LAHORE: The Punjab government is set to introduce ‘referral system’ to ease patient burden on the teaching hospitals and improve their services.

For years, the huge turnout of patients in the teaching hospitals has assumed ‘alarming proportions’ due to shortage of beds and other most basic facilities. At almost all health facilities two to three patients are forced to share a bed and the situation aggravates in case of an epidemic. It has also overburdened the doctors and paramedical staff, resulting in high incidence of misdiagnosis and wrong treatment.

A PC-I is in its final stage as the government has already earmarked Rs200 million – Rs100 million for the referral system and as much amount for establishment of clinics – in its Annual Development Programme (ADP) for 2014-15.

The scheme is being launched on the basis of a study conducted by the Punjab Devolved Social Services Programme (PDSSP) in 2008. The PC-I of this scheme will be finalised by the end of this month.

Pilot project to determine hospitals’ efficiency

The health department has initially identified four major districts as pilot project -- Lahore, Faisalabad, Rawalpindi and Multan. The government will establish referral clinics in the major towns of these districts to use them as referral centres. The patients will be referred from these clinics to the teaching hospitals of the four districts.

Health Secretary Dr Ijaz Munir told Dawn that the health department had underlined the nine towns besides Cantonment areas in Lahore to establish referral clinics. “We have identified a teaching institute, Jinnah Hospital, in Lahore as a pilot scheme to introduce the system,” he said.

Dr Ijaz said the health authorities had finalised modalities with the Jinnah Hospital chief executive and the OPD will be shut down for the general patients. “The OPD of Jinnah Hospital will attend only those patients who will be sent by the referral clinics,” he said.

The health secretary further said a computerised system would be part of the programme linking it to the Jinnah Hospital to keep record of the every referred patient at the clinics, including nature of the disease, name of the consultant concerned, appointment day and time. “The consultant will be informed through the computerised system about the total number of patients he will have to attend daily during official time.”

He said the department had hired services of the consultants of the Technical Resource Facility (TRF) which is funded by the UK’s Department for International Development (DFID) and the Australian Department of Foreign Affairs and Trade (DFAT). The implementation on this scheme would be started from the first week of September, he added.

According to documents the establishment of a functional and efficient referral system was considered key to ensuring adequate access to healthcare delivery services for the programme area population. Under this programme, the referral system will be established through creating functional links between ‘Household-Outreach staff-BHU-RHC-THQ-DHQ’ i.e., linking all health service providers and services operating at various levels of healthcare delivery system.

“The Punjab government will notify the implementation of referral system and roles and responsibilities of healthcare providers at various levels of the service provision.”

The referral system will essentially have four functional levels -- first level (Household to Community Midwives and BHU), second level (BHU to RHC and THQ Hospital), third level (RHC to THQ and DHQ Hospital) and fourth level (THQ to DHQ and Tertiary Care Hospital), say documents.

First Level of Referral System:

At the household level, this programme has community-based staff members i.e., lady health workers (LHWs), community midwives (CMWs) and lady health supervisors (LHSs). Each household will be registered with the respective LHW as well as BHU. Each LHW will be linked with CMW and BHU.

Moreover each CMW will be linked with LHS and BHU. Therefore each household will functionally be connected with BHU in case a referral is made by LHW or CMW. The LHW, CMW and the BHU i.e., the primary functionaries of primary healthcare system (PHC) constitute the first level of referral system for the population residing within the catchment area of a BHU.

Second Level of Referral System:

The second level of referral system will be established between BHU and RHC/THQ level. The patients presented at or referred to BHU will be managed at that facility or will be referred to RHC or THQ depending upon the nature of requirement. The healthcare providers at BHU i.e., health officer, LHV, medical technicians and dispenser and healthcare providers at RHC and THQ constitute the second level of referral system.

Third Level of Referral System:

The third level of referral system will be established between RHC and THQ/DHQ level. The patients presented at or referred to RHC will be managed at that facility or will be referred to THQ or DHQ depending upon the nature of requirement. The health care providers at RHC i.e., health officer, woman medical officer, LHV, nurse, medical technician and dispenser and the health care providers at THQ and DHQ constitute the third level of referral system.

Fourth Level of Referral System:

The THQ will refer all those patients to DHQ or Tertiary Care Hospital who will be beyond its capacity on prescribed “THQ Referral Form”.

Similarly, the DHQ will refer patients to teaching hospital on prescribed ‘DHQ Referral Form’. On receiving a referral from THQ, the healthcare providers at referral facility i.e., DHQ and teaching hospitals will provide feedback to referring facility on the same form.

This communication between referring and referral facilities will be part of records at corresponding levels of the system.

Published in Dawn, Aug 2nd , 2014