Factors contributing to patients bypassing the 2nd and 3rd levels of primary health care facilities in Kirinyaga districts Kenya

Abstract

Provision of Primary Health Care moves a country towards a more efficient and higher quality health care system. Bypassing of 2nd and 3rd levels of Primary Health Care facilities reveal that the patients understand various measure of quality at the facilities that they visit and bypass. Patients seek medical services from the facilities that provide high quality consultations and prescriptions. There must be clear defmed roles for different levels of health facilities as confusion in service delivery may exist between District Hospital and Health Centers. There is need to have well defined referral criteria within the health system /from 2nd to 4th level of PHC facilities to avoid non referred patients overloading the District Hospital. The main objective of this study was to determine the factors contributing to patients bypassing the 2nd and 3rd levels of PHC facilities in Kirinyaga District. The study population involved patients attending both outpatient and family planning departments. Pretested interview schedules were used as research tools. In data analysis, Chi-square test was used to test relationships between variables. Results showed that 96.1% of respondents did not visit their nearest local facility for medical services but went direct to the district hospital. Significant relationship (X2 =30.1 df=12 p=0.003 was noted between age of the respondents and visit to local facilities. Also relationship between sex of respondents and visiting local facility . (X2=9.6; df=l, p=.OOI) was noted. About 42.1% of respondents believed the District Hospital had more qualified staff. There is therefore need for District Health Management Team (DHMT) to asses the requirement of both dispensaries and health centres in terms of staff and services as well as have defmed referral criterion. Results of this study may be useful to policy makers within the district to improve the referral system so as to avoid overloading the district hospital with referral patients.