Referral to hospital in Nepal: 4 years' experience in one rural district

Formal referral systems have been proposed as a strategy to improve access to secondary care, yet their implementation can be problematic. This paper describes data from referrals in one rural district in Nepal over a four year period. Whilst the characteristics of those patients attending hospital after referral were similar to those described in other developing countries, the rate (1.0 per 1,000 population per year) is much lower, especially when compared to estimated need. Geographical and other barriers to access to secondary care in rural Nepal are discussed.