OPERATIONALIZING

THE HEALTH
REFERRAL SYSTEM
DEFINITION OF “ CATCHMENT”
 Area: geographic area served by the
hospital
 Population
 Primary: population within the political
subdivision where the health facility is
established
 Secondary: population of the other
political subdivision that have access
(within 17.5 km) to the health facility
 OPERATIONALIZING THE
HEALTH REFERRAL SYSTEM

 Setting- up the Referral System

 Referral System Flow Chart

 Referral Procedure
 I. STEPS IN SETTING- UP A
REFERRAL SYSTEM
1. ORGANIZING THE REFERRAL
SYSTEM
2. PLANNING FOR A COMPREHENSIVE
REFERRAL SYSTEM
3. DOCUMENTATION
4. ADVOCACY
5. SUSTENANCE
 1.) ORGANIZING THE
REFERRAL SYSTEM
 PHO to initiate the process
 DOH to commit to Technical
Assistance
 Identify point persons
 ILHZ is board functional
 Task force to spearhead the project
 Conduct “Strategic Planning”
2.) Planning for Comprehensive Referral System
 Preparatory Phase
Mandate from LGE
MOA among stakeholders, this serves as
a commitment and that parties should
adhere to agreements
Brainstorming meetings to assess
situation, identify health services to be
improved, issues and concerns to be
addressed( e.g. prevalent health
problems, availability of medicines, etc
Define geographic boundaries and
catchment areas of identified facilities.

Identify the levels of care available

and validate info from stakeholders

Identify the ILHZ technical committee

membership who shall be responsible
to operationalize the system
 Planning and Implementation Phase
Prepare or review existing strategic and
operational integrated health plans
Conduct planning workshops to
delineate responsibilities of the
different referral levels, include the
design of a monitoring system.
Conduct periodic evaluation and
refining of the system
Prepare a manual of operations for the
particular ILHZ
3.) DOCUMENTATION
 “This involves going through the process
of identifying the requisites of the
referral system and all that goes with the
system to make it work”…
…issues …concerns…
…policies …guidelines...
…it must be tailored fit to the needs of the
locality!
 DOCUMENTATION

 Introduction

 Operations
 Policies
 Flowchart of facilities within the
referral network
  Health care resources for
the referral system
 List of Health Facilities
 Essential health care services/
minimum package activities
 List of health personnel

 Monitoring and Evaluation

 Standards Forms Used in the
Referral System
4.) ADVOCACY
 ORIENTATION MEETINGS

 COMMUNITY MUST BE INFORMED

 COMMUNICATION PLAN OF THE

ILHZ
5.) SUSTAINING A FUNCTIONAL
REFERRAL SYSTEM
 REGULAR AND PERIODIC
MONITORING
 POINT PERSONS FOR OPERATIONAL
FUNCTION
 ANNUAL REPORTS
 HUMAN RESOURCE DEVELOPMENT
 Tertiary Hospital
Private Hospital Private Hospital

DH District Hospital DH

RHU Rural Health Unit RHU

Private Clinics Private Clinics

BHS

Community
Conceptual Framework of the Referral System
II. REFERRAL SYSTEM FLOW
CHART
 FACTORS TO CONSIDER:
– Geographical location
– Competencies oh the health
personnel
– Capabilities of the health facilities
– Logistics
– Customs and practices
 III. REFERRAL PROCEDURE
 PATIENTS MUST BRING THE REFERRAL SLIP
CINTAINING PERTINENT INFORMATION:
History (Present illness, family, past
medical history)
Chief complaint, initial diagnosis,
interventions (therapeutic or diagnostic)
Instructions after consultation
Course in the referring
Reasons for the referral
 ONCE THE REASON FOR THE REFERRAL
HAS BEEN ADDRESSED, PATIENT REFERRED
BACK WITH RETURN SLIP:
 Final Diagnosis
 Diagnostic and Therapeutic Interventions
 Condition upon discharge
 Instructions
 Activities to be undertaken by the
receiving facility
 Discharge summary
 ALL REFERRALS MUST BE
DULY RECORDED BY
REFERRING AND RECEIVING
FACILITIES. INFO IS
NECESSARY FOR POLICY
FORMULATION AND
IMPROVEMENT OF SERVICES
RENDERED
 PATIENTS SHALL BE REFERRED AFTER
THE FOLLOWING HAS BEEN SATISFIED:
 Assessment of patient was done
 Decision as to who must accompany
the patient
 Availability of ambulance or other mode
of transportation
 Facility to be referred has been
identified