Evaluation of referral system in Thaba Nchu Health sub-district

[摘要] Introduction: South African health system embraces the District Health System model.1 District health system includes health stations or posts, other health care facilities suchas private health practitioners, community based organisations. primary health careclinics and district hospitals. District hospitals provide first level of outpatient or inpatientcare for patients who have been referred by their primary care providers. Districthospitals usually provide 24 hour care and are integrated into district health system.The above set up is similar in Thaba Nchu Health sub district where Dr.J.S.MorokaHospital (DJSMH) is a district hospital and therefore, a referral point for 11 clinics withinThaba Nchu sub district and 4 clinics from the neighbouring sub district. In addition,there are 5 general practitioners rooms within Thaba Nchu sub district. The DJSMH isoverburdened with increasingly high caseload.Main Aim: To evaluate the referral system in the Thaba Nchu Health Sub-district, FreeState Province in terms of the factors that influences its function.Methodology: This was a descriptive study undertaken at Dr.J.S.Moroka HospitalOutpatient and Casualty departments. The study included review of routinely collectedhospital information on patients’ records and registers. No intervention was done forthis study.Results : The referral system within the sub district is not fully functional. Most patientsthat are seen in the DJSMH are self referrals. The case load and work load of the twodesignated areas could be reduced if most of the patients could have started and beseen at the primary health care clinics. Although the registers were helpful in collectinginformation, the documentation on patients’ records by health workers is not consistent;it is poor and need to be improved. The records have shown that the personnel aredoing little in strengthening the referral system within the district.Conclusion: This study was the first of its kind to be done in this DJSMH. Althoughthere are good practices with regard to referral system within the Thaba Nchu subdistrictand Dr. J.S Moroka Hospital, much still has to be done to ensure that the primaryhealth care clinics and hospitals are effectively functioning in rendering servicesrelevant to each level of care. More patients seen in the DJSMH are self referrals thatcould be managed at the primary health care clinics. The interventions recommendedin this study will assist in strengthening the delivery of district health care system and inparticular improve the referral system within the sub district.

[发布机构] University of the Witwatersrand