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Background: The time spent between referring and receiving health facilities is an important determinant of the outcome of the referred patients/clients especially among women in low-income countries due to poor access to early and appropriate referrals. Thus, the aim of this study is to assess the average time spent between referring and service utilization at receiving health facility. Methods: A cross-sectional study was employed by using time and motion approach. Structured questionnaire and observation checklist were used for collecting data. SPSS 21 version was used for data analysis and binary and multivariable logistic regression analysis was carried out to identify a variable that has a significant association on the basis of OR, 95% confidence interval, and a P value of less than.05. Result: A total of 266 women participated in the study with the mean age of the study population is 24.65 (±5.03) years. The majority, (223 (83.8%)) of the participants came for maternal health services and more than half, (143 (53.8%)) of the respondents were self-referrals. Among the referred cases, the main reason for the referral was for further evaluation and management. Women spent a maximum of 540 min on the way to arrive at receiving health facility. Residence and distance were the predictor variables for average time spent. Conclusion: In general, women wait a maximum of one and half hours to contact health care providers for assessment and more than two-fifth of the women wait more than 3 h to get the service at receiving health facility.
Study setting: This cross-sectional study was conducted from February to May 2020 in 2 purposively selected districts [Omo Beyam and Omo Nada] in Jimma zone. Jimma zone is situated in Southwest Ethiopia, 357 km from the capital city, Addis Ababa. Jimma Zone is home for nearly 2.5 million people (CSA, 2007). There are 3 425 206 populations, 21 woredas, 562 Kebeles, 15 527 Gare, 75 232 Shane, 1 tertiary hospital, 3 general hospitals, 3 primary hospitals, 122 Health centers, and 512 health posts in the zone. The 2 districts have a total of 336 055 populations, 46 health posts, 11 health centers, and 1 primary hospital. All clients receiving Maternal, Newborn and Child Health (MNCH) related services during the specified study period at all levels of health care delivery point in the 2 districts. First the 2 districts were purposively selected and a list of public health facilities under each district was prepared based on their level/ tier/rank. Then, 5 health centers and one hospital were randomly selected from the 2 districts to be included in the study. Then, all women/clients and their children visiting the selected health facilities and received care during the study period were observed and interviewed. Measurement of time: Time and motion study, which is a direct observational prospective study was employed to determine a “normal” or average time spent between referring and receiving services and for delivering particular services from entry to exit for clients visiting a health facility for MNCH service (Figure 1). Client flow procedure across different health facilities and multiple phases of referral system, 2019. The data were collected using Interviewer administered questionnaire and observation checklist by trained midwives and nurses. Data collectors and observers were assigned at all randomly selected health facilities. After the referred clients/patients entered to the compound of the referral receiving health facilities, the data were collected using 3 approaches. In the first stage, clients/patients referred and presented at the current health facility during study period were observed starting from their entry to the compound. Once clients enter into the health facility, the time spent at each encounter such as card room/registration, triage, counseling/contact with health care providers, laboratory, and pharmacy to their exit or end output like admission/discharge/or referred to the next higher health facilities were recorded. Nonparticipatory observational approach was used. In the second approach, client exit interviews on the same individual were done through a questionnaire prepared by the researchers focusing on the objective of the study. The collected data were entered and cleaned in excel sheet and exported to SPSS version 21.0 for analysis. Binary and multivariable logistic analyses were respectively used to identify candidate variables and see the independent predictors of average time spent in the utilization of MNCH service considering P value less than .05, 95% confidence interval (CI), and adjusted odds ratio (AOR), and the results were presented using narrative texts, tables, and figures. In this particular study: Referral time is defined as the time elapsed between once the referral was decided, and until the patient reaches the receiving facility or time elapsed between referring the patient from one health facility to another, and section waiting time is the time the client spends at specific service delivery point within the health facility waiting to receive care or services. Total waiting time is the sum of all the section waiting times. Waiting time is the time that patients spend waiting to receive service and it was measured as total waiting time and section waiting time. Referral time: It is the time elapsed between once the referral was decided, and until the patient reaches the referral or time elapsed between referring the patient from one health facility to another. Section waiting time: The time the client spends at a specific service delivery point within the health facility waiting to receive care or services. Total waiting time: This is the sum of all the section waiting times. Waiting time: This is the time that patients spend waiting to receive a service. This was measured as total waiting time and section waiting time.
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