PESHAWAR: Health department will launch the first-ever referral system for patients in collaboration with World Bank in four designated districts of Khyber Pakhtunkhwa.

“So far, there is no referral system as result of which tertiary care hospitals are overburdened with patients. The new system is aimed at providing care to patients with minor issues at primary level and referring complicated cases to other facilities,” officials told this scribe.

They said that patient referral system would be started through Khyber Pakhtunkhwa Human Capital Investment Project (KP-HCIP) in Peshawar, Nowshera, Swabi and Haripur.

The referral strategy will be implemented in collaboration with Rescue 1122 for which a wide range of trainings for approximately 2,200 healthcare workers, including doctors, nurses, lady health visitors, paramedics and support staff, have been conducted in designated districts whereas dedicated training on referral protocols is scheduled to be conducted this month to ensure uniform implementation of the strategy at all levels of care.

The initiative will be enforced with World Bank’s help

“Referral protocols, including who will be referred to other hospitals, are being hammered out,” said officials associated with the initiative.

The referral strategy is particularly designed to strengthen Basic Emergency Obstetric and Newborn Care (BEmONC) to provide essential lifesaving services for maternal and newborn complications, including administration of drugs, assisted vaginal delivery and newborn resuscitation.

Secondly, it seeks to provide to patients Comprehensive Emergency Obstetric and Newborn Care (BEmONC) services plus more complex surgical interventions like C-sections and blood transfusions besides management of other severe complications.

Officials said that the system was desperately needed to reduce infant mortality rate and ensure provision of better and timely services to critically-ill patients. Under the system, patients from community will first be referred to the nearest basic health unit (BHU) or rural health centre (RHC) having BEmONC facilities.

The patients, who cannot be managed at BHU or RHC, will be sent to Category-D hospitals with CEmONC facility for comprehensive emergency obstetric and neonatal care.

“If further specialised or critical management is required, patients will be referred to Category-B level hospitals for advanced care,” officials said.

The system will be fully integrated with Rescue 1122 to ensure timely and safe movement of patients. The referral criteria included obstetric emergencies, neonatal complications, trauma and accidents, cardiac and stroke and high-risk chronic illnesses.

The supervisory role will be played by independent monitoring unit (IMU) of health department that will use standardised referral forms with proper documentation.

“Under the new mechanism, proper linkage system will be put in place,” officials said. They said that patient from community would go to BHU or RHC from where they would be sent to ultimate referral point and for that purpose community linkages would be strengthened through lady health workers (LHWs) and community health committees.

The secondary referral point will be Category-D and Category-C hospitals with 24/7 BEmONC/CEmONC services while the last referral destination will be tertiary care hospitals, including medical teaching institutions (MTIs) in Peshawar and at divisional headquarters hospitals in other target districts.

Officials said that collaboration with Rescue 1122 for emergency transport and overseeing role of IMU would ensure integration of the system. The Khyber Pakhtunkhwa cabinet has mandated Rescue 1122 to provide emergency response services across healthcare facilities which will cater to all BEmONC-related emergencies, ensuring timely referral and transport of patients.

The service is integrated with command and control systems, enabling real-time dispatch, monitoring and coordination with receiving hospitals.

The referring facilities will ensure availability of services or beds to the next level hospitals so that patients are not suffered for want of care, according to officials.

Published in Dawn, September 2nd, 2025