title: Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital.
abstract: BACKGROUND
  The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger.
  
  
  METHODS
  Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred.
  
  
  RESULTS
  The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children.
  
  
  CONCLUSIONS
  Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with.
authors.affiliation: Belgian Technical Cooperation, Brussels, Belgium. paul.bossyns@pandora.be
authors.forename: Paul
authors.initials: P
authors.lastname: Bossyns
authors.forename: Ranaou
authors.initials: R
authors.lastname: Abache
authors.forename: Mahaman S
authors.initials: MS
authors.lastname: Abdoulaye
authors.forename: Hamidou
authors.initials: H
authors.lastname: Miyé
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Depoorter
authors.forename: Wim
authors.initials: W
authors.lastname: Van Lerberghe
mesh_terms: D000293:Adolescent; D000328:Adult; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006767:Hospitals, District / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009548:Niger / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data