Table 4 Themes and sub-themes from thematic content analysis of responses

Themes and Sub-themes

 Transportation barriers inhibiting effective referrals

  Long distances

  Poor road networks

  Lack of appropriate transportation

 Communication barriers inhibiting effective referrals

  Phone unavailable or not answered at receiving facility

  Non-clinical contact at receiving facility

  No feedback from receiving facility

 Referral protocol and guideline failure

  Absence of protocol or guideline

  Lack of training on referral processes

 Family refusal for newborn referrals

  Fear of the unknown

  Low expectations for referral outcome

  Referral refusal due to financial constraints