Assessment of Referral System on Maternal Services in Cagayan De Oro City, Philippines

A retrospective document analysis study aimed to assess the referral system on maternal services based on the referral forms of referred women of reproductive age from the referral facilities to the receiving hospital from January to December 2019. The specific objectives of the study were to describe the use of standard referral forms, compliance of the healthcare workers in using the standard form based on 14 criteria, and the utilization of relevant data related to maternal services based on 16 criteria. There were 3330 referral forms received by the receiving facility on different formats of forms during the study period. A random sampling of 384 referral forms was used as study population. Among 384 referral forms (random sampling), only 126 (31.8%) used the standard referral forms. The compliance of these referral forms using 14 criteria showed that 116 (92.06%) referral forms complied with only 51-75% of the criteria, and none of the referral forms complied with all the 14 criteria. On assessing the data entries among 384 referral forms with different formats, there were six data entries consistently used more than 60% by the healthcare providers which were not part of the printed form: last menstrual period (67.87%), expected date of confinement (64.84%), fundic height (63.04%), fetal heart beat (60.76%), birthweight (62.59%), and age of gestation (60%). Based on the 16 criteria, majority of referral forms (210) utilized 51-75% of the 16 criteria, 122 referral forms utilized 76-99%, 51 forms utilized 26-50%, and 1 form utilized less than 25% of the data entries. Several studies documented that referral forms and functional referral systems are vital to an improved maternal mortality rate (MMR) and infant mortality rate (IMR). Therefore, as part of a continued quality referral system, it is highly recommended that the required referral forms be re-assessed, revised, and regularly monitored on its form compliance and utilization.