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The study has identified weak referral system as one of the important constraints.
In our study, non-availability of transport was quoted as the major reason for a weak referral system.
"The referral system still is weak, referral from the health facilities to the district hospital, specifically for major obstetric complications".
This includes shortage of supplies and drugs, lack of monitoring and supervisory mechanisms, and a weak referral system.
Some PHCs also lacked the drugs and equipment needed to provide delivery services and exhibited weak referral and follow-up systems.
For example, weak referral systems and poor quality commodities were bottlenecks mostly identified by Asian country teams (Table S1 and S2, additional file 2).
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Further exploration is needed about whether worse quality care or weaker referral systems in rural versus urban facilities may account for the difference in mortality rates.
Parallel systems for community health that are not integrated with the primary health care system risk weaker referral systems, supervision and support by facility based care providers, and policymaker buy-in to support supply chain and other systems components".
Our results show that delays in TATs caused by equipment, workload and manpower challenges in public laboratories are even more disastrous in settings with weak counselling and referral systems.
Limited stakeholder involvement could result in weak collaborative systems and referral networks between CHAs and other health service providers at community level.
The Primafamed project has been linking these different countries, in order to fight for the cause together – Existing health systems in several countries are weak (poor coordination, poor referral systems, poor communication and little funding).
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CEO of Professional Science Editing for Scientists @ prosciediting.com