Assessment of institutional referral process of pregnancy –related cases in Bosomtwe district, Ghana

Background: Referral is a vital but often neglected component of maternal and newborn health services in most developing countries, where most maternal deaths occur. It is widely accepted that substantial reductions in maternal mortality and severe morbidity are impossible to achieve in many developing countries, where referral systems perform well below expectations, without an effective referral system for complicated cases. Thus, a key tenet of the nationwide safe motherhood program launched by the Government of Ghana in 2002 was to improve maternity referral system, as an important back up for antenatal, labour and delivery, and postnatal services in the primary level health care facilities especially and at the district level. The aim of this study was to assess the effectiveness of maternal health referrals between St. Michael’s Hospital, Pramso and other healthcare facilities in Bosomtwe District of Ghana. Methods: A quantitative descriptive cross sectional study, was conducted using a twenty-five item questionnaire from initiating health facilities and a twenty item questionnaire from receiving facility containing questions about the referred process, availability of resources and service provision, transportation and staff knowledge and skills. In all thirty-seven skilled attendants were interviewed. Twenty-two in initiating health facilities and fifteen in the receiving facility in the district were interviewed. Data were entered and analyzed using SPSS version 16.0 and results was presented in frequency tables and percentages. Results: It is evident from the study that the health institutions in the Bosomtwe District rarely adhere to the standard referral policy of the Ghana Health Service. Patients with pregnancy-related cases are referred from the initiating facilities in the district in cases of complications. Labour cases exceeding an average of 18 hours or pregnancy with complications are referred to the St. Michael Hospital, Pramso. Patients due for referrals are listed in the referral register. A staff of the initiating facility and a relative of the client accompany the referred client to the receiving facility. The initiating facility presents a letter to the receiving facility to confirm the referral and wait for feedback on the case. In the district, notwithstanding the challenges related to transportation and infrastructure, the health facilities are prepared to initiate and refer cases to the next level health facilities. The staff are equipped to provide maternity, child health, emergency obstetric care services and family planning services. The receiving facility was also prepared to receive and effectively manage pregnancy-complicated cases. The facilities have adequately trained staff to provide services. Nonetheless, like the staffs of the initiating facilities, the staffs have limited knowledge on the GHS referral policy as they rarely receive training on the policy. The challenges of the receiving facility were more related to transportation as there was no ambulance for referral purposes. The facilities also encountered challenges related to reluctance of clients to be referred and limited knowledge of staff on some pregnancy related cases that impeded smooth and effective referral process and management. Conclusions: The study recommends that GHS and the district health administration should set up a more effective monitoring team to check and periodically review the referral process in order to reduce all forms of barriers that increases the delays in the referral channel. The team should be well equipped financially and logistically to effectively deliver on their mandate.

Source: KNUST