Factors Affecting the Provision of Referral Services at the Primary Level of Health Care in Zomba District in Malawi
Abstract:
The study was conducted
to investigate the factors that affect management of the referral system at the
primary level of health care in Zomba district in Malawi. To accomplish this
purpose the study sought to identify the criteria that guided primary health
care providers in making referral decisions; assessed the effectiveness of the
role of community leaders in the management of referral process at primary care
level, and investigated the challenges affecting the implementation of referral
system at the primary health care level in Zomba district. The study took a
qualitative approach and used face-to-face interviews to collect data from
purposively selected nurses, clinicians, health surveillance assistants,
ambulance drivers, transport officers, community and health committee leaders
from six conveniently sampled primary health facilities. The findings revealed
that primary care facilities faced a number of challenges such as lack of
referral transport, poor communication, lack of referral guidelines, shortage
of skilled personnel, lack of diagnostic equipment and drugs which led to the self-referral
and the bypassing of primary care facilities in Zomba district. The study
recommended that the government should enhance the availability of needed
resources such as skilled personnel, diagnostic equipment, drugs, referral
ambulances and communication technology in order to facilitate the referral of
patients. The Ministry of Health should provide referral guidelines to all
health care providers at all levels as well as consider
constructing a district hospital to provide secondary level health care
services.
The district health office needs to maintain all the ambulances and provide
fuel consistently in order to improve the quality of primary health care
referral services.
Keywords: Primary health care,
referral system, patient outcome, referral process.
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