Factors Influencing Upward Referral System of Patients in Nairobi County, Kenya

Abstract

The right to health is the fundamental requirement of every human being. Additionally, accessible health services in the shortest possible time leads to quality health outcomes, which is a priority area in the service delivery pillar. A well-functioning health system ensures smooth movement of patient within the referral system and existence of a strong referral mechanism that provide mandated services equivalent to level of care. The study aimed at establishing the determinants of upward referral system of patients in Nairobi County. Expectancy-value theory and choice-making theory laid the foundation for this study. The study was conducted guided by the descriptive research design. The study focused on a population of 594 health workers working in three hospitals, Mbagathi hospital, Mama Lucy hospital and Makadara health center. The study sample was 239 health workers sampled through stratified and simple random sampling techniques. Raw data was realized from the field by the use of selfadministered structured questionnaires as well as interview guide. The study realized both quantitative and qualitative data. SPSS version 25 was used in coding, entering and analyzing the raw data. Further, Percentages, frequencies, mean score and standard deviations were used in analyzing the data. The results were presented by the use of tables and figures while the interpretation and explanations was narratively presented. The qualitative data was analyzed thematically guided by the study variables and objectives. The Pearson’s correlation and the multivariate regression analysis was conducted with the aim establishing the direction and magnitude of the connections that exists between the study variables. The study found and concluded the Proximity to the referral hospital was the only significant factor in the realization upward referral system (sig.002). Further the equipment required, complexity of patient disease and knowledge of referral system were insignificant determinants of upward referral system with significance values of .136, .113 and .171 respectively. The study recommended that health facilities should invest in the communication systems supported by the activities such as workshops and seminars aimed at promoting the awareness of the referral system guidelines amongst the HCW. Also, recommends that management should set aside some funds to finance the training of HCW on specific health concerns that lead to unnecessary referrals. The study recommends that the MoH should purchase a chopper for airlifting the critical cases which would be worse or cause death if transit done by road.