An Evaluation of Maternal Referral Pathways in Public Hospitals in La Dade Kotopon Municipality

Abstract

A functional maternal referral system is important in minimizing maternal related challenges associated with antenatal care, labor and delivery; and postnatal services at primary, secondary and tertiary levels of care. The study sought to evaluate maternal referral pathways in the La Dade Kotopon Municipality by using La General Hospital and Police Hospital as cases for the study. The study adopted the Three Delays, Access Model and the System Thinking Approach to inquire into the issue of maternal referral pathways. The mixed-method approach and a case study design with a descriptive survey were employed for the study. A semi-structured questionnaire and an in-depth interview guide were used to collect data from a sample size of 390 pregnant mothers/patients, 10 midwives and two gynecologists from La General Hospital and Police Hospital. Purposive and convenient sampling techniques were used to select midwives, gynecologists and pregnant mothers/patients respectively. The quantitative data was analyzed by using Statistical Package for Social Science (SPSS) version 21. Moreover, a thematic content analysis approach was used to analyze the qualitative data collected from the midwives and gynecologists. The findings showed that pregnant mothers do not understand maternal referral pathways. Factors such as inadequate surgeons and midwives, inadequate blood in blood banks and severe and complicated maternal cases are some of the factors that necessitate maternal referrals in the municipality. However, the hospitals are plagued with inadequate surgeons and midwives, inadequate blood in blood banks, poor maternal records and non-compliance with maternal referral protocols, which have affected the operations of these hospitals. The study recommends that there should be an improvement in capacity building of the hospitals; appointment of highly competent staff, improvement in blood situations, and effective supervision to ensure compliance with maternal referral protocols. The study xviii recommends that there is still the need to evaluate the effectiveness of maternal referrals pathways by looking at the linkage between private and public health facilities.