Barriers to proper maternal referral system in selected health facilities in Eastern Ethiopia: a qualitative study
Date
2024
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Background Appropriate maternal referral system plays an essential role in curbing maternal mortality. Although
the occurrence of obstetric complications is often unpredictable, addressing bottlenecks of the referral system
is crucial to facilitate the women to have access to timely lifesaving interventions. Nonetheless, little is known
about the barriers to maternal referral system in the eastern Ethiopia. Therefore, this study aimed to explore the barriers
to maternal referral system at selected referral hospitals in eastern Ethiopia.
Methods Key informant interviews and in-depth interviews were conducted among purposively selected respondents
who had a role in maternal referral processes. A total of 12 key informants that comprised of liaison officers,
healthcare providers and three in-depth interviews with referred women were conducted. Semi-structured interview
guide was developed and used to facilitate the interviews. All the interviews were tape recorded, complemented
by note taking. Then audio recorded interviews were transcribed as per verbatim and imported to NVivo for coding
and merging. The data were thematically synthesized.
Results The study identified a range of barriers that affect the maternal referral system in Eastern Ethiopia. The main
barriers are grouped into three domains, such as: communication, transportation, and healthcare system. The most
commonly reported barriers were lack of pre-referral communication and feedback, using informal communication,
incomplete referral forms, poor ambulance service including misuse of ambulances, lack of skilled healthcare
escort and lack of medical equipment at emergency, unnecessary self-referrals, poor referral skills and limited number
of health professions.
Conclusions The maternal referral system is overwhelmingly affected by lack of skill, logistics (referral form), misuse
of available ambulance, poor communication, and limited seeking of feedback. Regular consultative meeting with relevant
stakeholders and uptake of feedback are crucial to improve referral communication, proper use of ambulance
and building capacity of health workforce about referral are essential to improve maternal referral system.
Keywords Maternal referral practice, Barriers to proper referral, Eastern Ethiopia
Description
Research Article
Keywords
Maternal referral practice, Barriers to proper referral, Eastern Ethiopia