Finally, we have been able to put in place the pilot of the much-awaited Patient Referral System in Lahore. In infancy stage yet, the Referral System has a huge potential to quintessentially transform the health landscape of the province.
The Patient Referral System envisages development of direct online linkage system among healthcare facilities of key tiers. Currently, we face an overwhelming turn out at Tertiary Care Hospitals. This is largely due to general perception that all required facilities for patients are available at Tertiary Care hospitals. Keeping this convenience in view, people try to visit Tertiary Care hospitals which become overcrowded by patients who could easily have been dealt with at the smaller clinics and smaller health unit developed by govt. of the Punjab all over the province.
In order to streamline healthcare service delivery, the government has taken a revolutionary step and is setting up Referral System at Jinnah and Mayo Hospitals as a pilot project. The appalling spectacle of overcrowded hospitals where two to three patients are forced to share a bed (the situation aggravates in epidemics) creates serious discomfort for all health managers. This over-crowding leaves an impact on performance of doctors and paramedical staff as well, resulting in high incidence of misdiagnosis and wrong treatment. A fair distribution of workload among facilities will reduce burden at Tertiary Care Hospitals and ensure optimum utilization of the Primary Health facilities. Also, one solution to our burgeoning population is optimum utilization of all public health facilities already available at the doorstep to majority of people. It is pertinent to mention that amongst our many other failures, one was not being able to catch up with the innovations and developments in the rest of the world. Our part of the world, especially Iran, have successfully adopted the referral model with a great degree of success. It is tragic we could not learn from the best practices from our immediate neighbors, as merely replicating them with minor adjustments was not a big deal. Not that the previous government was not spending money, it is the fact that money was not being spent in proper direction. In contrast, our top priority remains the streamlining of the functional components of the department for best possible service delivery. Our primary focus is on prevention, then enhancing the efficiency and strategic placement of the available resources. Keeping the above in view, the Referral System is being introduced in areas around Tertiary Care Hospitals. As a pilot, the dispensaries and Filter Clinics in Jinnah Hospital zone are linked with it. In total, Lahore has been divided in five zones for the larger Project. The existing local dispensaries, Filter Clinics and Family Units in Jinnah Hospital zone are being renamed as Jinnah Satellite Filter Clinics and will provide treatment to population at their doorstep. For more serious patients, these Clinics will serve as referral platforms for the Tertiary Care services. On referral, the data of the patient will be updated at the respective Tertiary Care Hospital simultaneously. The patient will reach the Referral Desk of the respective Tertiary Care Hospital with specific color forms and bar codes that can be scanned and then will be admitted straightaway.
Our part of the world, especially Iran, have successfully adopted the referral model with a great degree of success. It is tragic we could not learn from the best practices from our immediate neighbors, as merely replicating them with minor adjustments was not a big deal
The first tier in the healthcare hierarchy are Dispensaries/Family Unit/Filter Clinics which are providing services to the community and are largely underutilized. There are 103 dispensary Units in Lahore and in the first phase we plan to modify a total of 15 Dispensaries around the three Tertiary Care hospitals (Jinnah Hospital, Mayo Hospital and Services Institute of Medical Sciences) into state-of-the-art Satellite Units which will provide health facilities such as, obstetrics including Ante-natal care, delivery services, Immunization, screening clinics, minor surgery, ENT and eye. Under the Referral System, cases requiring serious surgery and advanced medical treatment will be referred to the attached Tertiary Care hospital for further treatment and hospitalization.
In the pilot phase, the dispensaries of Sabzazar, Wahdat Road and Township are attached with Jinnah Hospital Lahore whereas Shadbagh, Qila Lachman Singh, Sanat Nagar and Lytton Road are being attached with Mayo Hospital Lahore. The facilities are being renamed as Jinnah Satellite Filter Clinics to ensure ownership and familiarity. The Hospital name shall be used with attached primary facilities. Consultants of Medicine, Pediatrics, Gynecology, Surgery, Eye and Diagnostics are being provided at the selected Satellite Clinics by the relevant Tertiary Care hospital.
The outcome of this patient Referral System will be reduced burden of patients at Tertiary Care Hospitals. With proper Referral policy in place, the staff can provide better services to patients at all levels, minimize duplication, reduce overcrowding in urban hospitals and ensure accessibility, affordability, equality and equity in health services. It will also introduce accountability, transparency and responsiveness among healthcare professionals and institutions. As discussed above, these Satellite Clinics will provide medical facilities to walk-in patients and only those patients who need advanced treatment shall be referred to nearby OPDs.
Once SehatInsaf Cards are available to majority population, we will scale up the Patient Referral Services to Private Hospitals and General Practitioners as well so that the ultimate aim of quality and low cost treatment is achieved. The Referral System provides a seamless integration of Primary & Secondary Healthcare Department and Specialized Healthcare & Medical Education Department. It will provide an opportunity for Primary and Secondary Healthcare Department to train doctors at the facilities of the Specialized Healthcare and Medical Education Department. Patients will be the biggest beneficiaries as they can get direct treatment by avoiding long OPD lines. To the government, it provides a smart patient load management with quality care for patients.
Another important thing to mention here is that this is a collaborative effort of Primary & Secondary Healthcare Department and Specialized Healthcare & Medical Education with valuable suggestions from experts like Prof. MehmudShaukat, Prof. ArifTajammul and Prof ArshafNizami for which I am indebted to them.
I would reiterate that the backbone of a successful health system is the capacity and efficiency of its Referral System. The absence of this system has caused a number of bottlenecks in our healthcare system. Based on the lessons learnt in the pilot phase, we will scale it up first in Lahore, then gradually expand it to the rest of the Punjab.
The writer is a Provincial Minister Health