DETERMINANTS OF A FUNCTIONAL REFERRAL SYSTEM IN KISUMU COUNTY, KENYA PATIENTS’ PERSPECTIVE
Purpose: Most referral health facilities are faced with challenges ranging from congestion of patients at these health facilities, strained/ limited resources (both human and material) to deal with the voluminous patients, slow rate of service delivery to the patients which normally results in compromised quality of medical care provided to the patients. The study therefore aimed to find out the determinants of a functional referral system in two high level health facilities; Jaramogi Oginga Odinga Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCH).
Methodology: A cross sectional study was conducted using a quantitative approach to data collection. Three hundred and thirty eight out-patient clients were systemically selected to participate in the study. Data was collected using Individual questionnaire. The collected quantitative data were coded and analyzed using the SPSS 25.0 Computer program. The quantitative data were then analyzed using the descriptive statistics and logistic regression models.
Results: The research findings revealed that there is a positive significant correlation between primary health facility characteristics (r = 0.474**; P<0.000).It also revealed that there is a positive significant correlation between receiving facility characteristics (r = 0.475**; P<0.000) to a functional referral system. Further Multivariate analysis also revealed a significant association between referral health facility characteristics and a functional referral system, (β3 = .425, P =.000).The results further revealed that there was a negative significant association between receiving health facility characteristics and a functional referral system, (β4 =.-0.156, P < .000).
Unique Contribution to Theory, Practice and Policy: The County government of Kisumu should supply adequate drugs and equipment’s to attract more patients seeking medical care services to the primary level facilities. Quality of services offered and general cleanliness at the primary health facilities should also be improved to boost patient’s confidence in them.
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Al-Doghaither, A. H., Abdelrhman, B. M., Saeed, A. A. W., & Magzoub, M. E. M. A. (2003). Factors influencing patient choice of hospitals in Riyadh, Saudi Arabia. Journal of the Royal Society for the Promotion of Health, 123(2), 105–109.
Anderson, R. T., Camacho, F. T., & Balkrishnan, R. (2007). Willing to wait?: The influence of patient wait time on satisfaction with primary care. BMC Health Services Research, 7(1), 31.
Auditors report. (n.d.). Performance Audit Report of the Auditor-General Specialized Healthcare Delivery at Kenyatta National Hospital - Health Publications.
Ayub Medical College., Y., Shaikh, B. T., & Kumar, R. (1988). Journal of Ayub Medical College, Abbottabad : JAMC. Journal of Ayub Medical College Abbottabad (Vol. 23). Ayub Medical College. Retrieved from http://jamc.ayubmed.edu.pk/index.php/jamc/article/view/2628
Chapter 2 Overview of the Health System in Kenya. (2005.). Retrieved March 9, 2019, from https://www.researchgate.net/publication/265099088_Chapter_2_Overview_of_the_Health_System_in_Kenya
GOK/MOH. (2016). Kenya Health sector referral implementation guidelines 2014 1st edition, 1–44.
Hsia, R. Y., Mbembati, N. A., Macfarlane, S., & Kruk, M. E. (2012). Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap. Health Policy and Planning, 27(3), 234–244.
KENYA HEALTH SECTOR REFERRAL STRATEGY - Health Publications. (n.d.). Retrieved March 9, 2019,
Kohi, T. W., Mselle, L. T., Dol, J., & Aston, M. (2018). When, where and who? Accessing health facility delivery care from the perspective of women and men in Tanzania: a qualitative study. BMC Health Services Research, 18(1), 564.
NoorAli, R., Luby, S., & Rahbar, M. H. (1999). Does use of a government service depend on distance from the health facility? Health Policy and Planning, 14(2), 191–197.
Okoli, H., Obembe, T., Osungbade, K., Adeniji, F., & Adewole, D. (2017). Self-referral patterns among federal civil servants in oyo state, South-Western Nigeria. The Pan African Medical Journal, 26, 105.
Opon, S. O. (2016). Provision of essential health package in public hospitals: a case of Homabay County hospitals, Kenya. Pan African Medical Journal, 24.
Otieno, S. O., & Macharia, D. (n.d.). Factors Influencing Utilization of Health Services in Kenya: The Case of Homa Bay County. International Journal of Public Health Science (IJPHS), 3.
Roberts, J., Sealy, D., Marshak, H. H., Manda-Taylor, L., Gleason, P., & Mataya, R. (2015). The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study. Malawi Medical Journal : The Journal of Medical Association of Malawi, 27(4), 145–150.
Simba, D. O., Mbembati, N. a a, Museru, L. M., & Lema, L. E. K. (2008). Referral pattern of patients received at the national referral hospital: challenges in low income countries. East African Journal of Public Health, 5(1), 6–9.
The WHO health system building blocks framework. Source: WHO 2007 1. | Download Scientific Diagram. (n.d.). Retrieved March 9, 2019,
WHO | The World Health Report 2008 - primary Health Care (Now More Than Ever). (2013). WHO.