Presentation on theme: "STRENGTHENING REFERRAL SYSTEM TO IMPROVE MATERNAL HEALTH"— Presentation transcript:
1STRENGTHENING REFERRAL SYSTEM TO IMPROVE MATERNAL HEALTH The Kenya Red Cross Experience
2IntroductionA functional referral system is key in reducing maternal mortality.A referral system is defined as a mechanism to enable client’s health needs be comprehensively managed using resources beyond those available where they access care (Kenya Health Sector Referral Strategy).An effective referral system ensures a close relationship between all levels of the health system and helps to ensure people receive the best possible care closest to home.It assists in making cost- effective use of hospitals and primary health care services.A well functioning referral system requires active collaboration and cooperation between the different stakeholders and care providers within a referral networkGood morning Ladies and gentlemen, all protocol observed. I will not repeat the statistics that we heard yesterday but I would like to recall Dr. Abdo’s presentation where he mentioned that having a functional referral system is an important action towards reducing maternal mortality. I take this opportunity to congratulate the MOH for recently launching the Kenya Health Sector Referral Strategy and the kenya National Guidelines For patient Referral.
3UNDERLYING CAUSES OF MATERNAL DEATHS Three distinct levels of delay which contribute to maternal morbidity and mortality.Delay in deciding to seek appropriate care. This is due to socio cultural barriers, failure to recognize danger signs, failure to perceive severity of illness and cost considerations.Delay in reaching Health facility: this is due to long distances to facility, poor conditions of roads, lack of transportation and cost considerations.Delay in receiving adequate emergency care at facility: this is due to shortage of staff, supplies and basic equipments among others.
4FRAMEWORK FOR REFERRAL SYSTEM IN KENYA REFFERAL SERVICECLIENT MOVEMENTSERVICE/EXPERTISE MOVEMENTSPECIMEN MOVEMENTCLIENT PARAMETERS MOVEMENT
5REFFERAL CHAIN AS DEFINED IN REFERRAL STRATEGY National ReferralNATIONAL REFERRAL SERVICESCounty ReferralCOUNTY REFERRAL SERVICESPrimary carePRIMARY CARE SERVICESCommunityCOMMUNITY SERVICES
6TYPES OF REFERRALS Emergency referrals Urgent Referrals Non Urgent ReferralsThese referrals entailClient movementService/Expertise movementSpecimen MovementMovement of client parameters.
7MAJOR GAPS IN REFERRAL SYSTEM IN KENYA Kenya Health sector Referral strategy June 2013 – June 2018:Policy and strategic levelNo transport policy for Health sectorNo by pass policyNo coordination structure for the referral servicesLack of quality standards and performance monitoring tools.No policy guidelines on who is responsible for financing Referral services in the Country.
8MAJOR GAPS IN REFERRAL SYSTEM IN KENYA Operational levelIneffective networking of the different levelsBy passing of lower levels of facilitiesInappropriate referrals.Inadequately resource facilities according to norms and service standardsLack of effective referral monitoring system.Inadequate communication and transport systems.Ineffective referral and feedback systemLack of referral coordinating forums and review meetingsIssues of financing.Lack of integration.
9BRIDGING THE GAP – COMMUNITY FACILITY LINKAGE KRCS ROLEBRIDGING THE GAP – COMMUNITY FACILITY LINKAGE
10KRCS ROLEKRCS appreciates that a well functioning Referral system must have clear quality standards that are influenced byHealth systems determinants: capabilities of lower tiers/levels, availability of specialized personnel, training capacity, organizational and coordination arrangements, cultural issues, political issues and traditions.General determinants: population size and density, terrain and distances between urban centres, pattern and burden of disease, demand for and ability to pay for referral care.The KRCS model of strengthening referrals seeks to address the gaps that exist along the referral chain in the Country.
11KRCS SUPPORT TO REFERRAL CHAIN Community based demand creation activities organized around the Community Health strategy. This creates community based referral mechanisms to facilitate linkage with primary care services.Provision of Ambulance services for Client movement from Community to Health facility and from health facility to Health Facility.
15KRCS SUPPORT TO REFERRAL CHAIN Provision of vehicles and other logistics for expertise movement during medical outreaches
16KRCS SUPPORT TO REFERRAL CHAIN Construction/ equipping of health centres and dispensaries to ensure that they can provide appropriate services. This enables management of the referrals from communities and also facilitates referrals to nearest County Referral.Equipping and upgrading of hospitals to ensure service provision for the referrals from the health centres.Dadaab Level 5 Hospital
18COMMUNITY LED REFERRAL FACILITYPRECONDITIONSFunctional Ambulatory system.Functional health facilityQuality of carePRECONDITIONDecision makingKnowledge /awarenessperceptionAmbulanceHEALTH FACILITYHOUSE HOLDCHEW/HWCHWFEEDBACKDETERMINANTSHRH adequacy and know howAttitudeQuality of careDETERMINANTSMale involvementSocial supportcostFUNCTIONAL HEALTH CARE SYSTEM,COMMUNITY EMPOWERMENT AND INVOLVEMENT
19LESSONS FROM COMMUNITY LED MODEL From January to May 2014, 760 mothers have been referred under this model in Isiolo and Garissa Counties.This model enhances follow-up of the mother pre during and post the referral.This model ensures early identification of danger signs by the trained CHVs with support from the CHEWs.It enhances community ownership.
20PATIENT/CLIENT LED REFERRAL PRECONDITIONSFunctional Ambulatory system.Functional health facilityQuality of carePRECONDITIONDecision makingKnowledge /awarenessperceptionHEALTH FACILITYAmbulanceCLIENTCAREGIVERDETERMINANTSHRH adequacy and know howAttitudeQuality of careDETERMINANTSMale involvementSocial supportcostFUNCTIONAL HEALTH CARE SYSTEM
21LESSONS FROM PATIENT/CLIENT LED MODEL From January to May 2014, 1,747 mothers have been referred under this model in Isiolo and Garissa Counties.Creates good networks for inter hospital transfers.
22FUNCTIONAL HEALTH CARE SYSTEM,COMMUNITY EMPOWERMENT AND INVOLVEMENT REVERSE REFERRALFACILITYCOMMUNITYPRECONDITIONSFunctional Ambulatory system.Functional health facilityQuality of carePRECONDITIONDecision makingKnowledge /awarenessperceptionAmbulanceHOUSE HOLDHEALTH FACILITYCHEW/HWCHWDETERMINANTSHRH adequacy and know howAttitudeQuality of careDETERMINANTSMale involvementSocial supportcostFEEDBACKFUNCTIONAL HEALTH CARE SYSTEM,COMMUNITY EMPOWERMENT AND INVOLVEMENT
23LESSONS FROM REVERSE REFERRALTHIS MODEL Workable model for the hard to reach areas and areas with low facility coverage.
24Key components for effective referral CONCLUSIONKey components for effective referralFunctional Community health strategyAmbulatory servicesFunctional health facilities.Important to note that Community Facility linkages are key in the Kenyan context for improved referrals in context of maternal health
25Need for coordination across the different parts of the health system CONCLUSIONThere is need to align the health system with the needs of the population looking at the geography and income distribution (Arid and Semi Arid Lands, Hard to reach areas, terrain, conflict areas etc)Need for coordination across the different parts of the health system