NA

Referral Pathways

Where referrals flow, where they fail, and how to unblock them — from community to tertiary care.

Referral flow — where care escalates

Volume, rejection rate and turnaround at each hand-off

Community / CHW
Primary clinic
Volume12.4k/yr
Rejected3%
Turnaround1 days
Primary clinic
District hospital
Volume6.8k/yr
Rejected11%
Turnaround6 days
District hospital
Regional hospital
Volume3.1k/yr
Rejected18%
Turnaround12 days
Regional hospital
Tertiary / specialist
Volume1.4k/yr
Rejected27%
Turnaround34 days
Bottleneck detected: Regional → Tertiary referrals show 27% rejection and 34-day turnaround (target 14). Paediatric surgery is the main driver. Recommended: e-referral triage + specialist outreach.

Care journey — Hypertension

Standard pathway coverage vs target

Watch
  1. Community screening58%

    CHW BP checks in the ward

  2. Clinic confirmation74%

    Repeat BP + risk assessment

  3. Medication initiation62%

    First-line therapy started

  4. Lifestyle counselling44%

    Diet, salt, activity

  5. Monthly follow-up51%

    Adherence & titration

  6. Lab monitoring39%

    U&E, lipids, HbA1c

  7. Specialist referral71%

    Physician / cardiology

  8. Long-term control46%

    BP at target

Pathway integrity

Where patients are lost

Screening → Diagnosis-26%
Diagnosis → Treatment start-12%
Treatment → Follow-up-23%
Follow-up → Lab monitoring-31%
Referral → Specialist attend-29%