Medical care- poor referral system strains health care
BERNARD Nsubuga recently felt feverish and had back pains. He took a blood test that revealed he had typhoid. He was subjected to 112 chloramphenicol capsules which failed to cure it.
By Thomas Pere
BERNARD Nsubuga recently felt feverish and had back pains. He took a blood test that revealed he had typhoid. He was subjected to 112 chloramphenicol capsules which failed to cure it.
The typhoid resurfaced every after two weeks, subjecting him to take over seven different types of drugs.
“I recycled the drugs for about three years until I referred myself to another clinic where I was given stronger antibiotics that healed me,†he says.
Dr. Jacinto Amadua, the commissioner of clinical services at the Ministry of Health, says referral in health care practice is the sending of a patient from one unit to another to receive care.
He says referrals should be done for better treatment, attention and advice from a senior or higher level. Or the reverse from a higher or senior level to a lower one for prescribed treatment, especially close enough to your home.
Dr. Robert Wangoda, a surgeon at the Accident and Emergency Department in Mulago Hospital, says health care referral practices are virtually non-existent or at best a weak medical practice that requires strengthening in Uganda.
For instance, Mulago is a tertiary level referral hospital (for specialised health care), sub-served by 11 regional referral hospitals each with a capacity to provide both general and specialised health care.
Within the catchment area of each regional hospital are district hospitals supported by health centres.
Ideally, the referral procedure should respect this hierarchy of health facilities.
However, most patients at Mulago Hospital use it as their point of first entry into the health care system.
To reduce unnecessary referrals to Mulago Hospital, the Government needs to equip divisional hospitals well so that they can replace health centres.
Since Mulago is the only public funded hospital in Kampala, most city dwellers unable to afford private medicare head there as their Primary Health Care (PHC) centre. Mulago is not a PHC centre.
“Unfortunately, medical professionals who ought to lead by example do not respect the referral system either,†says Dr. Wangota
“Many medical workers in lower level health units often inappropriately refer their patients directly to Mulago while by-passing nearby district hospitals near their patients’ homes,†he adds.
Adding that this has resulted in inappropriate congestion of the referral (receiving) hospital and wastage of health care resources due to non-utilisation in peripheral health units.
According to Dr. Wangoda, referrals must be done under the jurisdiction of a clinician or a team of clinicians undertaking care of the patient when a higher level of care is expected.
Sometimes, patients or their caretakers may request for referral to their preferred hospital for various reasons ranging from socioeconomic to perceived quality of care.
Wangoda says if the need for referral has been agreed upon between the patient and clinicians, the referring unit is required to communicate sufficient details of the patients’ medical condition.
It should also indicate previous management to the referral hospital or unit in advance so that proper arrangements are made to receive the patient.
Currently, many clinicians give details of prescriptions rather than adequate clinical notes on the referral forms, which is not very helpful.
In addition, the patient should be clinically stable before being transferred to another centre.
“Inappropriate patient referrals strain available but already inadequate health care resources. Besides, it leads to non-utilisation and therefore wastage of drugs,†Dr. Wangoda says.
Sometimes, patients from far away places may inevitably incur high upkeep costs. In fact some often request to be admitted to reduce their costs.
This is unfortunate as the services they seek could be obtained from lower level health units near their homes.
Ignorance of patients on health care referral also makes them vulnerable to exploitation by some private health care providers who are after profits.
Worse still, some private practitioners hold on to patients, only to refer them when terminally ill for fear of documenting death as this does not seem to be good publicity for their business.
This is unacceptable as it defeats the purpose of referring a patient. This is not to say that referring is wrong. Sometimes a clinician may be overwhelmed with a patient and in need of help.
The referring clinician must send the patient with written feedback from the referral centre. Dr. Wangoda says health care planners and policy makers need to streamline and strengthen health care systems.
Restoring the public’s confidence in lower level health care services by providing the necessary and adequate health care resources is key.
He says all health care professionals and the general public need to be educated on the health care referral system.
In developed countries, gate-keeping by family physicians easily identifies who, what, when and where to refer, something lacking in Uganda.
Dr. Amandua says in spite of irregularities, people in need of a second opinion about their health should seek it from a different physician.
What a referral checklist should contain
Your contact information: Name, address, phone and fax numbers and e-mail
Information about your patient: Name, birth date, address, phone number, Social Security Number, insurance information
Your patient’s complete medical history and records: Surgeries/procedures
devices-type/settings
Description of your patient’s current medications: dosages, allergies etc
Diagnostic test reports and any other details.
BERNARD Nsubuga recently felt feverish and had back pains. He took a blood test that revealed he had typhoid. He was subjected to 112 chloramphenicol capsules which failed to cure it.
The typhoid resurfaced every after two weeks, subjecting him to take over seven different types of drugs.
“I recycled the drugs for about three years until I referred myself to another clinic where I was given stronger antibiotics that healed me,†he says.
Dr. Jacinto Amadua, the commissioner of clinical services at the Ministry of Health, says referral in health care practice is the sending of a patient from one unit to another to receive care.
He says referrals should be done for better treatment, attention and advice from a senior or higher level. Or the reverse from a higher or senior level to a lower one for prescribed treatment, especially close enough to your home.
Dr. Robert Wangoda, a surgeon at the Accident and Emergency Department in Mulago Hospital, says health care referral practices are virtually non-existent or at best a weak medical practice that requires strengthening in Uganda.
For instance, Mulago is a tertiary level referral hospital (for specialised health care), sub-served by 11 regional referral hospitals each with a capacity to provide both general and specialised health care.
Within the catchment area of each regional hospital are district hospitals supported by health centres.
Ideally, the referral procedure should respect this hierarchy of health facilities.
However, most patients at Mulago Hospital use it as their point of first entry into the health care system.
To reduce unnecessary referrals to Mulago Hospital, the Government needs to equip divisional hospitals well so that they can replace health centres.
Since Mulago is the only public funded hospital in Kampala, most city dwellers unable to afford private medicare head there as their Primary Health Care (PHC) centre. Mulago is not a PHC centre.
“Unfortunately, medical professionals who ought to lead by example do not respect the referral system either,†says Dr. Wangota
“Many medical workers in lower level health units often inappropriately refer their patients directly to Mulago while by-passing nearby district hospitals near their patients’ homes,†he adds.
Adding that this has resulted in inappropriate congestion of the referral (receiving) hospital and wastage of health care resources due to non-utilisation in peripheral health units.
According to Dr. Wangoda, referrals must be done under the jurisdiction of a clinician or a team of clinicians undertaking care of the patient when a higher level of care is expected.
Sometimes, patients or their caretakers may request for referral to their preferred hospital for various reasons ranging from socioeconomic to perceived quality of care.
Wangoda says if the need for referral has been agreed upon between the patient and clinicians, the referring unit is required to communicate sufficient details of the patients’ medical condition.
It should also indicate previous management to the referral hospital or unit in advance so that proper arrangements are made to receive the patient.
Currently, many clinicians give details of prescriptions rather than adequate clinical notes on the referral forms, which is not very helpful.
In addition, the patient should be clinically stable before being transferred to another centre.
“Inappropriate patient referrals strain available but already inadequate health care resources. Besides, it leads to non-utilisation and therefore wastage of drugs,†Dr. Wangoda says.
Sometimes, patients from far away places may inevitably incur high upkeep costs. In fact some often request to be admitted to reduce their costs.
This is unfortunate as the services they seek could be obtained from lower level health units near their homes.
Ignorance of patients on health care referral also makes them vulnerable to exploitation by some private health care providers who are after profits.
Worse still, some private practitioners hold on to patients, only to refer them when terminally ill for fear of documenting death as this does not seem to be good publicity for their business.
This is unacceptable as it defeats the purpose of referring a patient. This is not to say that referring is wrong. Sometimes a clinician may be overwhelmed with a patient and in need of help.
The referring clinician must send the patient with written feedback from the referral centre. Dr. Wangoda says health care planners and policy makers need to streamline and strengthen health care systems.
Restoring the public’s confidence in lower level health care services by providing the necessary and adequate health care resources is key.
He says all health care professionals and the general public need to be educated on the health care referral system.
In developed countries, gate-keeping by family physicians easily identifies who, what, when and where to refer, something lacking in Uganda.
Dr. Amandua says in spite of irregularities, people in need of a second opinion about their health should seek it from a different physician.
What a referral checklist should contain
Your contact information: Name, address, phone and fax numbers and e-mail
Information about your patient: Name, birth date, address, phone number, Social Security Number, insurance information
Your patient’s complete medical history and records: Surgeries/procedures
devices-type/settings
Description of your patient’s current medications: dosages, allergies etc
Diagnostic test reports and any other details.