title: Understanding referral from primary care clinics in rural Kenya: using health information systems to prioritize health services.
abstract: This study analyses the referral patterns of patients, over time, from primary care to secondary or tertiary level facilities in rural Africa. The data come from a health information system of a non-governmental organization with a decade of experience in health services delivery in Samburu District, Kenya. The differential referral patterns from two communities are examined in some detail to shed more light on the meaning of a 'referral rate' in this context. First, referral rates over time for two clinics are calculated and compared. These quantitative data, obtained from monthly reports from 1989 to 1997, are interpreted in the light of qualitative data obtained from interviews with community health workers, nurses and members of the communities. The main differences in referral between these ostensibly similar communities are for malaria, trauma and anaemia. Social, environmental and specific health services factors are used to explain these differences. We demonstrate that basic information from health information systems, which tell us little on their own because referral in this context is a rare event, can be combined with local knowledge from the community to provide evidence for health managers to set priorities for public health and clinical interventions.
authors.affiliation: 1440 Canal St Suite 2200, Tulane University, New Orleans, LA 70112, USA. kmacint@tulane.edu
authors.forename: Kate
authors.initials: K
authors.lastname: Macintyre
authors.forename: Mohamed
authors.initials: M
authors.lastname: Lochigan
authors.forename: Frederick
authors.initials: F
authors.lastname: Letipila
mesh_terms: D015276:Health Care Rationing / Q000458:organization & administration*; D006292:Health Priorities; D006801:Humans; D007256:Information Systems / Q000458:organization & administration*; D007630:Kenya; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*