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|Title: ||Assessment of institutional referral process of pregnancy –related cases in Bosomtwe district, Ghana|
|Authors: ||Otchere, Joyce Gifty|
|Keywords: ||Referral process|
|Issue Date: ||22-Oct-2020|
|Abstract: ||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.|
|Description: ||A thesis submitted to the Department of Population, Family
and Reproductive Health, College of Health Sciences, School
of Public Health Kwame Nkrumah University of Science &
Technology, in partial fulfilment for the award of the
degree of Master of Public Health in Population and
Reproductive Health, 2019|
|Appears in Collections:||College of Health Sciences|
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