Table 2 Barriers perceived to influence completion of referral for hypertension in western Kenya

Demand side factors

 Cost related factors

  Lack of money for treatment cost

x

x

x

  Lack of money and means for transport or fare

x

x

x

  Lack of money to buy medicines

x

x

x

 Referral knowledge

  Ignorance on importance of referrals

x

  Misconception about referral and referral facilities

x

  Challenges in navigating the referral facility

x

  Fear that referral signaled a poor prognosis

x

Supply side factors

 Facility accessibility

  Long distance to the referral facility

x

x

x

  Poor road infrastructure

x

x

x

  Bad weather conditions

x

x

x

  Lack of ambulance for transport

x

 Service Cost & Availability

  Long waiting hours before being attended to

x

x

x

  Lack of specialized clinics for hypertension

x

  Expensive cost of treatment and investigations

x

x

x

  Lack of specialized health providers

x

x

  Shortage of health providers

x

x

  Lack of medicines for hypertension in the health facility

x

x

x

 Referral Management

  Lack of proper protocol and tools for referrals

x

  Lack of proper explanation on the need for the referral

x

  Poor communication with the referral facility

x

  Unwillingness of referral facilities to accept referrals

x

  Lack of a written letter for referral

x