Table 3.

Effective referral systems

Question	No of studies	Evidence synthesis	Quality
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]