What factors influence informal health providers' decisions to refer patients to formal health facilities in urban slums: implications for health system strengthening
1
College of medicine, Health policy research group, university of nigeria, Enugu, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
informal health providers (I.H.Ps.) deliver essential services in urban slums where access to formal healthcare is limited. however, their decisions to refer patients to formal health facilities have consequences for patient safety, care continuity, and overall health system performance. understanding the factors that influence this decision is critical for designing effective strategies that contribute to health system strengthening in low-resource settings.
METHODS:
the cross-sectional study was conducted among 135 I.H.Ps. in eight urban slums in enugu state, nigeria. participants completed a structured, pre-tested questionnaire on healthcare service provision. Univariate, bivariate, and regression analyses were used to assess factors predicting referral decisions.
RESULTS:
bivariate analysis indicated that facility type (p<.001), training (p= .001), gender (p= .001), registration with a government body (p= .001), and inspection by a government body (p<.001) are all positively related to I.H.Ps referring to formal health facilities (F.H.F.). training (p=.001), facility type (p<.001), and inspection by government (p=.039) were also found to be negatively related to an I.H.P. resorting to giving traditional medicine. binary logistic regression revealed that training is the key factor influencing IHPs to refer a patient to F.H.F. (B = 1.72, OR = 5.59, p >.01). The I.H.Ps.' diagnosing illness was a key factor discouraging them from referring patients to F.H.Fs. (B = -.88, OR = 0.41, p =.04). Training was also a key factor influencing I.H.Ps. to avoid resorting to traditional medicine (B = -2.37, OR = 0.09, p =.04).
CONCLUSIONS:
Our findings highlight the impact of training and I.H.Ps.' diagnosing illnesses play in influencing the decisions of I.H.Ps. in urban slums to make referrals to F.H.Fs. policymakers' strengthening of structured training and regulatory oversight among I.H.Ps. in urban slums is crucial for improving referral practices, quality of health service provision, and strengthening health system resilience in Nigeria and similar contexts.
informal health providers (I.H.Ps.) deliver essential services in urban slums where access to formal healthcare is limited. however, their decisions to refer patients to formal health facilities have consequences for patient safety, care continuity, and overall health system performance. understanding the factors that influence this decision is critical for designing effective strategies that contribute to health system strengthening in low-resource settings.
METHODS:
the cross-sectional study was conducted among 135 I.H.Ps. in eight urban slums in enugu state, nigeria. participants completed a structured, pre-tested questionnaire on healthcare service provision. Univariate, bivariate, and regression analyses were used to assess factors predicting referral decisions.
RESULTS:
bivariate analysis indicated that facility type (p<.001), training (p= .001), gender (p= .001), registration with a government body (p= .001), and inspection by a government body (p<.001) are all positively related to I.H.Ps referring to formal health facilities (F.H.F.). training (p=.001), facility type (p<.001), and inspection by government (p=.039) were also found to be negatively related to an I.H.P. resorting to giving traditional medicine. binary logistic regression revealed that training is the key factor influencing IHPs to refer a patient to F.H.F. (B = 1.72, OR = 5.59, p >.01). The I.H.Ps.' diagnosing illness was a key factor discouraging them from referring patients to F.H.Fs. (B = -.88, OR = 0.41, p =.04). Training was also a key factor influencing I.H.Ps. to avoid resorting to traditional medicine (B = -2.37, OR = 0.09, p =.04).
CONCLUSIONS:
Our findings highlight the impact of training and I.H.Ps.' diagnosing illnesses play in influencing the decisions of I.H.Ps. in urban slums to make referrals to F.H.Fs. policymakers' strengthening of structured training and regulatory oversight among I.H.Ps. in urban slums is crucial for improving referral practices, quality of health service provision, and strengthening health system resilience in Nigeria and similar contexts.
| eISSN: | 2654-1459 |
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