Effective communication with care givers and receiving facility

Giving information to the mother and the family/support network is a critical step before referral. You should inform about the reasons and importance of referral, risks of non-referral, how to get to the receiving facility - location and transport, and who to see and what is likely to happen.

Sharing information, confidentiality and consent

Consent should be informed and clearly explaining the process of referral and the information that will be shared for decision making. Everybody who works with or who has contact with children should be able to recognise and know how to act upon evidence. The referral process involves the children and their families. Focus on outcomes for children after referral. The mother's socio-economic condition must be considered in the referral process.

Communicate With the Child's Mother During the Child Referral

The four steps, you should follow to refer a child to a health centre or hospital:

1. Explain to the mother about the need for referral, and get her agreement to take the child.
   

   If you suspect that she does not want to take the child, find out the possible reasons. These are as follows:

   • She thinks that hospitals are places where people often die, and she fears that her child will be dying.
   • She does not think that the hospital will help the child.
   • There is no one to take care of her other children during her stay in the hospital or health centre
   • She is needed for farming or any job during child care in the health centre or hospital.
   • She does not have money to pay for transportation, hospital bills, medicines or food for her during the hospital stay.
   • Calm the mother's fears and help her resolve any problems. For example, if the mother fears that her child will die at the hospital, reassure her that the hospital has physicians, supplies, and equipment that can help cure her child.
   • Explain what will happen at the hospital and how that will help her child.
   • If the mother needs help at home while she is at the hospital, ask questions and make suggestions about who could help. For example, ask whether her husband, sister or mother could help with the other children or with meals while she is away.
   • Discuss with the mother how she can travel to the hospital. Help arrange transportation if necessary.

   You may not be able to help the mother solve all her problems and be sure that she goes to the hospital. However, it is important to do everything you can to help. If a referral is not possible, there are some things you can do for the child from your clinic.

2. Write a referral note for the child.
   
   • The name and age of the child.
   • The date and time of referral.
   • Description of the child's problems.
   • The reason for referral (symptoms and signs leading to severe classification).
   • Treatments that you have given.
   • Any other information that the health worker at the hospital needs to know to care for the child, such as earlier treatment of the illness or immunisations needed.
   • Your name and the name of woreda, kebele and your health facility.
3. Give the mother any supplies and instructions needed to care for her child on the way to the hospital:
   
   • If the hospital is far, give the mother additional doses of antibiotic and tell her when to give them during the trip. If you think the mother will not go to the hospital, give her the full course of antibiotics, and teach her how to give them.
     - Tell the mother how to keep the young child warm during the trip.
     - Advise the mother to continue breastfeeding
4. Ensure effective communication between the referring and receiving facility
   

Write a referral note for the mother to take with her to the health centre. Tell her to give it to the health worker in the health centre and write the information below:

• The name and age of the child.
  
• The date and time of referral.
  
• Description of the child's problems.
  
• Symptoms and signs leading to severe classification.
  
• Treatments that you have given.
  
• Any other information that the health worker at the health centre needs to know to care for the child, such as earlier treatment of the illness or immunisations needed.
  
• Your name, Woreda, Kebele and the name of your health post.
  

REFERRAL FORM