ArticleHealth policy and planning2021
A network analysis of patient referrals in two district health systems in Tanzania.
Article in Health policy and planning, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies.International journal of environmental research and public health · 2022Pooled it
- Improving Primary Healthcare: Applying Grapevine (Healthcare (Basel, Switzerland) · 2026Article
- Network characteristics of referrals for chronic disease patients: results from hierarchical medical reform in Shenzhen, China.BMC public health · 2024Article
- Role of actor networks in primary health care implementation in low- and middle-income countries: a scoping review.Global health action · 2023Article
- The impact of performance-based financing within local health systems: Evidence from Mozambique.Health economics · 2023Article
- No increase in use of hospitals for childbirth in Tanzania over 25 years: Accumulation of inequity among poor, rural, high parity women.PLOS global public health · 2022Article
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Authors and funding
3 authors.
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Abstract
Patient referral systems are fragile and overlooked components of the health system in Tanzania. Our study aims at exploring patient referral networks in two rural districts in Tanzania, Kilolo and Msalala. Firstly, we ask whether secondary-level facilities act as gatekeepers, mediating referrals from primary- to tertiary-level facilities. Secondly, we explore the facility and network-level determinants of patient referrals focusing on treatment of childhood illnesses and non-communicable diseases. We use data collected across all public health facilities in the districts in 2018. To study gatekeeping, we employ descriptive network analysis tools. To explore the determinants of referrals, we use exponential random graph models. In Kilolo, we find a disproportionate share of patients referred directly to the largest hospital due to geographical proximity. In Msalala, small and specialized secondary-level facilities seem to attract more patients. Overall, the results call for policies to increase referrals to secondary facilities avoiding expensive referrals to hospitals, improving timeliness of care and reducing travel-related financial burden for households.
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