Referrals’ Effectiveness

Output

% of referred children aged 6–59 months who completed the referral to the designated treatment service

This indicator measures the proportion of referred children who completed the referral by reaching and being assessed by the designated treatment service. For this indicator, a referral is considered effective when the referred child completes this step, regardless of whether the child is subsequently admitted for treatment. The indicator therefore measures referral completion, not treatment uptake, quality of care or treatment outcomes. A low value can indicate barriers affecting referral completion, but the indicator alone does not identify their causes.

Determine the indicator's value by using the following methodology:

 

1) Define the reference period during which referrals will be included (for example, three months from 1 April to 30 June).

 

2) For the defined reference period, determine:

• the number of children aged 6–59 months who were referred by a health worker or volunteer to a designated treatment service based on low MUAC and/or oedema identified during screening; and

• the number of those same referred children who reached and were assessed by the designated treatment service (include children who were admitted as well as those who were assessed but not admitted)

Use a referral tracking system that enables referrals to be matched with information from the receiving service. For example, community health volunteers can use a double-slip referral system, where the caregiver receives one referral slip and the volunteer keeps the other. The slips can then be compared with records from the receiving service to determine which referred children arrived.

 

3) To calculate the indicator's value, divide the number of referred children aged who reached and were assessed by the designated treatment service by the total number of children referred during the reference period. Multiply the result by 100 to convert it to a percentage.

This data can be disaggregated by sex and treatment-service catchment area, and, if relevant and feasible, also by age group, referral reason and referral source.

1) For this indicator, an ‘effective referral’ means that the referred child reached and was assessed by the designated treatment service. It does not imply that the child was admitted, received treatment, recovered, or that the referral system as a whole was effective.

2) Where useful, programmes can also analyse completed referrals by whether or not the child was subsequently admitted for treatment. This can help identify possible issues with referral criteria or differences between screening and admission assessments.

3) Do not interpret a low value automatically as poor caregiver acceptance of the programme. Referral completion can be affected by distance, transport costs, communication, service availability, waiting times, referral procedures and other barriers. Where referral effectiveness is low, investigate the reasons before deciding on corrective action.

Also consider using the following indicators:

• Coverage of MUAC Screening (shows whether screening reaches the intended child population)

• Coverage of Acute Malnutrition Treatment Services (shows whether children needing treatment are receiving it)

• Recovery (Cure) Rate (measures treatment outcome after access to care)

• Default Rate (shows whether enrolled children remain in treatment)