A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Children
Abstract
Over 50% of sick children are treated by private primary-level facilities, but data on
patient referral processes from such facilities are limited. We explored the perspectives of healthcare
providers and child caretakers on the referral process of children with common childhood infections
from private low-level health facilities in Mbarara District. We carried out 43 in-depth interviews
with health workers and caretakers of sick children, purposively selected from 30 facilities, until
data saturation was achieved. The issues discussed included the process of referral, challenges in
referral completion and ways to improve the process. We used thematic analysis, using a combined
deductive/inductive approach. The reasons for where and how to refer were shaped by the patients’
clinical characteristics, the caretakers’ ability to pay and health workers’ perceptions. Caretaker
non-adherence to referral and inadequate communication between health facilities were the major
challenges to the referral process. Suggestions for improving referrals were hinged on procedures
to promote caretaker adherence to referral, including reducing waiting time and minimising the
expenses incurred by caretakers. We recommend that triage at referral facilities should be improved
and that health workers in low-level private health facilities (LLPHFs) should routinely be included
in the capacity-building trainings organised by the Ministry of Health (MoH) and in workshops to
disseminate health policies and national healthcare guidelines. Further research should be done on
the effect of improving communication between LLPHFs and referral health facilities by affordable
means, such as telephone, and the impact of community initiatives, such as transport vouchers, on
promoting adherence to referral for sick children.
Description
Keywords
Referral, Primary private health facilities, Low-income countries
Citation
Mwanga-Amumpaire, J.; Kalyango, J.N.; Ndeezi, G.; Rujumba, J.; Owokuhaisa, J.; Stålsby Lundborg, C.; Alfvén, T.; Obua, C.; Källander, K. A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda. Children 2021, 8, 996. https://doi.org/ 10.3390/children8110996