Number of people provided with referrals for services in the past three months

How to use this indicator

Referral is an essential component of any community-based HIV program, whether it serves the general population, vulnerable children and their families, or key populations. Health and social service systems rely on community workers to ensure that individuals at risk of acquiring HIV (or in need of treatment, care, or support services) are linked to services as soon as possible. Timely referral and linkage to care are crucial factors in HIV prevention, treatment, and care, and are important parts of ensuring nationwide access and equity to those living with and affected by HIV, as well as those with a serious risk of acquiring HIV. These individuals require a wide range of comprehensive care and support services and need to know where they can receive services when necessary. This indicator verifies the existence of a referral system, but it also provides details on the demand of services in line with their supply.

Numerator

Number of adults and children who received a referral for a service of any kind during the reporting period from a community worker

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

Community-based organizations and community workers can collaborate with providers of care and support to ensure that individuals are linked to care and receive services according to their needs. Community workers can refer beneficiaries to the following services:

Health services (health facility, clinic, mobile unit, or drop-in center)

• HIV testing and counseling
• Sexually transmitted infection screening, prevention, and treatment
• Antiretroviral therapy
• Prevention, diagnosis, and treatment of tuberculosis
• Screening and vaccination for viral hepatitis
• Reproductive health (family planning, prevention of mother-to-child transmission)
• Medication-assisted therapy
• Needle syringe program
• Post-violence care

Psychological services (health facility, clinic, drop-in center, commmunity-based organization [CBO], nongovernmental organization [NGO], or faith-based organization [FBO]):

• Emotional support and follow-up counseling
• Support groups and/or post-test clubs for people living with HIV/AIDS, people affected by HIV/AIDS, spiritual support groups
• Post-violence counseling

Legal support services (NGO, CBO, FBO, legal agency, probation office, police, local authorities, social institutions, or health facility):

• Child or adult protection services (protection against violence, abuse, exploitation, or trafficking)
• Protection of succession rights
• Training and orientation on protection of the child
• Inheritance support
• Will writing support
• Removal from dangerous situations
• Assistance to report child abuse and neglect
• Assistance to resolve child abuse and neglect cases
• Fostering and adoption
• Child rights education
• Vital registration
• Succession planning (making of a will and memory book)
• Education of individual on legal rights
• Post-violence clinical services
• Legal counsel
• Police services
• Psychosocial support for sexual, physical, and/or emotional violence

Nutrition services (school, health facility, NGO, CBO, and FBO):

• Nutrition assessment, counseling, and support
• Food and nutritional supplements
• Nutrition education

Socioeconomic strengthening services (NGO, CBO, and FBO):

• Cash transfer (conditional/nonconditional)
• Vocational/business skills training
• Loan
• Bond
• Savings group
• Credit
• Microfinance
• Apprenticeship
• Business incentives
• Income generation in cash or kind (agricultural inputs)
• Material or financial support for shelter
• Other form of economic support

Education services (school, CBO, NGO, and FBO):

• School feeding
• Take home ration cards
• Contribution to school materials
• School registration and tuition support
• Contribution to expenses related to schooling
• School supervision
• School reinforcement
• Moral support: support for resolution of relationship problems
• Death management assistance

Data will be collected from community workers who track the number of referrals that they make during the reporting period. Community workers can provide detail to the service delivery point on the individuals to be expected, and details on their vulnerabilities, especially if they are at high risk of acquiring HIV or are living with HIV. Community workers should coordinate with the service delivery point to confirm in person or via phone, text message, or mobile app that the referral was completed (see the completed referral indicator defined here).

Community workers should provide beneficiaries with referral forms that they can keep so that they are aware of the name and details of the service delivery point, including the service that they are being referred for. Community workers may collect sensitive information, but information that could lead to disclosure of HIV or sexually transmitted infection status should not be indicated on the referral form given to the client.

It is also recommended that beneficiaries be provided with referral by text or mobile application, if they have their own phone. These methods are considered more dependable, because paper forms can be easily damaged or lost. Text alerts can also be a dependable mechanism to follow up with individuals who have not completed their referrals. Tracking completed referral tends to be extremely difficult for national programs and national health management information systems. It is advised to use some sort of technology that allows for tracking of referrals. Some projects are piloting electronic referral systems that allow data of completed referrals to be sent back to the community health worker (CHW) via text, whereby the information about referral completion is stored in the national health information system.

Data source

Vulnerable children, key population, and HIV programs all rely on their community workers engaged in supporting beneficiaries at the community level to track this information. The following types of forms usually include this information: service provision tools, graduation checklists, vulnerable children service forms, caregiver/household head service forms, referral forms for vulnerable households, sensitization activity forms, people living with HIV support activity forms, HIV activity reports for community organizations, CHW reports, and outreach peer calendars, among others.

Disaggregation

• Age (<1 year, 1–4 years, 5–9 years, 10–14 years, and 15–17 years for children; 18–24 years, 25–49 years, and 50+ years for adults)
• Sex
• Pregnancy/lactation status
• Key population type (sex workers, men who have sex with men, people who inject drugs, transgender people)
• Type of service (see list by category above)
• HIV status

Some countries aggregate the counts of referrals based on the category of services provided, and this could be an alternative to tracking referral to all types of services, especially if community workers are trained on where the services fall in each category. 

Data quality considerations

Although this indicator can be used to look at the quantity of referrals from the community level, it cannot be used to determine whether referrals were completed during the reporting period—whether people follow through on the referral and receive the service at the service delivery point. This indicator also does not indicate the quality of the referral or whether it was provided in a timely manner, with complete information per country guidance, or to the appropriate and most accessible service delivery point for the client. Double counting should be avoided, such as of people receiving referrals more than once or from numerous sources.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Referral

Category

Vulnerable Children, Key Populations, Prevention of Mother-to-Child Transmission, Home-Based Care, HIV Prevention

References

National AIDS programmes. (2004). A guide to monitoring and evaluating HIV/AIDS care and support (Rep.). (2004). Geneva, Switzerland: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/42895/9241591439.pdf;jsessionid=10A5A38CBC9163B77825FA9D6022970D?sequence=1

Tumilowicz, A. (2010). Guide to screening for food and nutrition services among adolescents and adults living with HIV. Washington, DC: Food and Nutrition Technical Assistance II Project (FANTA-2), Academy for Educational Development. Retrieved from https://www.fantaproject.org/sites/default/files/resources/Nutrition_Interventions_Screening_Guide_Final.pdf