DELIVERY OF COMMUNITY HEALTHSERVICES
(REFEERALSYSTEM)
PREPARED BY,
MRS,M.JOSEPHIDAYANA,
TUTOR.

OBJECTIVES
At the end of the class students
are able to
 Define referral system.
 Reason for referral.
 Rationale for referral.
 Characteristics of referral system.
 Levels of referral system.
 List the types of referral system
 Components, perspectives and issues ,
responsibilities.

DEFINITION
A referral system is a mechanism that
enables a patient’s health needs to be
comprehensively managed using
resources beyond those available at the
location they access care from, be it in a
community unit, dispensary, health centre
or a higher level facility

REASONS FOR REFERRAL
 To seek expert opinion.
 To seek additional or different services.
 To seek admission and management
 To seek use of diagnostic& therapeutic
tools
 For continuity of care

CHARECTERISTICS
 Patient should be given optimal care at
the right level, right time and right cost.
 Optimal and cost efficient utilization of
health care system.
 Optimal and appropriate utilization of
specialist services for needy persons
 Optimal utilization of primary health care
services.


RATONALE OF REFERRAL
SYSTEM
 Most common, most complicated and
life threatening diseases requires
different levels.
 Maximize limited resources & avoid
duplication of services.
 Ensures a close relationship between
all levels of the health system.
 Helps people receive the best possible
care closes to home

Cont…
 Support primary health centers.
 Helps to build capacity.
 Reduce the high proportion of
customers seen at the outpatient
clinics at 2nd facilities.

TYPES OF REFERRAL

LEVELS OF REFERRAL SYSTEM
Primary level of care:(PHC)
 Developed to urban and rural areas
 Referral site for the village health worker
& basic health units
 Usually is the 1st contact level between
community & other levels of health
facility.
 Provide management for common &
minor alignment requiring simple
uncomlicated intervention.

Secondary level of care:(District Hospital)
 Referral site for the primary care facilities
 Given by physicians with basic health training.
 Usually given in health facilities either private
owned or government operated
 Rural hospitals, state general hospital, out-
patient department are main sites of care.
 Rendered by specialists in health facilities.

Tertiary level of care: (Superspecality Hospitals)
 Referral site for the secondary care facilities.
 Can be medical centers, regional, provincial
hospitals and specialized hospitals.
 Provide care for complicated, uncommon and
serious diseases requiring highly specialized or
high technology interventions.

REFERRAL SYSTEM IN INDIA
 Sub centres(SC)
 Primary Health Centres(PHC)
 Community Health Centres(CHC)
 Sub District Hospitals
 District Hospitals
 Tertiary Level Facilities In Medical
College Hospitals
 Super Speciality Hospitals In India

COMPONENTS
 Can be adjusted relevant to the local
situation.
 Components can include:
 health system
 Referral process at the 1st level of care
 Referral activities
 Referral process at 2nd or tertiary level
 Supervision and capacity building

PERSPECTIVES & ISSUES OF
ESTABLISHING REFFERAL
 HEALTH SYSTEM ISSUES
 Service providers & quality of care.
 Performance expectations &
involvement of organization.
 All service providers are expected.
 Follow the agreed protocols of care.

REFERRAL PROCESS AT 1ST LEVEL:
 During visits of H.C, it is important that the
health worker
 For proper performance the health workers
 Protocols need to include
 Making decision to refer comes after the
gathering and analyzing relevant information
using protocols as a guide
 Deciding to refer dose not mean that the health
workers is inadequate or bad.

REFERRAL ACTIVITES
 adoption of standardized referral forms to
ensure equality whenever a referral is
initiated
 patients referred out should be
accompanied.
 Carefully filled referral card cab helps to get
timely attention at the receiving facility.

REFERRAL PROCESS AT 2ND OR 3RD
LEVEL:
 The receiving facility
 The supervisor
SUPERVISION AND CAPACITY BUILDING:
 Facility managers & supervisors at all
levels should monitor all referrals to &
from facilities.
 Supervisors should discuss referred
cases.

RESPONSIBLITIES OF NURSE
 Informed consent
 Selection of consultant
 Acceptance
 Task performance
 Feedback

BIBLIOGRAPHY
 Kamalam. S, “ESSENTIALS IN
COMMUNITY HEALTH NURSING
PRACTICE”, 1st edition, 2008 jaypee
brothers, new Delhi, page no, 105-110
 B. T. Basavanthappa “COMMUNITY
HEALTH NURSING”, 1st edition, 2008
jaypee brothers, Mumbai, page no 30-
35
 Kasturi sundar rao, “community health
nursing”, BI publications;265-270