Existing guidelines on the referral protocol system in the state for referring cases from secondary- to tertiary-level institutions (district hospitals, general hospitals, medical college hospitals, and other specialty institutions) were initially developed against the backdrop of the need for a well-organised referral system in Kerala. Healthcare institutions at the primary, secondary, and tertiary levels of care across the state, however, vary in terms of their infrastructure, availability of equipment, and human resources. There was a need for these existing guidelines for referring cases to higher-level institutions to be further contextualised and made applicable to the realities of service delivery in the state.

In the previous financial year onwards SHSRC-Kerala was entrusted with the responsibility of drafting the revised guidelines catering to the needs of the state. Efforts were undertaken to categories healthcare institutions, in terms of their infrastructure, the availability of human resources and other diagnostic services for the ease of physicians to refer and receive referrals of their patients. These guidelines were aimed to benefit health professionals working within the health system and improve patient health outcomes.

To draft these revised referral guidelines, state-level workshops and the formation of expert committees were undertaken. Revisions were made and forwarded to the Directorate of Health Services and the Directorate of Medical Education for review and suggestions.

At the beginning of this financial year, the referral protocol underwent several unofficial revisions following its submission to the Directorate of Health Services and the Directorate of Medical Education. These changes were made through a series of online and offline meetings and discussions. After extensive vetting, a final vetting workshop was conducted at SHSRC-Kerala Hall 1, where the referral protocol was finalized.