Frontline health workers are the backbone of a health system. But even the best trained and equipped frontline worker cannot address every health issue they see. There is often the need to refer a person to a clinic or hospital for more complex diagnostics or more comprehensive treatment. In a well-functioning health system a patient record will accompany the referral and the receiving facility will be notified of the referral. This transfer reduces the cost and improves the quality of the care that is provided. Unfortunately, in most low income countries, there is no patient record or notification that is sent to the referral facility and no one follows up to make sure the patient did in fact reach the referral facility.

D-tree International has integrated this referral process into many of its programs. One example is the safer delivery program in Zanzibar where women are referred by community health workers to a health center or hospital for delivery. Because of the urgency of the referral when a woman is in labor, the referral process in this case includes not only the transfer of a patient record but also arrangements for transportation using local private vehicles with the result that over 75% of pregnant women do reach a health facility for their delivery. In another maternal health program, the patients record is automatically sent to the receiving facility so that appropriate care can be delivered with a message going to the frontline health worker saying when the patient arrived or if the patient did not arrive asking the frontline health worker to follow up with the patient directly.

Achieving this continuum of care is one of the goals of a well-functioning health system and is one of the ways D-tree International is strengthening health systems and improving the quality of care within those systems.