Establishment of a referral and counter-referral system

The effectiveness of a health system is measured by the quality of the services it provides (primary care, hospitals), but also by its ability to ensure continuity of care across these different levels. The establishment of a referral and counter-referral system is an essential tool for ensuring this continuity of care. The Guiglo District Management Team, with a view to ensuring continuity of care and strengthening the effectiveness of the health system, has been organizing a referral and appeal process since 1999. Our study describes the implementation of this process and presents some of its results. Our analysis shows that the utilization rate and the referral rate are relatively low, and that a significant proportion (31%) of referred individuals do not access the hospital. Improving the tools used, strengthening health workers' ownership of the process, and enhancing communication among the various stakeholders are proposed as ways to improve the process.