9. Patient Referral to Secondary and Tertiary Health Care Levels

This chapter addresses the conditions for which a patient in a rural health center can be diagnosed or treated locally or has to be sent to a higher care level institution, and reviews the minimum knowledge health practitioners must have to arrive at such a decision, aided by medical imaging. Emphasis is placed on the importance of primary health care, where the majority of diseases can be prevented and diagnosed, and on the need of having services among the three or four health care levels well coordinated and interrelated. To ensure smooth referral and counter referral processes and guarantee continuity of care for patients who require it, functional links between centers of differing degrees of complexity must be clearly established. Recommendations regarding patient referral in resource-poor settings and an example of a system that functions very well in an industrialized country are presented and discussed.