Assessment of quality of referral system among health centers in Eastern Zone of Tigray, Ethiopia, 2019

Abstract

Background: Implementation of a well-managed and functional referral system leads to good health care quality. The referral system is an important public health issue. However, in Ethiopia, there is no available literature that assesses the quality of the referral system of Health Centers. So these results will help health managers as a baseline in decision making. Objective: To assess the quality of the referral system among Health Centers in Eastern Zone of Tigray, Northern Ethiopia, 2019. Method: Institutional based cross-sectional quantitative study was conducted. Eight Health Centers were selected using simple random sampling. A total of 422 sample size was calculated and allocated to each health center using probability allocation technique. Three data collection tool was used, data on the availability of inputs were collected through observation, patient interview questionnaire was used to assess patient satisfaction, and record review form was used to gather data from referral paper and feedback paper for the process part at the study period. Study participants were selected using the systematic sampling technique every k th value. Collected data were entered using epi info version 7 .2.0 .1. Data were also cleaned and analyzed using SPSS version 25. Descriptive and, binary logistic regression was performed using SPSS version 25. Result: The response rate was 98.5%. Half (50%) of Health Centers had referral registry form, 22% of patients were provided ambulance, 63.6 % of patients were referred with referral paper and none of the health centers had a focal person (liaison). Concerning referral papers, 17 % of them were good in quality. Feedback to health centers was sent for 15% of referral; of those feedbacks 35 % were good in quality. Patient satisfaction was 47 % and there were no statically significant socio-demographic factors. Conclusion and recommendation: the quality of a referral system of Health Centers was poor. It needed to be strengthened by selecting a focal person at Health Centers, availing registry form and referral papers to health centers, and by strengthening feedback mechanism. Further study will be also helpful to assess the predictor of poor quality of referral system.