Sub District Maternal Referral Practices In Ho Municipality

ABSTRACT

Background: The referral system is emphasized as a back-up function of particular importance in pregnancy and childbirth, as a range of potentially life-threatening complications require management and skills that are only available at higher levels of care (WHO, 1994). In Ho municipality, the proportion of maternal deaths arising from referrals from the periphery to the Volta Regional Hospital had increased from 63% in 2012 to 81% in 2013.

Objectives: The objectives of this study were to determine maternal referral rates of primary care providers, describe the referral processes of primary care providers, explore patient and health system factors in the referral practices and determine the knowledge of healthcare providers in the sub-district facilities in Ho Municipality on danger signs related to pregnancy complications.

Methodology: The study was conducted in 10 sub-district facilities in Ho Municipality from 1st March to 5th June 2015. A cross sectional exploratory and descriptive study with mixed methods was employed. Data were collected using a data extraction tool and in-depth interviews with interview guides. Data were extracted from 266 patient’s medical records. Also, 12 midwives and 2 community health officers were interviewed. Data were analyzed using stata 12.0 version and Nvivo 10.

Results: Referral rate for sub-district facilities was 61.7%. Referral processes in Ho Municipality complies with the guidelines of the Ministry of Health’s policy on referral though with some challenges. Presence of a danger sign was the significant patient factor influencing referral decision in the sub-district. There was good knowledge on danger signs related to pregnancy complications among all care providers. Poor transportation systems, staff attitude at receiving facilities and poor communication among health workers were challenges confronting the referral system.

Conclusion: The main challenges facing the referral system in Ho Municipality are health system factors particularly concerning human resources and logistics and pharmaceuticals. Streamlining health systems factors will therefore result in tremendous improvement in referral practices in Ho Municipality.

Key words: Client, danger sign, referral rate, primary care giver.