Rethinking Referral Systems

By: Ann Blanc,

Written by: Ann Blanc

Over the last 2 ½ days, the Averting Maternal Death and Disability (AMDD) project and the Bill & Melinda Gates Foundation co-hosted a consultation on “Rethinking Referral Systems”. The meeting gathered together a group of professionals working on improving referral systems in low resource settings, including people from the maternal and newborn health, transport, roads, and emergency medicine fields.

The Director of AMDD, Lynn Freedman, started the meeting by posting a quote from Albert Einstein, who said, “Everything should be made as simple as possible, but not simpler.” She used this quote to encourage the participants to expand our thinking about referral systems for maternal and newborn health to embrace a “systems perspective” – a perspective that recognizes that systems are complex and non-linear, that they adapt to innovation and respond to feedback. This perspective recognizes that the parts of a system can’t be separated from the whole. These are abstract ideas but we had the opportunity to translate them into more concrete terms by drawing pictures in small groups of a maternal and newborn health referral system – trying to incorporate its structures, viewpoints, responsibilities, and processes.

Once the drawings were completed, it was obvious that the groups recognized the complexity of referral systems – these were messy, dense drawings! But, it was also obvious that there were many entry points at which improvements could be made – starting at the community level and reaching into comprehensive emergency obstetric care facilities. We spent the next two days discussing these issues, listening to fascinating presentations about work going on in the field (cell phone applications, electronic medical records, GIS modeling, call centers), and working on a decision guide, and research agenda.

It was a stimulating couple of days and we all came up with follow up actions we planned to take within our own organizations. My commitment was to share this information with those who read our blog and make sure you know where to get the materials presented at the meeting as well as some great background resources. Click here for these materials and check back because a report on the meeting and other materials will also be added shortly.