Referral System in Nigeria: Study of a Tertiary Health Facility

Background: The three levels of health care delivery in Nigeria should enjoy patronage from clients and a good referral system is the main link between these levels. The primary health centers are supposed to be the point of first contact of patients. Patients are then referred from here to other levels of health care. This survey examines referral system in Nigeria with a study on new patients seen in a tertiary health facility.
Method: This cross-sectional survey was conducted with 1,416 new patients seen at University of Ilorin Teaching Hospital, Ilorin interviewed over a period of 4 weeks to examine the referral system in Nigeria.
Result: A total Only 100 (7.1%) of them were referred to the hospital, the rest (92.9%) reported to the hospital directly without referral. The new patients (87.1%) were predominantly resident in Ilorin. The proportion of those referred is higher among patients from outside Ilorin than those from within. Most of the patients referred were from doctors from private clinics. Both the educated and non-educated bypass the primary and secondary levels of health care.
Conclusions: A high proportion of patients seen in this tertiary health facility were not referred. The result of this is overcrowding of the tertiary health facilities with problems that can be managed at the lower levels. Highly skilled manpower and equipments are wasted on health problems requiring lesser resources to solve. Necessary steps to make clients utilize primary and secondary health facilities need to be put in place and create disincentives for patients bye-passing these levels.