To identify the determinants of a functional referral

to identify the determinants of a functional referral system and give recommendations based on
the results achieved.
2.0 LITERATURE REVIEW AND THEORITICAL REVIEW
2.1 Functional Referral system
An effective and functional referral system ensures health services to all people in Kenya in the
following ways; cost effective health services are provided to the citizens, proper coordination
and standardization of the referral service, promotion of equity and universal health care
coverage to all the citizens and enhance health care planning through performance monitoring of
the health care process. This in turn will strengthen lower health facilities and capacity of all the
health care workers, improve efficiency of health system by ensuring appropriate use of health
services, health care services are provided at the lowest possible cost and better linkage between
health facilities at all levels, (Kenya Health Sector Strategy, 2014). A functional referral health
facility should follow the guidelines discussed below to achieve the desired outcomes.

Global Journal of Health Sciences
ISSN 2519-0210 (Online)
Vol 4, Issue 1, No.2, pp 11 - 31, 2019
14
2.1.1 General layout of the Kenyan Referral System
The National Health body defined Kenya Essential Package for Health (KEPH) and the Health
Service Norms and Standards to guide service standard definitions and service norms for various
inputs at each level of care. Contrary to the expectation, proper guidance on the linkage of
services and continuity of care across the different levels has been inadequate and ineffectively
managed. The health sector consequently developed the referral strategy to guide the sector in
building an effective referral system that responds to the health needs of the Kenyan population.
This will ultimately lead to the realization of the Vision 2030, sustainable development goals and
universal health coverage (GOK/MOH, 2014).
The vision 2030 contains the overall government policy on health. The referral strategy reviews
the overall strategic framework and policy that governs the roll out and operations of the referral
strategy. The Kenya Health Sector Referral Implementation guidelines 2014, indicates that
effective referral networks should provide linkages across the different levels of the health
system, from the community to the tertiary level. This will ensure that patients receive the full
spectrum of care provided by the health system, regardless of the level at which they physically
access health care. It addresses clients movement, expertise movement, specimen movement and
client parameter movement as key elements. The guideline further outlines the rights’ of every
person as far as health access is concerned, roles of the MOH in setting guidelines, roles of the
County government and the documentation required for the referral to be complete. The Kenyan
health system was organized around six levels of care (before devolution), but was further
classified into four tires of care based on the scope and complexity of care - after the devolution
(Overview of the Health System in Kenya, 2005). (See figure 1 below).