The South African public health sector follows a hierarchical referral system. District hospitals play a central role between the primary health care (PHC) clinics, community health centres (CHCs), regional and tertiary hospitals. They provide level one (generalist) services to in- and outpatients referred from PHC clinics and CHCs. District hospitals should ensure that patients are treated at the appropriate level of care and receive continuity of care. However, patients often bypass these facilities and go directly to district hospitals, resulting in increased caseloads. Studies have identified several factors (e.g. accessibility, acceptability, efficiency and effectiveness) that might influence a referral system and its usage. We aimed to develop an understanding of the South African district referral system.
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Mojaki et al. (2011) studied this question.