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Why referal system on maternal child health care is weak in Sub Sahara Africa countries?

By Meseret Desta Haileyesus(SMW,BSC,MPH) | 19 Jun, 2014

International experience shows that a comprehensive referral system should address: community education, transportation plans, funding schemes, a unified records system, provider technical competence supported by training and supervision, equipping and renovating healthcare facilities,overall emergency preparedness and political support through policy and protocols. still a lot of mothers dies because of weak referral system. any experience? models? let us discuss on that.



Blessings Banda Replied at 3:54 AM, 27 Jun 2014

Hello Meseret,
This is a great topic. Basing on my experience, in sub-Saharan Africa there is a common issue on culture. I am glad that you have mentioned community education which is expected to be delivered and be acted upon. Most women in Malawi will not seek Antenatal services until they get consent from husband and relatives. Again most of these may miss the first appointment which is supposed to be within the first trimester. I would wish we had more resources to work much on community education in this. I suppose other connected issues are provision of the essential health package at all health facilities even in most rural areas and availability of great innovations and training. Weak referral system should be addressed beginning from the community awareness to provision of care at health center level.


Blessings Banda
HIV and Nutrition Manager
Partners In Health/Abwenzi Pa Za Umoyo

Seleus Sibomana Replied at 4:08 AM, 27 Jun 2014

Hi, Meseret,
I think it is all about the referral system which is weak in general.
Talking from experience of Burundi, people do not see the difference
between a national hospital, and a district hospital. They would rather go
for the nearest national hospital for something that would be taken care of
at the clinic.
I agree that the culture plays a lot. In Burundi culture, the pregnancy
should not be known to the public unless it is already obviously prominent.
Thus, efforts at getting pregnant women to have their first antenatal visit
in the first trimester are counter productive.
Furthermore, referral system has to do a lot with the decision making
process for a child or a unwell woman. Usually the man has the money, and
takes the decision. It is not only at being aware by women on what to do
and when to do it, but it is about changing gender relations or powers for
maternal and child health referral system to improve.
But also, our poverty, our roads, our transport means...

Meseret Desta Haileyesus(SMW,BSC,MPH) Replied at 1:15 AM, 16 Jul 2015

Thanks all for your suggestion.


Herbert Kadama Replied at 2:40 AM, 16 Jul 2015

Thanks for the topic. According to the research I did in Uganda, why women don't deliver in health facilities
The major factors included; distance from the health facilities, transport costs, lack of birth preparedness plan, preference of traditional birth attendants, perceived poor quality of services at heath facility, deeply embedded social cultural beliefs, low education level of women and the spouse, poor social economic status of mother and rude health care workers.

Elizabeth Glaser Replied at 2:51 AM, 16 Jul 2015

If you have not already done so, I encourage you to read more about the role of disrespectful and abusive health care workers in driving women away from delivering in health facilities.
Bowser , D and Hill, K. for USAID (2010) Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth:Report of a Landscape Analysis.

This is meant as an attack on health care workers; when staff are not well treated, do not receive regular pay, have few supports or resources then they may take it out on their patients. Therefore this behavior in staff may be evidence of systemic problems, but regardless of why it occurs, it can drive women away from delivering in a facility.


Elizabeth Glaser Replied at 2:53 AM, 16 Jul 2015

To clarify my last email - This is NOT meant as an attack on health care staff. Very sorry for the typo.

AMANUEL DESTA Replied at 3:25 AM, 22 Jul 2015

Such type of discussion is very important that gives input for the improvement of the referral linkage on time.
So, besides to the disrespectful of the role of the health providers on applying the referral linkage on time, I suggest also
the health providers have luck of interest to update their professional development hence it leads them to have less knowledge
on what they are expected to do so what problem the patient has and when to be referred the time. Therefore, it needs to have emphasis by the responsible bodies in relation to the health tier system to improve this referral system on time.

Elhadji Mamadou Dioukhane Replied at 6:39 AM, 22 Jul 2015

Hi to you all
What Elizabet sait is so important that I think we have to meditate on it. the health care providers aren't anywhere well treated in the poor countries. So that they won't do any kind of sacrifices to make things better.
From my experience, everytime I go through a trouble with a widewife in my catchment area I find out that the main reason is money or power or work conditions.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.