Barriers to proper maternal referral system in selected health facilities in Eastern Ethiopia: a qualitative study.
BMC Health Services Research · 2024-03-27 · Qualitative study
Abstract
BACKGROUND: Appropriate maternal referral system plays an essential role in curbing maternal mortality. Although the occurrence of obstetric complications is often unpredictable, addressing bottlenecks of the referral system is crucial to facilitate the women to have access to timely lifesaving interventions. Nonetheless, little is known about the barriers to maternal referral system in the eastern Ethiopia. Therefore, this study aimed to explore the barriers to maternal referral system at selected referral hospitals in eastern Ethiopia. METHODS: Key informant interviews and in-depth interviews were conducted among purposively selected respondents who had a role in maternal referral processes. A total of 12 key informants that comprised of liaison officers, healthcare providers and three in-depth interviews with referred women were conducted. Semi-structured interview guide was developed and used to facilitate the interviews. All the interviews were tape recorded, complemented by note taking. Then audio recorded interviews were transcribed as per verbatim and imported to NVivo for coding and merging. The data were thematically synthesized. RESULTS: The study identified a range of barriers that affect the maternal referral system in Eastern Ethiopia. The main barriers are grouped into three domains, such as: communication, transportation, and healthcare system. The most commonly reported barriers were lack of pre-referral communication and feedback, using informal communication, incomplete referral forms, poor ambulance service including misuse of ambulances, lack of skilled healthcare escort and lack of medical equipment at emergency, unnecessary self-referrals, poor referral skills and limited number of health professions. CONCLUSIONS: The maternal referral system is overwhelmingly affected by lack of skill, logistics (referral form), misuse of available ambulance, poor communication, and limited seeking of feedback. Regular consultative meeting with relevant stakeholders and uptake of feedback are crucial to improve referral communication, proper use of ambulance and building capacity of health workforce about referral are essential to improve maternal referral system.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Communication & handover · Interagency collaboration · Pregnant patients
Related articles
- Perspectives of health workers on malaria case referral among pregnant women attending antenatal care in Savelugu Municipality, Ghana: A qualitative descriptive study. (PLoS One, 2025)
- Referral linkage among public health facilities in Ethiopia: A qualitative explanatory study of facilitators and barriers for emergency obstetric referral in Addis Ababa city administration. (Midwifery, 2019)
- Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana. (Glob Public Health, 2015)
- Contextual conditions shaping the upward referral of obstetric emergencies from community health centres in the Eastern Cape: a Straussian Grounded Theory study. (Front Glob Womens Health, 2026)
- Smooth Transitions: Enhancing Interprofessional Collaboration when Planned Community Births Transfer to Hospital Care. (J Midwifery Womens Health, 2022)
- Cross-context qualitative synthesis of a mobile obstetric referral emergency system (MORES) in Ghana and Liberia. (PLoS One, 2026)