Improving emergency obstetric referral systems in low and middle income countries: a qualitative study in a tertiary health facility in Ghana
Date
2020-01-10
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Publisher
BMC Health Services Research
Abstract
Background: Timely access to emergency obstetric care is crucial in preventing mortalities associated with
pregnancy and childbirth. The referral of patients from lower levels of care to higher levels has been identified as
an integral component of the health care delivery system in Ghana. To this effect, in 2012, the National Referral
Policy and Guidelines was developed by the Ministry of Health (MOH) to help improve standard procedures and
reduce delays which affect access to emergency care. Nonetheless, ensuring timely access to care during referral of
obstetric emergencies has been problematic. The study aimed to identify barriers associated with the referral of
emergency obstetric cases to the leading national referral centre. It specifically examines the lived experiences of
patients, healthcare providers and relatives of patients on the referral system.
Methods: Korle Bu Teaching Hospital, Accra was used as a case study in 2016.The qualitative method was used and
in-depth interviews were conducted with 89 respondents: healthcare providers [n = 34];patients [n = 31] and
relatives of patients [n = 24] using semi-structured interview guides. Purposive sampling techniques were used in
selecting healthcare providers and patients and convenience sampling techniques were used in selecting relatives
of patients.
Results: The study identified a range of barriers encountered in the referral process and broadly fall under the
major themes: referral transportation system, referrer-receiver communication barriers, inadequate infrastructure and
supplies and insufficient health personnel. Some highlights of the problem included inadequate use of ambulance
services, poor management of patients during transit, lack of professional escort, unannounced emergency referrals,
lack of adequate information and feedback and limited supply of beds, drugs and blood. These findings have
implications on type II and III of the three delays model.
Conclusions: Initiatives to improve the transportation system for the referral of obstetric emergencies are vital in
ensuring patients’ safety during transfer. Communication between referring and receiving facilities should be
enhanced. A strong collaboration is needed between teaching hospitals and other stakeholders in the referral chain
to foster good referral practices and healthcare delivery. Concurrently, supply side barriers at referred facilities
including ensuring sufficient provision for bed, blood, drugs, and personnel must be addressed.
Description
Research Article
Keywords
Maternal health, Emergency obstetric care, Referral system, Tertiary health facility, Ghana