Definition of Terms

Types of Referral
Referral System Conceptual Framework
Elements of Referral System
Strengthening Referral System, Benguet
Experience
Gains, Benefits and Impact of a
Strengthened Referral System, Benguet
Experience
Challenges encountered in the
Strengthening of Referral System, Benguet
Experience

Module 6, Session 1
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OBJECTIVES:
At the end of the session, the participants will be Referral –
able to:

Define Referral System; Set of activities undertaken by

Identify and Explain the Types of Referral System;
Appreciate the Referral System Framework; Health Provider in response to its
Comprehend the Principles and Concepts of a Referral
System;
inability to provide diagnostic and
Know and understand the steps, procedures and therapeutic intervention
activities of Strengthening the Referral System,
Benguet experience; and
Know and appreciate the gains, benefits and impacts
of a strengthened referral system, Benguet experience.

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 Referral System – Self-Referral –

A two-way relationship between Referrals made by the individuals

health facilities ensuring continuity themselves to higher centers
and complementation of Health and (hospitals) by-passing lower level
Services facilities based on perceived
inadequacy on the lower level

Module 6, Session 1
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Functional Referral System – External–

1. Competent personnel assigned at Vertical –

the lower level Referral from Lower to Higher
2. Roles and Functions are clearly Referral from Higher to Lower
defined to avoid duplication
3. Ensures that services needed to be Horizontal –
delivered at the lower level are in Referral from one facility to another
fact delivered with same level but different catchment

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 Internal– Public – Private Agencies / Partners

Referral within the facility from Referral from Public Sector / Agency
to Private Organization or Non-
one personnel to another
Government Organization and Vice Versa

Module 6, Session 1
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Community

BHS (1st Level)

Primary Care
RHU (2nd Level)

Level I Hospital
Secondary Care
Level II Hospital

Provincial Hospital
Tertiary Care
Medical Center /
Regional
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 Module 6, Session 1
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Barangay Health Station Rural Health Unit

 Prenatal  Control of NCDs Prenatal
Plus
 Normal Delivery (Smoking, REDCOP, Normal Delivery
Minor Surgery
Post partum Care
 Post partum Care etc) Family Planning
 Family Planning  Health Promotion and Immunization Appropriate referral to
Nutriiton (Vitamin A and Iron hospitals / specialists
 Immunization Education Supplementation
 Nutriiton (Vitamin A  Management of Public Growth Monitoring Environmental Health
Control of CDs (ARI, TB, STDs, Services
and Iron Health Services etc)
Supplementation (Planning, Health Control of NCDs (Smoking, Oral Health
REDCOP, etc)
 Growth Monitoring Info, Coordination Health Promotion and Education Supervision of HHR and
 Control of CDs (ARI, with NGOs, etc) Management of Public Health Health Services within the
Services (Planning, Health Info, catchment
TB, STDs, etc) Coordination with NGOs, etc)

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 Hospital Joint DH Board and TWG Meeting
Outpatient Laboratory Services (Bakun)
Consultations X-ray
Issues Raised
In-patient medical and Pharmacy Services
Referral Activities (Return Slips do not go back)
surgical care Transport and
Communication Signatories on Death Certificates for DOA cases
Emergency Room Care
Minor Surgery Referral of more Medico-legal Cases (who should accomplish
urgent and certificate)
Major Emergency complicated cases to
Surgery (CS, Others
higher level
Appendectomy, etc) Coordination with Resolution
Complicated Deliveries PH, POs, NGOs, Prepare a Referral Manual

Module 6, Session 1
Basic Orthopedics Private clinics
Blood Transfusion
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Activated organized Mt. Trail ILHZ

Technical Working Group SITUATIONAL ANALYSIS
Scheduled TWG Meetings and Write-shops Tools Elements of Referral
Brain Storming System Considered
Developed and Prepared Planning
Focus Group
Templates Discussions Facilities
Problem Tree to Equipment
Identified Program, Projects, Activities and Logistics
Objectives Tree
Strategies Ishikawa Diagram
Drugs / Medicines
Staffing / Health
or Fishbone
Identified Indicators and Means of Human Resource
Logframe Treatment Protocol
Verification TOWS/SWOT Analysis Operational
Micro- & Macro- Framework
Identified Budgetary Requirements and
environmental Financial (Budget)
Sources Analysis Considerations

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 SITUATIONAL ANALYSIS SITUATIONAL ANALYSIS
Where and What We Were Where and What We Wanted to be

Strengths
Existence of a Referral Activity
Orientation of Health
Personnel
Presence of Patient Transport
System
Presence of Facilities and
Equipment
Presence of two-way radio
Weaknesses
Existence of a Strengthened Functional Referral
No Referral Manual / Guidelines System
No uniform forms
Existence of a uniform and harmonized Referral
Fast turnover of HHR
Old and defective Patient Manual and Guidelines
Transport System Improved and Upgraded Facilities and Equipment
Old and dilapidated Facilities Improved and Upgraded Patient Transport System
and Equipment
Coordinated Health Workers and Health Facilities
Understaffing

Module 6, Session 1
Supportive LCEs No privacy of communication Quality Health Service
Dedicated HHR and Competent and Skilled Health Force
Weak coordination

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Preparation of Referral System Manual and  Referral Manual was used until …
Guidelines  Project: Strengthening of Local Health
Systems in the Province of Benguet
Resolution of MT ILHZ Approving,  Reformatting of Referral Slips
Adopting and Implementing the developed
Referral System Manual  Development and Generation of Report Forms
 Revision of existing discharge summary
Reproduction and Distribution of Forms  Developed National, Provincial, Municipal and
Health Workers Directory
 Recording in Referral Logbooks
Orientation of Health Personnel within the  Quarterly Reporting
ILHZ
 Monitoring and Evaluation

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 Referral Manual adopted and
implemented province-wide

Health Workers at all levels were

oriented including Private
Practitioners

Referral Folders with reproduced

Referral Manuals were distributed in
all Hospitals, RHUs, BHSs and PHO.

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Incoming Referral from Lower Level Health Facilities: BY ILHZ, BY

QUARTER 2010

Leading Causes of Incoming Referral: BY ILHZ 2010

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 Incoming Referral from Higher Level Health Facilities: BY ILHZ 2010 Referral from Higher Level to Lower Level

Leading Causes of Incoming Referral: BY ILHZ, 2010

Module 6, Session 1
MT ILHZ 3K ILHZ
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Referral from Higher Level to Lower Level Referrals from Lower Level to Higher

BKD ILHZ BLIISTT ILHZ

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 Referrals from Lower Level to Higher
BKD ILHZ BLIISTT ILHZ
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Upgraded and Improved Facilities and
Equipment (Ambulance, X-ray, Blood
Chemistry Analyzer, Buildings)
Increased budget for drugs, medicines
and logistics
Increased reimbursements from PHIC
Strengthened Drug Management
Integrated in Investment &
Rationalization Plans
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Common Health Trust Fund
Sharing of Health Human Resource
Continued Recording and Reporting
Improved Health Services
Opportunities for Training
Better Coordination among Health
Facilities and Personnel
Evidence-based data utilized by
Decision Makers for Policy
Interventions
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 Facilities – some still under construction and renovation
Procurement of Logistics, Drugs and Medicines – still
delayed
Tedious process in procurement
Common Health Trust Fund – unutilized by some ILHZs
HHR – manpower out-numbered by increasing population
Policies and Guidelines on the Manual – needs constant
review and re-visit
Some Reports are incomplete and not timely submitted
Orientation of New employees / Health workers and
regular re-orientation on the Referral System

Module 6, Session 1
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