Managing Obstetric Referrals in a Refugee Camp Setting

Location:

Introduction:

ARCAmerican Refugee Committee is managing health centers in 3 refugee camps in Rwanda. All the facilities are integrated into the Ministry of Health (MOH) structure to ensure provision of high quality curative and preventative primary health care, including reproductive health and nutrition for refugees.

Project Description:

ARCAmerican Refugee Committee provides primary health care according to MOH standards, including antenatal care (ANC), safe delivery, post-natal care, and family planning services. Patients presenting with complications at ANCAntenatal care visits, outpatient consultations, or inpatient consultations are immediately referred to a district hospital. If necessary, a plan to deliver at a district hospital is established. Women who come to the maternity service to deliver but are determined to be complicated and beyond the capacity of health center to handle safely are also immediately referred to the district hospital using ambulances available at each camp health center. If the case is not able to be managed at the district hospital level, the woman is referred to the next level (tertiary hospital). The referral to secondary or tertiary levels is based on standard operating procedures developed by UNHCRUnited Nations High Commissioner for Refugees using referral forms; these document the outcome of the referral and help the referring institution learn from the process. Referral costs to secondary level institutions (district hospital) are paid by ARCAmerican Refugee Committee, with reimbursement from UNHCRUnited Nations High Commissioner for Refugees, while tertiary level referrals are covered by another partner.

Results:

Full integration of refugee health services into the host country MOHMinistry of Health structure has enabled refugee women to access comprehensive EmONCEmergency obstetric and newborn care and other secondary and tertiary health care services. This process has helped to ensure that cases are referred on time and has had a positive impact on maternal mortality, with 2 or fewer deaths per year in the camps where ARCAmerican Refugee Committee provides services.