Referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state, Nigeria

Abstract

Objective: This study aimed to examine the referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state of Nigeria. Materials and Methods: A concurrent embedded descriptive mixed method consisting of both quantitative and qualitative methods was adopted for the study. Participants (104) were recruited using multistage sampling and 8 participants using purposive sampling techniques for quantitative and qualitative aspects of the study, respectively. The three-phase delay model directed the study. A self-developed structured questionnaire and an in-depth interview guide were used to elicit quantitative and qualitative responses from the participants. Quantitative instrument was tested for reliability, while the qualitative instrument went through the rigors of qualitative data. Results: Findings revealed low level of referral and counter-referral practices as only 19 (18.27%) and 30 (28.85%), respectively, of care providers referred patients above 10 times in a year. The study also revealed inadequate human and material resources for referrals and counter-referrals. The mean on barriers to referral was 2.90, which was above the cutoff of mean of 2.50, which indicates that the barriers are militating against referral and counter-referral in obstetric emergencies. Conclusions: Low levels of referral and counter-referral practices are identified with inadequate resources among others posing as barriers. Therefore, provision of standard operational procedures/protocols in every health-care facility as well as provision of adequate material and skilled human resources among others is recommended to enhance referral and counter-referral network in obstetric emergencies. There is also a need for teamwork and synergy among all stakeholders in the referral chain.