EXECUTIVE SUMMARY
Within the humanitarian response in Lebanon there is growing recognition that strengthening multi-sector referral systems and pathways is fundamental to increasing the effectiveness of the response and enhancing accountability to people of concern.
Within the response there are several sector level referral tools supporting manual referral systems. However, there remains a gap in common systems and tools to facilitate multi-sector referrals with many sectors and individual organisations manually and inconsistently tracking referrals.
The Referral Information Management System (RIMS) provides organisations with a common platform to facilitate, track, follow-up and monitor referrals and extract referral data across sectors. The analysis that can be derived from referral data can provide valuable insights into understanding the drivers of effectiveness of referrals, and thus support the identification of evidence-based solutions to gaps and bottlenecks in referrals and subsequent service provision.
To analyse effectiveness and accountability within referral pathways, data from RIMS between September 2018 and February 2019 has been analysed to better understand where and how effectiveness of multi-sector referrals is positively and negatively influenced using speed, timeliness and accuracy as indicators.
RIMS was developed in 2017 and initially piloted across five organisations. In 2019, RIMS is expected to be used by 24 organisations. This report has been developed by DRC and will be followed by additional thematic reports diving into some of the initial findings stated here.
Another further two general analytical reports such as this will be produced over 2019.
Summary of key findings and recommendations
• Ensuring accurate and coordinated documentation of referrals using common indicators for measurement enables analysis of how to continue to increase the effectiveness of referrals: Using data to generate evidence on where and how effectiveness within referral pathways can be gained, and indeed how it is undermined, enables an evidence-based targeted approach to strengthen multisector referral pathways. It would be beneficial for coordination bodies to look at using the common indicators of speed, timeliness and accuracy to define and analyse the effectiveness of multi-sectors referrals to enable concerted efforts towards improving cross-sector referrals.
• Using internal accountability mechanisms appears to positively impact referral effectiveness: Within individual organisations, ensuring consistent monitoring of referrals at individual user and management levels is in and of itself central to enhancing accountability around referrals and ultimately, improving the effectiveness of referral pathways, as shown through referral data between RIMS users.
• Child Protection bottlenecks: Bottlenecks identified in Child Protection case management, particularly in the Bekaa, indicate a gap in coverage of service availability as compared to other sectors. This finding needs further consultation with the relevant sector coordination representatives as well as Child Protection actors to determine appropriate recommendations.
• Challenges with the accuracy of referrals: There is a clear gap in effectiveness of referral pathways in the area of referral accuracy. Accuracy of referrals is measured through the percentage of referrals that were ‘Not-Eligible’ compared to those that were ‘Successfully Closed/Accepted’ or ‘No Service Delivered’. There is a need for more concerted and streamlined efforts across sector coordination to map eligibility requirements across services.
• Cross-agency referral coordination appears to have a positive impact on the effectiveness of referrals: Using data from RIMS as a baseline, referrals made after cross organisation referral coordination efforts can be measured for effectiveness as it relates to speed, timeliness and accuracy. As such it is possible to determine how to design components of cross organisation coordination efforts to impact different indicators of effectiveness. RIMS data can additionally support individual organisations to target which sectors and which other organisations to coordinate with based on their own historical referral data.
• RIMS system usage appears to positively impact effectiveness: Initial findings have shown that referrals between RIMS-users are more effective than referrals between RIMS users and non-RIMS users. This point of analysis will require further monitoring of a larger dataset from a wider net of organisations gathered through RIMS.
• Distinguishing between redirections and referrals is important to improve effectiveness within referral pathways: Ensuring that those who are responsible for referrals are appropriately trained to carry out technical assessments is essential for improving the overall effectiveness of referrals, specifically in terms of accuracy, as well as ensuring appropriate confidentiality for individual beneficiaries. RIMS recommends that a distinction is made between the role of those redirecting information (such as staff working on helpdesks or hotlines) and those making referrals.
• The use of referral targets appears to positively influence the volume of referrals: The use of referral targets as typically seen within the protection sector appears to positively impact the volume of referrals. Sector coordination and humanitarian organisations could determine appropriate approaches to introduce referral targets across non-protection sectors to increase the practice and volume of cross sector referrals.
• Referral capacity and emergency response planning: Findings indicated that during the emergency flood response in early 2019 referrals increased significantly but the overall duration of these referrals was slower than those in other months analysed. Further analysis supported by qualitative data collection methods should be conducted to develop a better understanding on how best to target referral capacity within disaster preparedness planning.
• Response coordination: Throughout the analysis it is evident that response coordination plays a significant role in influencing the effectiveness of referral pathway as seen when comparing coordination approaches in northern Lebanon and the Bekaa. Further analysis and additional consultation is required to identify which specific aspects of coordination can positively influence referral pathways.