POSTDOC FELLOW, NOGUCHI MEMORIAL INSTITUTE FOR MEDICAL RESEARCH, UNIVERSITY OF GHANA
Background: The urgency and unpredictability of obstetric emergencies necessitate a strong referral system to higher centers where these can be well managed for good outcomes. An efficient inter-facility communication system enhances the referral process and improves outcomes. The aim of the study is to assess the role of an enhanced inter-facility referral communication system on the processes and outcomes of maternal health referrals in the Greater Accra region of Ghana. Methods: This implementation research was conducted in three phases in three districts of the Greater Accra region using mixed methods approach: structured questionnaires for the quantitative part and focus group discussions, in-depth interviews and non-participant observations for the qualitative part. Over a nine month period, all obstetric referrals to the district referral facility were assessed for the processes and outcomes of referral both for the mother and neonates. The first 4 months of data constituted the baseline data (before intervention). The intervention package consisted of training of health workers on complications of pregnancy and related referrals, provision of communication tools to all facilities referring patients to the district hospital, formation of facility level referral teams and strengthening inter-facility feedback mechanisms, and was rolled out in the last 4 months in all 3 districts and evaluated over the period (after intervention). The referral processes were documented including, indications for referrals, completeness of referral forms and use inter-facility referral communication and how these compare to the national referral policy guidelines, and any changes following the intervention package.