In order to analyze factors that influenced these care-seeking patterns, a census of the narratives was conducted to document the length of each narrative, the topics covered, and the quality of information on each topic of interest (providers and places sought for care, referrals, and obstacles to receiving care).
The most significant obstacles to referral to the tools were the attitudes of clinicians and clinical teams.
(Midwife) Lack of money and transportation were mentioned as the main obstacles for referral but also fear of medical complications or pain after surgery emerged as additional factors.
Constrained health systems and non-functional referral strategies are major obstacles for effective primary health care delivery; both essential to curb the under-five mortality and achieving Millennium Development Goals [ 4].
Besides these obstacles, the referral system is affected by the transportation system because there are not enough ambulances or available drivers, with one stating that, "we have two drivers for the ambulance but sometimes one is on leave and the other is driving health workers to the communities, so we don't have a driver when there is an emergency".
Under this level most obstacles point toward the referral system, particularly difficulties at the hospital level, in communication, and with the transportation system.
Previous UK research suggests that the implementation of occupational health guidelines, particularly prompt intervention, may be hindered by organisational obstacles such as strict referral criteria [ 21].
Recognizing these obstacles, providing referrals to Mae Tao Clinic was unrealistic, and establishing standing health facilities risked sabotage from the Burmese military's deliberate tactics to destroy health infrastructure [ 24].
During the consultations, survivors said they experienced serious obstacles in accessing services, with limited referral mechanisms, patchy coverage and service providers often lacking case management skills and real understanding of violence against women.
This is evidence that providers are either displeased or encountered obstacle with the FFS method during patients' referrals.
Any UN plan – even a referral of North Korea to the International Criminal Court – would hit the immediate obstacle of a Chinese veto in the security council.
