Referral System for Emergency Obstetric Care in Gujarat State

Background- An effective referral system is an essential prerequisite for a well functioning Emergency Obstetric Care (EmOC) service. It is the link between the home of the mother and a well equipped facility. The study attempts to explore the crucial link of referral system between the primary and higher level facilities.

Objective- To study the existing referral system for emergency obstetric care in the state of Gujarat, evaluate its strengths and weaknesses, and suggest ways of improvement for providing better referral service.

Methodology- Based on the RCH (Reproductive and Child Health) status and geographical location, 2 districts each were chosen from good, medium and poor districts. Primary data was collected through visits to facilities and through interviews of key informants at state, division, and district level. The recent Public Private Partnership (PPP) with Emergency Management Research Institute (EMRI) and its impact on the existing referral system was also studied. Secondary data was collected through state and district health management information system. A desk review of available research literature on studies on referral system was also carried out.

Results- The study revealed a rudimentary government referral transport system. The focus of the system is more on number of ambulance and drivers, and less on the number of referrals provided. Most of the PHCs do not have proper ambulances. The lack of standard procedure and referral protocols in the government facilities were aggravated by absence of records related to referrals. The availability of vehicle for transport is improving with the advent of EMRI; however there is a greater need for transparency in its processes and data.

Conclusion- By giving due importance to EmOC referral system and treating it as an integral part of maternal health, many more lives of mothers can be saved. The referral system and transport should focus on the requirements of the patients. Public Private Partnership can be one of the options for providing transport but ultimate responsibility of providing quality services rests with the government.