Assessement of the primary health care referral practices at Sekyere West District of Ashanti

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An integrated health system in which the different elements that provide health care are intimately linked with each other by a functional referral system is the ideal if the task of reaching the entire population with effective health services is envisioned. This could not be achieved by either the hospital or other local health services acting in isolation, independent of each other. The services have to be integrated and the referral system is an important element for this integration. The conceptional focal point of this integration is the district health system, encompassing the district hospital, health centres, maternity homes and private clinics. s Sekyere West district has a district hospital and seven health centres providing health services. Against this background the study on analysis and appreciation of actual referral practices was planned, to generate information which could be used for further planning to improve the referral system in the district. The principal concern of the study, therefore, was to study the prevailing referral practices and factors affecting these practice. It also aimed to assess the comprehensiveness of the services being provided by the district hospital. Specific areas of interest in the study include determining the existing referral practices in the district assessment of health workers knowledge on referrals; identifying the problems related to the referral system; determining whether services provided are referral level services. In order to answer the study question a qualitative descriptive study design was chosen. Face validation method was applied to check the validity of the collected data. The study population consisted of health care providers at the health centres and the hospitals. Five of the health centres were visited. At the health centres the Medical Assistants in charge and at the hospital, both the Chief Medical Officer as well as the Nurse in charge were interviewed. Records at the health centre and hospital were also analysed. The problem of incorrect se]f referrals and the failure by the hospital staff to provide adequate information to their primary health care colleagues (Health Centres) was a hindrance. Referrals letters were not sent neither was there counter referrals, thus the services were not comprehensive and there was no continuity of care. There were no clear guidelines on referral and supervision and monitoring which has been identified as an important element for referral system was completely lacking. On providers knowledge on referrals it was found out that health workers understand what referrals is and cases to be referred. Problem identified by the health care providers were poor communication between the hospital and the health centres, transportation and poverty, as most patient could not bear the cost of treatment at the district hospitals. On range of services it was assessed that the services being provided were adequate for a district hospital.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirement for the award of Master of Science degree in Health Services Planning and Management, 2000