Referral for Health Services among Outpatients at Nyeri County Referral Hospital, Kenya
One of the fundamental human rights is right to health. To achieve this within a health system with different levels of care there is need for a functional referral system that enables continued uninterrupted care across different levels. Data available in Nyeri county health department however shows that clients bypass the primary level facilities and present themselves to referral facilities thus placing huge demands for health services on tertiary facilities. This research therefore sought to establish factors associated with referral for health care services at the County Referral hospital during (Universal Health Coverage) UHC implementation in Nyeri County. The study employed a cross-sectional study design targeting patient, health care professionals and managers at the County Referral hospital in Nyeri. Administration of structured questionnaires and key informant interviews were carried out to acquire qualitative and quantitative data. A sample size of 402 respondents was estimated proportionate to the population from a sampling frame of patients seeking outpatient services at the County Referral hospital. Purposive sampling was used to pick key informant respondents while patient respondents were picked by systematic random sampling. Acquired data was analyzed by use of SPSS version 23 and MS excel. Inferential statistics included Chi-Square tests done at a confidence interval of 95% to ascertain association between the study variables while thematic analysis was applied for qualitative data. The study found that majority of respondents were female, young, self-employed, had low income and lived in rural areas. Chi-square tests showed that sex (p=0.004), level education (p=0.000) and residence (p=0.000) were significant. Majority of the respondents said that they had never been given information about the referral process. Even among those who had received information, majority reported information given was not clear. Lack of awareness was also highlighted as a factor influencing referral during key informant interview. Awareness (p=0.000) was significant. Slightly less than half responded they were dissatisfied with health care services they received Chi-square results showed that distance (p=0.000), infrastructure (p=0.004) and general satisfaction (p=0.000) were significant. The odds of females practicing referral as compared to males (OR= 0.54;95% CI 0.35-0.82), awareness (OR=0.21;95% CI 0.13-0.34) residence (OR=23.47 95% CI 13.54-40.69) remained significant in the logistic regression analysis. Descriptive results showed that respondents were dissatisfied with waiting time and patient-doctor relationship. Lack of medicine and lack of information were other factors cited for dissatisfaction. The study therefore concluded that referral for health care services among outpatients was predicted by socio-demographics, awareness and health system factors with awareness being the most important predictor. The findings of this study therefore call for a public sensitization campaign to enhance the utilization of primary healthcare facility with the ultimate goal of having a smooth referral process. The county governments also need to ensure that primary health facilities are adequately staffed and well equipped especially with medicines.