The healthcare referral system in the Child Health and Mortality Prevention Surveillance (CHAMPS) catchment areas, Bombali District, Sierra Leone is inefficient, resulting in delayed and inappropriate care for patients. This case study showcases the implementation and impact of the CHAMPS Data-to-Action project in improving the referral system from peripheral health units (PHUs, primary level of care) to the district hospital (secondary level of care). The Ministry of Health (MoH) at the national level has clear policies (1) (2) on appropriate referrals to different levels of care. However, this policy is poorly implemented. The CHAMPS DeCoDe findings highlighted issues with the referral system such as late referral of patients, reluctance of patients to seek care due to poor customer service at the referral facilities, lack of transportation from the peripheral facilities to the referral facilities, etc. The poor quality of care that patients receive at the referral hospital, despite being made to pay for care that should be free under the free healthcare services initiative (1) (2), has led to low trust in the health system. Our multipronged intervention included training of health care workers (HCWs), intensive clinical mentorship for HCWs and community health workers (CHWs), establishing a referral network between the primary and secondary health care facilities (HCFs), improving documentation, facilitating the referral process, and donation of essential supplies to the pilot facilities. Overall, the number of referrals increased as the nurses were better able to detect critical cases. Patients who were supported were appreciative of the clinical mentors and the entire process. Although patient and facility feedback was not systematically captured during the pilot phase, these will be evaluated in the 2024/25 budget cycle and documented in an updated case study.

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Enhancing Healthcare Referral Systems to improve maternal and birth outcomes and reduce U5MR