| SHC, N = 63 | PHC, N = 49 | Sub-district hospital /CHC, N = 35 |
---|---|---|---|
Components of referral practice, % | |||
 Prepare referral note | 41 | 63 | 69 |
 Counsel | 65 | 57 | 74 |
 Advise to call ‘108’ in case of emergency | 75 | 69 | 74 |
 Arrange transport | 8 | 6 | 14 |
 Communicate via phone | 70 | 39 | 14 |
 Provide stabilising care | 13 | 18 | 14 |
Problems faced in referring antenatal women | |||
• Patients are uncooperative, they refuse to go to higher centres –PHC & CHC | |||
• Transport is not available in remote villages. ‘108’ ambulances are sometimes late –PHC in HP | |||
• No transport for antenatal elective or emergency referral –PHC in HP | |||
• ANM supervisor conducted ANC and referred by herself –PHC in HP | |||
• Nurse experienced and willing to provide care, but in-experienced doctor suggested referral –PHC in HP | |||
• Not a delivery point, so all pregnant women referred to the delivery point –PHC in HP | |||
• Not clear about when to refer. Mostly refer when doctor is not available –PHC & CHC | |||
• Refer to District hospitals on weekend, as doctors may not be available at CHC/Sub-district hospital-PHC in HP | |||
• Referral not accepted at higher centre –PHC in HP | |||
• ANC referrals usually from the outpatient clinic and there was no record maintenance –PHC & CHC | |||
• Lab technician not available to provide basic investigations –PHC & CHC in HP | |||
• No information on any change in services and availability of blood at the higher centre –PHC | |||
Support required from system to improve referrals for antenatal women | |||
• Transport facility for emergency antenatal care cases –PHC & CHC | |||
• Need access to obstetrician. In case of any high-risk or complication, the patient needs to visit an obstetrician at least once –PHC & CHC | |||
• Call centre support to discuss difficult cases | |||
• Training required to upgrade knowledge and skills for high-risk and complication cases | |||
• Support from senior staff and doctor to allow ANC care and help in decision making for management of difficult cases | |||
• Need more staff. PHCs should have two medical officers and at least 3–4 staff nurses and one lab technician –PHCs in HP | |||
• Moral support from the system and senior staff should support our decisions | |||
• Lab technician required at seven PHCs and 2 Sub-district hospitals; radiology services required for USG at CHC or Sub-district hospital. | |||
• Blood bank and better testing facilities for thyroid and diabetes so that more women can be managed at CHC/Sub-district hospitals |