title: Referral of children seeking care at private health facilities in Uganda.
abstract: In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector.
  
  
  
  A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members.
  
  
  
  A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers.
  
  
  
  In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.
authors.affiliation: Ministry of Health, Box 7272, Directorate of Clinical and Community Services, Kampala & Department of Community & Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda. akmbonye@yahoo.com.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Mbonye
authors.affiliation: Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Esther
authors.initials: E
authors.lastname: Buregyeya
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Elizeus
authors.initials: E
authors.lastname: Rutebemberwa
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: Siân E
authors.initials: SE
authors.lastname: Clarke
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: Sham
authors.initials: S
authors.lastname: Lal
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Kristian S
authors.initials: KS
authors.lastname: Hansen
authors.affiliation: Institute for International Health, Immunology and Microbiology, Centre for Medical Parasitology and Institute for Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
authors.affiliation: Department of Paediatrics, College of Physicians & Surgeons, Columbia University, New York, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: LaRussa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017149:Private Sector / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*