Practice and Challenges facing Referral System for Obstetric Complication Management in a North Central State, Nigeria; A Qualitative analysis of Healthcare Providers

Abstract

An effective referral system is essential for reducing maternal morbidity and mortality, particularly during obstetric complications. In Nigeria, gaps in referral processes often contribute to delays in accessing appropriate care, despite existing policies. Understanding the perspectives of healthcare providers is critical to addressing these challenges. Objective: This study explored the practices and challenges associated with the referral system during obstetric complication management in a North Central State, Nigeria. Methods: A qualitative study design was employed, utilizing in-depth interviews with healthcare providers across primary, secondary, and tertiary healthcare facilities. Data were analyzed thematically to capture experiences, referral practices, and challenges within the system. Results: The findings revealed that while healthcare providers recognized referral as a vital component of obstetric complication management, practices were hindered by inadequate communication, a lack of functional transportation and ambulance services, and poor coordination between facilities. Resource limitations, patient financial constraints, and weak feedback mechanisms further compromised the efficiency of referrals. Providers also highlighted systemic challenges such as understaffing, inadequate training, and absence of standardized referral protocols. Conclusion: The referral system for obstetric emergencies in the studied setting is characterized by fragmented practices due to some significant barriers, which undermine timely access to quality maternal care. Strengthening referral pathways requires improved inter-facility communication, provision of essential logistics, adherence to standardized protocols, and supportive health policies.