Pattern of referral before and after referral intervention among primary health centers in North-Western Nigeria

Introduction: The revised Nigerian National Health Policy and the WHO Expert Committee on the Role of Hospitals as the First Referral Level both recognize primary health care (PHC) as the entry point in the referral system. This study was carried out to assess the effect of training of PHC workers on referral and instituting referral focal person among PHCs on key referral indicators in Zaria and Giwa local government areas, North-Western Nigeria. Methodology: The study was a quasi-experimental study with pre- and postinterventional components carried out among seventy participants in the intervention and 62 participants in the control groups who were selected through a multistaged sampling technique. Data were collected using a structured self-administered questionnaire containing close-ended questions. Data were analyzed with SPSS software version 20.0. Results: Preintervention, majority of the respondents (74.3%) in the intervention and (67.7%) control groups had not received training on referral process. Postintervention, increase was noted in mean referral rate from 0.18 ± 0.28 to 0.52 ± 0.34, which was statistically significant, and mean counter referral rate from 0 ± 0 to 40.34 ± 45.53 in the study group, but there was no statistically significant change in the control group. Conclusion: Postintervention, significant increases were noticed in two of the practice indicators; referral rate and counter-referral rate in the study group only. The other practice indicators did not record a significant increase.