Factors Influencing Upward Referral System of Patients in Nairobi County

Background: The referral system forms main health systems coordinating a mechanism ensuring the harmonious movement of patients between different levels of health care institutions for effective and efficient service delivery. The study aimed at establishing the determinants of upward referral system of patients in Nairobi County. Methods: Cross-Sectional data collected from 204 respondents from 2May to 30June, 2021, through a structured questionnaire from level 3-5 public facilities in Nairobi County was used. Data was analyzed using SPSS. Doctors, nurses and clinical officers who have referred patients in the previous three months were included while those who had not were excluded.Results: Bivariate analysis results revealed that knowledge of referral system (r=179*, p=0.011) and complexity of patient disease (r=097, p=0.170) had positive and significant correlation with upward referral system. Multivariate analysis results showed that proximity to the referral health facility had positive and statistical significant (β4=0.640, p<0.002) to upward referral system.Conclusions: The results revealed that although healthcare workers know about the referral strategy, they lack full comprehension of the referral strategy. Patients are mostly referred when higher diagnostic equipment are needed and when the medical conditions are dire. The study recommends professional medical education to equip the human resources for health with the requisite knowledge on the referral system and establishment of effective communication systems between the lower levels health facilities and the higher or specialized facilities to ensure there a smooth referral system in Nairobi County.