Barriers to Referral in Swaziland: Perceptions from Providers and Clients of a System under Stress

Macintyre, Kate; Littrell, Megan; Hotchkiss, David R.; Mndzebele, Sibongile; Nkambule, Rejoice; Malima, Batsile; Gumbi, Sikhomba; Dhlamini, Thembeyena; Brown, Lisanne; Kemerer, Verne

doi:10.2202/1948-4682.1183

Cited by 12 publications

(16 citation statements)

References 22 publications

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“…The strength and sustainability of CHW programs rely on enhancing infrastructural support through providing reliable transportation, equipment and drug supplies—key dimensions of the NHI/UHC reforms (Lehmann, Friedman, & Sanders, ). Findings from this study corroborate those from Ghana on obstetrics programs and from Swaziland on HIV/AIDS clients’ transport difficulties after referral instructions (Macintyre et al, ; Nuamah et al, ). The study context had reliable emergency ambulance services for most sites, with a few requiring expensive means that were not feasible for poor individuals.…”

Section: Discussionsupporting

confidence: 87%

Exploring the roles and factors influencing community health workers’ performance in managing and referring severe acute malnutrition cases in two subdistricts in South Africa

Mambulu-Chikankheni

Eyles

Ditlopo

2018

Health Soc Care Community

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As primary providers of preventive and curative community case management services in low- and middle-income countries (LMICs), community health workers (CHWs) have emerged as a formalised part of the health system (HS). However, discourses on their practices as formalised cadres of the HS are limited. Therefore, we examined their role in care, referral (to clinics) and rehabilitation of severe acute malnutrition (SAM) cases. Focusing on SAM was essential since it is a global public health problem associated with 30% of all South Africa's (SA's) child deaths in 2015. Guided by a policy analysis framework, a qualitative case study was conducted in two rural subdistricts of North West province. From April to August 2016, data collected from CHW's training manuals and guideline reviews, 20 patient record reviews and 15 in-depth interviews with four CHW leaders and 11 CHWs. Using thematic content analysis which was guided by the Walt and Gilson policy triangle, data was manually analysed to derive emerging themes on case management and administrative structures. The study found that although CHWs were responsible for identifying, referring, and rehabilitating SAM cases, they neglected curative roles of stabilisation before referral and treatment of uncomplicated cases. Such limitations resulted from restrictive CHW policies, inadequate training, lack of supportive supervision and essential resources. Concurrently, the CHW program was based on weak operational and administrative structures which challenged CHWs practices. Poor curative components and weak operational structures in this context compromised the use of CHWs in LMICs to strengthen primary healthcare. If CHWs are to contribute to Sustainable Development Goal (SDG) 3 by reducing SAM mortality, strategies on community management of acute malnutrition coupled with thorough training, supportive supervision, firm operational structures, adequate resources and providers' motivation should be adopted by governments.

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Section: Discussionsupporting

confidence: 87%

Exploring the roles and factors influencing community health workers’ performance in managing and referring severe acute malnutrition cases in two subdistricts in South Africa

Mambulu-Chikankheni

Eyles

Ditlopo

2018

Health Soc Care Community

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“…In many developing countries, a high proportion of clients or patients seen at the outpatient departments at secondary health care facilities could be appropriately looked after at primary health care centers [3].…”

Section: Introductionmentioning

confidence: 99%

Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia

Geta

Siraneh

Yesuf

2019

Preprint

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BackgroundPatient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first or without being told to refer themselves by health professional. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals. The study aims to determine the magnitude and identify determinants of outpatient self-referral at referral hospitals.MethodsFacility based cross sectional study design was used to collect data from December 01- 30; 2017.The sample size was determined by using single population proportion formula. Data entry and analysis were made using SPSS version 20. Descriptive statistics of frequency, bivariate and multivariate logistic regression were performed.ResultsA total of 404 outpatients were included making response rate 96.8%. Among 391 outpatients interviewed 330(84.4%) were self-referred.The factors significantly associated with outpatient self-referral were referral information (AOR and 95%CI=0.324(0.150-0.696), illness severity (AOR and 95% CI=3.496(1.473-8.297), confidence of patients to get providers (AOR and 95 CI=3.027(1.510-6.070), availability of laboratory (AOR and 95%CI=4.966(2.199-11.216) and drugs (AOR and 95%CI=2.366(1.013-5.526) and quality of services (AOR and 95%CI=2.996(1.418-6.328).ConclusionThe proportion of outpatients’ self-referral was high and that associated with referral information, patient confidence to get health care providers, severity of illness, availability of laboratory and drugs, and quality of services. There should be monitoring system of referral linkage of health facilities at all levels and the health facilities should create awareness in the community about referral linkages of health facilities.

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“…15,16,18 The human medical field has long recognized the need to scrutinize clinician and patient factors in order to smooth out the referral process and make certain therapies more readily available to patients. [12][13][14][19][20][21][22][23] Findings from studies such as these have been used to improve the specialist-generalist relationship, provide better continuity of care and ensure better patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

A pilot study to identify perceived barrier and motivating factors of primary veterinarians in the USA for specialty referral and management of atopic dermatitis with allergen‐specific immunotherapy

Flanagan¹,

Schick²,

Lewis³

2020

Veterinary Dermatology

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Background Allergen‐specific immunotherapy (ASIT) may decrease clinical signs and potential neosensitization in dogs with canine atopic dermatitis (cAD). Identification of barriers to referral and specialty level case management may improve clinical outcome and satisfaction for both clients and primary veterinarians. Hypothesis/Objectives The objective of this cross‐sectional, descriptive, survey‐based pilot study was to identify factors influencing a veterinarian’s decision to recommend dermatology referral and prescribe ASIT for management of cAD. Methods and materials An online survey was administered to small animal veterinarians through two veterinary associations in the western United States. Participants were asked to rate factors using Likert scales. Results Of 60 responses, 18 (30%) rarely or never recommended ASIT. The top three factors against recommending ASIT included successful pharmaceutical management (100%), clients’ concern for cost (94.4%) and veterinarians’ perceptions that immunotherapy is unable to reduce pharmacological dependency (83.4%). The top three motivating factors included concerns for glucocorticoid adverse effects (83.3%), animal/owner quality of life (77.8%) and risk of antimicrobial resistant infection (55.6%). Results of the secondary objective revealed that 19 of 60 (31.7%) respondents rarely or never refer atopic pets to a dermatologist, citing cost of referral, availability of serological testing, and perception of limited benefits as the greatest barriers. Conclusions and clinical significance Numerous factors appear to influence decisions to recommend referral or ASIT for management of pets with cAD. Further work is needed to determine if these can be generalized to larger populations with a goal of providing suggestions to bridge these gaps and improve outcomes.

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Barriers to Referral in Swaziland: Perceptions from Providers and Clients of a System under Stress

Cited by 12 publications

References 22 publications

Exploring the roles and factors influencing community health workers’ performance in managing and referring severe acute malnutrition cases in two subdistricts in South Africa

Exploring the roles and factors influencing community health workers’ performance in managing and referring severe acute malnutrition cases in two subdistricts in South Africa

Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia

A pilot study to identify perceived barrier and motivating factors of primary veterinarians in the USA for specialty referral and management of atopic dermatitis with allergen‐specific immunotherapy

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