This study aimed to investigate the outcomes of leveraging existing CHW referral processes to integrate rehabilitation identification, provision of basic rehabilitation and referral tracking at the community and PHC level in Uganda and Pakistan.
Additionally, access to rehabilitation referral data from the community is highly beneficial in planning for service delivery at the PHC and district health level.
To better understand the context and referral systems, extensive engagement with networks of care (NoCs) stakeholders was conducted through co-design workshops to identify rehabilitation capacity development need and mechanisms to integrate rehabilitation referrals from community into the existing structures.
In 2023, over 200 CHWs across both countries were trained to appropriately identify individuals with rehabilitation needs and refer them to the PHC facility that the CHW is affiliated with.
Training included provision of documentation tools such as referral booklets and routine reviews with CHW supervisors and district coordinators as part of regular processes. This provided an opportunity for newly trained CHWs to consolidate referral documentation and provide a count of the number of referrals made on a monthly basis in Pakistan and quarterly in Uganda.
In Pakistan, 1,307 referrals for rehabilitation were made by LHWs. Of these, 174 were seen at the PHC facility for rehabilitation assessment, and 291 were referred to rehabilitation facilities.
In Uganda, 1,855 referrals for rehabilitation were made by VHTs. Of these 1,480 were managed at the PHC level for rehabilitation assessments, and 342 were referred to rehabilitation facilities.
The ability to leverage existing CHW referral processes has resulted in sustainable identification and tracking of rehabilitation referrals from community to PHC. Furthermore, it allows district health stakeholders to understand the need for rehabilitation and the translation of an active referral resulting in attendance at PHC facility for a rehabilitation assessment.
Building on this work, district health stakeholders are able to integrate routine follow-ups by CHWs to improve coordination of care for a complete referral.
This study will be a reference for sustainable rehabilitation referral pathways tracking at the community and PHC level which can be implemented across other districts in low to middle income countries.
rehabilitation
referrals
