A patient's needs and the seriousness of the disease are not the only factors that determine referral to the hospital. Healthcare managers constantly refer patients due to lack of professionals within their geographical location, leading to potential medical consequences for the patient, and increasing healthcare expenditure. In Kenya, understaffing in rural primary care facilities is particularly acute - where the doctor population ratio in rural areas is 1:33,000 compared to 1:1,700 in urban areas.
