The referral system for pregnant women and newborns in Kyrgyzstan lacks clearly-defined clinical pathways and mechanisms for managing patients’ journeys through different levels of care. Linkages between primary health care workers and specialists are insufficient or entirely absent, which impedes the continuum of care. In addition, pregnant women sometimes present at health facilities very late, after complications have already arisen. Low standards, a lack of transparency and the wrong incentives for referrals means that women with high-risk pregnancies do not always receive specialist care on time, while widespread ‘self-referral’ results in a high proportion of uncomplicated deliveries taking place at higher-level facilities.
To improve the referral system so that it meets the standards required by an integrated patient-centred system, the project supports working groups in each region to develop and introduce process and communication standards for referrals. In one district of Osh region it is working with local health authorities and inpatient and outpatient service providers to pilot a case management-based approach to high-risk pregnancies. At the same time, the project is supporting the implementation of recommendations from the second CEMD to improve the quality of antenatal care at primary care level in Osh region, including developing training materials for family doctors, family nurses and midwives.