PURPOSE:
A strong obstetric referral network between community health centres and hospitals is critical in providing high-quality maternal newborn health care especially in Sub-Saharan Africa where resources are limited and maternal and neonatal mortality are high. Referral is a process in which a lower-level facility transfers management of a patient to a higher-level facility. It consists of an initiating facility identifying need for referral, communicating with the receiving facility and then the referring facility receiving feedback on the outcome of the referred patient. Studies have identified that the feedback to referring facilities is often missing in this referral process. PROBLEM STATEMENT There is no formal feedback mechanism in West Nile Region of Uganda when obstetric patients are referred to higher health facilities. Feedback is critical as it helps with evaluating management of clients and completing a continuum of quality care which results in improved collaboration that strengthens health systems.

DISCUSSION:
Arua Regional Referral Hospital receives patients from 3 tertiary hospitals, 8 district hospitals and 16 health centres. A feedback mechanism tool has been developed to strength the obstetric referral process. Thirty-five health workers have been oriented on the tool. Currently we are analyzing the impact of the tool through changes in patient outcomes and in-depth interviews with staff in both referring and receiving facilities. The implementation of this tool might provide guidance on how to improve their obstetric referral process.

EVIDENCE WHERE RELEVANT:
WHO recommends feedback communication between the lower facility health units and the referral hospitals. There is lack of feedback to referring facilities and there is no studies that focused on improving this referral feedback process in Sub-Saharan Africa

KEY MESSAGE:
Feedback mechanism within the referral process is essential. Lesson from this quality improvement initiative can provide insight for others on how to strengthen the referral process. Poster session 4 (Group B)