Table 3 Effective referral systems

Which methods of working ensure effective referral?

n = 2

There is confusion between healthcare worker roles, particularly between midwives and physicians, which may impact on the effectiveness of referral.

The partograph is not always used as a communication tool between health workers at handover of care or referral.

Partograph findings are not always acted upon.

*V low [29, 32]

What are the issues or barriers related to effective referral?

n = 10

The partograph is a trigger for referral. However, there is some inconsistency in referrals based on partograph findings.

It is unclear if referrals made as a result of partograph use are appropriate.

There was little evidence of additional barriers to transfer, e.g., transport, cost etc.

**Low [23, 36, 38]

*V low [20, 28, 29, 31, 32, 37, 39]