I. Problem Statement
The effectiveness of Bangladesh's tiered public health system—from Upazila Health Complexes (UHCs) to specialized tertiary hospitals—is significantly limited by weaknesses in referral management and data collection. The current referral process mainly depends on paper forms that are inconsistently filled out, poorly stored, and rarely compiled for systemic review. As a result, the referral pathway does not effectively regulate patient movement, leading to congestion at tertiary facilities, inefficient use of resources, and limited national-level visibility of service gaps.
1.1. Quantifying the Problem
The shortcomings of the current paper-based referral mechanism are reflected in widespread bypassing of the formal health system and significant data loss:
Widespread Bypass: An estimated 56% of patients arriving at government tertiary facilities, such as Dhaka Medical College Hospital, are self-referred, bypassing the formal referral system. This practice fills specialized centers with cases that could have been treated at lower levels.
Institutional Failure Drivers: Even when formal institutional referrals happen, they are often caused by system gaps. The main reasons given for referral include inadequate facilities to treat the patient (53%) and lack of expert physicians (31%) at the referring facility. These findings reflect long-standing human resource and infrastructure constraints within Bangladesh's public health system.
Data Loss and Quality Deficit: Paper referral documents are often incomplete, illegible, or lost during patient transfer, resulting in fragmented clinical information at receiving hospitals. The absence of standardized, digitized referral data prevents the Directorate General of Health Services (DGHS) and the Ministry of Health and Family Welfare (MoHFW) from obtaining real-time, aggregated insights required for national planning, epidemiological surveillance, and accountability.
This systemic documentation failure is further compounded by the low incentive for lower-level doctors and nurses to manually fill out extensive paper forms, which the proposed solution seeks to eliminate.
