hence, due to the poor reputation of some health facilities, parents may be reluctant to go to them.
  • Is there anything you can do to help reduce the chances of a failed referral?

  • You might look back to Study Session 13 in the Antenatal Care Module and the discussion about Focused Antenatal Care (FANC). Remember that emergency care planning is a key part of the counselling you should have conducted with every expectant mother and her family before the birth. They should have saved money for the journey and arranged transport.

In addition to the antenatal counselling you have done with pregnant mothers and families, you will also have been mobilising community involvement to support them in the postnatal period. Study Session 1 of this Module discussed how to do this effectively. Remember that it is in the emergency situation that you can really see your work with the community bearing fruit.

  • Think of an example of how you might turn to the community for help with a postnatal emergency.

  • You may have thought of many different examples. Here is just one. The family is not financially prepared and doesn’t have a plan for transport. You persuade someone locally who has a vehicle to take the mother and newborn to the health facility, because it is a matter of life and death. Based on your earlier involvement with the community you are able to get agreement in advance from the kebele leaders that money will be found from a community fund to pay for the transport if the family cannot afford it. You thank the community leaders for their support and recognition that emergencies can often be successfully treated in a higher health facility, provided that the patient arrives in good time.

9.2.2  Knowing about local health facilities

9.4  How to make referrals happen