# Referral experiences of healthcare consumers: results from a cross-sectional study in urban slums in southeast Nigeria

## TL;DR

This study examines referral experiences in urban slums in southeast Nigeria, revealing low referral rates and the role of informal healthcare providers.

## Contribution

The paper provides new insights into referral patterns and challenges in urban slums, emphasizing integration of informal providers into the formal system.

## Key findings

- Only 7.4% of patients received referrals from primary healthcare sources.
- Referrals were mostly from patent medicine vendors and private clinics.
- Verbal referrals were most common, with significant variation between facilities and states.

## Abstract

The inadequate referral system in Nigeria is partly due to the proliferation of informal healthcare providers (IHPs) and constraints within formal providers in urban slums. With limited data on patient referral experiences across these providers, this paper explores referral experiences in urban slums in southeast Nigeria.

This study involved 1,025 people in eight slums in Enugu and Anambra states, using multi-stage purposive sampling. Data on referral experiences were collected through a pre-tested questionnaire and analyzed using descriptive statistics and logistic regression. Ethical approval was obtained, and informed consent was secured.

It found that only 7.4% of patients received referrals from their primary healthcare sources, mostly from patent medicine vendors, private clinics, and primary healthcare (PHC) centres to private clinics and laboratories. Verbal referrals were the dominant modality, although the types of referrals varied significantly between facilities that initiated referrals and between states.

This paper highlights the need for innovative solutions to integrate informal healthcare providers into the formal system, improving referrals and enhancing health services in urban slums.