RT Journal Article
SR Electronic
T1 Referral transit time between sending and first-line receiving health facilities: a geographical analysis in Tanzania
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001568
DO 10.1136/bmjgh-2019-001568
VO 4
IS Suppl 5
A1 Michelle M Schmitz
A1 Florina Serbanescu
A1 George E Arnott
A1 Michelle Dynes
A1 Paul Chaote
A1 Abdulaziz Ally Msuya
A1 Yi No Chen
YR 2019
UL http://gh.bmj.com/content/4/Suppl_5/e001568.abstract
AB Background Timely, high-quality obstetric services are vital to reduce maternal and perinatal mortality. We spatially modelled referral pathways between sending and receiving health facilities in Kigoma Region, Tanzania, identifying communication and transportation delays to timely care and inefficient links within the referral system.Methods We linked sending and receiving facilities to form facility pairs, based on information from a 2016 Health Facility Assessment. We used an AccessMod cost-friction surface model, incorporating road classifications and speed limits, to estimate direct travel time between facilities in each pair. We adjusted for transportation and communications delays to create a total travel time, simulating the effects of documented barriers in this referral system.Results More than half of the facility pairs (57.8%) did not refer patients to facilities with higher levels of emergency obstetric care. The median direct travel time was 25.9 min (range: 4.4–356.6), while the median total time was 106.7 min (22.9–371.6) at the moderate adjustment level. Total travel times for 30.7% of facility pairs exceeded 2 hours. All facility pairs required some adjustments for transportation and communication delays, with 94.0% of facility pairs’ total times increasing.Conclusion Half of all referral pairs in Kigoma Region have travel time delays nearly exceeding 1 hour, and facility pairs referring to facilities providing higher levels of care also have large travel time delays. Combining cost-friction surface modelling estimates with documented transportation and communications barriers provides a more realistic assessment of the effects of inter-facility delays on referral networks, and can inform decision-making and potential solutions in referral systems within resource-constrained settings.