• Summary
• Credits

1. Understanding the Concept
2. Evidence-Based Practices
3. Adaptability
4. Links with Other Services
5. Minimizing Paperwork
6. Physical Factors
7. Service Hours and Scheduling
8. Client Flow
9. Division of Labor and Job Design
10. Social Factors
11. Implementing the Concept
12. Bibliography

• INFO Project
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This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.

Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Good referral systems help family planning and other clinics offer clients the right care in the right place. Linking services with delivery sites offers clients access to appropriate care at every level of the health care system—from community facilities for basic care to district, regional, or higher-level facilities for specialized care.

Referral systems can give clients access to a complete range of services without interruption or unnecessary repetition of diagnosis or treatment. They also enable health systems to offer services in a central location that are not in enough demand to offer at every clinic.

Strengthen links between services. Referral agreements between health care facilities give clients better and quicker access to specialized services and follow-up care. Every facility at every level of the health system should be able to provide appropriate referrals. For instance, community health centers should be able to refer clients to district and regional facilities, government facilities should be able to refer clients to nongovernmental and other local clinics, and so forth.

Referral systems are vital because not all services can, or should, be offered at all facilities (see box, at right). For instance, not all service delivery sites have the equipment and trained providers necessary to insert IUDs and implants, or to perform sterilization procedures.

For certain types of services, such as urgent care for obstetric complications, the health system’s ability to arrange transport is a crucial part of its service delivery links. Facilities can work in advance with community organizations or unions to provide emergency transport in the event of obstetric complications (87). In the Kolokani region of Mali, for instance, contributions from the community and individual patients support a transportation and referral system for women who need emergency care during labor and delivery (7).

Organizations need to ensure that staff understand the value of referral and are familiar with referral procedures. Lists of contact names for services and referral sites, as well as information on hours of operation and fees, often make it easier for staff to refer clients.

Use both internal and external sources of referrals. Programs can establish procedures to make better use of internal referrals (that is, referrals within the same facility), as well as referrals between facilities. A facility that provides multiple services can coordinate services and scheduling procedures among its departments. Then, when clients come to see one provider, they can also schedule appointments with other providers in the facility or even receive referral services on the same day.

Facilities also can provide related services together, so that clients do not have to make repeated visits or wait more than once to see different providers. For instance, in the mid-1990s a Tanzanian hospital began offering family planning to women who brought sick children for care or who were giving birth in the hospital. Previously, contraceptives were not being offered directly through the maternity ward. Women had to make a separate visit for family planning services (31) (also see box below).

Deliver each service at the lowest-level facility that is practical. Programs can provide services at convenient locations throughout the community to minimize the distance clients must go to see providers. For instance, door-to-door distribution of condoms and supplying other contraceptives can reduce time and costs for clients. Community approaches often are the only way to reach women who cannot leave home (22, 23). They are also useful in rural areas not populous enough for a health post.

Where programs do not provide services in the home, they can provide community education and referral. In Botswana, for example, the public’s most frequent point of first contact for family planning is a family welfare educator. The educator is not authorized to offer clinical services or to supply contraceptives but instead provides health education, counsels clients about family planning options, and makes referrals to family planning clinics (8).

Programs can promote partnerships between the communities they serve and the health system. In Ghana the Ministry of Health and the Ghana Health Service joined with local traditional care systems. One of the projects improved referral and transport of women needing emergency obstetric care. Traditional birth attendants (TBAs) were linked with physicians at health centers by two-way radio. A motorized three-wheel vehicle was adapted to transport the women. Using this system, the TBAs were able to refer over 1,000 women for emergency obstetric care in 1996, a three-fold increase from 342 women in 1995 (51, 83).

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.