Assessing the functionality of an emergency obstetric referral system among public healthcare facilities in a low resource setting: an application of process mapping approach

Abstract

Abstract Background: Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions, using Ablekuma district in Accra, Ghana as a case study.Methods: The study is an analytical cross-sectional study. Nine (9) in-depth interviews (IDI) were carried out for a three-weeks period in June and July 2019 after informed consent with two (2) Obstetrics &amp; Gynaecology consultants, two (2) Residents, one family physician, and four (4) Midwives managing emergency obstetric referral across different levels of facilities. Data collected included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system.Results: Out of the 33 main activities in the referral process within the facilities, 24 (73%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), HCP knowledge and compliance of referral policy and guideline, and financing for referral. Healthcare providers suggested that strengthening communication and coordination, review of referral policy, training of all stakeholders and provision of essential resources would be beneficial.Conclusion: Our findings clearly establish that the emergency obstetric referral system in Ablekuma district, Accra-Ghana is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions likely to ensure that women receive timely and quality care.</jats:p