Number of people provided with completed referrals for services in the past three months

How to use this indicator

An effective referral system should include the following components: a group of organizations providing a range of comprehensive services, a directory of those services, referral protocols, processes to ensure referral completion, information exchanges and feedback loops among providers and community workers, tracking of referrals, and a coordinating unit responsible for the referral system. Effective linkage and communication mechanisms between structures and stakeholders that provide HIV care and support are essential to ensure that clients in desperate need of services can access care and support. An effective referral system should be able to adapt to different and evolving programs and services and should be easy for community workers and service delivery providers to use. The completed referral indicator can be used to track individuals who receive appropriate services based on the referral provided during the reporting period. Programs can use this indicator to determine the effectiveness of the community referral system, because the end goal should be uptake of service by individuals who are vulnerable to and living with or affected by HIV. This indicator can provide insight into demand for and access to services, and the effectiveness of community worker referral, whether they are provided in a timely manner, and to the appropriate and most accessible service delivery point for the client’s needs.

Numerator

Number of adults and children who received the service for which they were referred, regardless of service, by a community worker during the reporting period

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

This information can be gathered by a community worker through adequate follow-up and communication with service delivery providers, governmental agencies, and community-based organizations. It is recommended that national-level governmental agencies mandate standard operating procedures for referral systems. Many programs or health systems allow the referral process to happen organically. This leads to poor quality data on referral and referral system effectiveness. Ideally, community workers should coordinate with the service delivery point to confirm (in person or via phone, text message, or mobile app) that the referral was completed by their beneficiary and count the total number of beneficiaries with verified completed referrals during the reporting period. An individual should be counted only one time if they received care for the services they were referred for during the reporting period. Although calling or asking the client directly, to ascertain whether they completed the referral, is an option, it is not recommended, because verbal assent is not proof of completion. Community workers can also wait for news to return to them via counter referral form, but this approach is also not recommended, owing to a lack of timeliness and the possibility of losing the form. In some projects, clinics have a liaison to the community health worker (CHW), and this liaison brings information on clients seen at the clinic that week or month back to the CHW on a regular basis. Some projects are piloting electronic referral systems that allow data on completed referrals to be sent back to the CHW via text, whereby the information about referral completion is stored in the national health information system. Participation of community workers is vital in tracking HIV patients lost to follow-up and completed referral back to antiretroviral therapy (ART) services is crucial to ensure patients are brought back to care as soon as possible. Therefore, community workers are an important asset in controlling the HIV/AIDS epidemic.

Data source

This information is tracked primarily by programs for vulnerable children, to determine the state of referrals provided to households participating in their programs. The forms that are used to collect this information usually include child care monitoring forms, monthly registration forms, household assessment tools, and referral forms for vulnerable households. HIV programs typically also track completed referrals for ART.

Disaggregation

  • Age (<1 year, 1–4 years, 5–9 years, 10–14 years, and 15–17 years for children; 18–24 years, 25–49 years, and 50+ years for adults)
  • Sex
  • Pregnancy/lactation status
  • Key population type (sex workers, men who have sex with men, people who inject drugs, transgender people)
  • Type of service (see list here)
  • Service category (health, psychological, legal, nutrition, education, or economic strengthening)
  • HIV status

Some countries tend to aggregate the counts of completed referrals based on the category of the type of services provided, and this could be an alternative to tracking referral to all types of services, especially if community workers are trained on where the services fall in each category. 

Data quality considerations

Although this indicator can be used to examine the quantity of referrals from the community level, it cannot be used to determine the quality of services provided upon uptake of services for which referral was made. Referrals can be provided in one reporting period and then completed in another, but only completed referrals should be counted, which means a person has received services on the basis of that referral.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Completed referral

Category

Vulnerable Children, Key Populations, Prevention of Mother-to-Child Transmission, HIV Prevention, Home-Based Care

References

de la Torre, C. (2013). Monitoring referrals to strengthen service integration. Retrieved from https://www.slideshare.net/measureevaluation/monitoring-referrals-presentation-webinar-final

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