Effective, accountable and coordinated referral pathways are essential for improved referrals management between service providers and better, more holistic service delivery to persons of concern, particularly, in the context of an unstable funding landscapes which results in regular interruption/resumption of services and an unpredictable political and economic situation in Lebanon which affects vulnerable communities and service provision. In this report, strengthening of referral pathways and processes continues to be a major priority in order to better connect services, as well as clear divisions of responsibilities between agencies to ensure accountability to persons of concern is in service delivery. Further, more in depth understanding the reasons behind lack of response and follow up from receiving agency, inaccurate referrals, discrepancy between accepted referrals and actual service provision is essential to improve referrals effectiveness and ultimate gaps and challenges in service provision.
Quantitative data analysis of the Referral Information Management System (RIMS) created by DRC in 2017 to enable organisations in Lebanon to coordinate and manage referrals across sectors., as well as Focus Group Discussions conducted by service providers across Lebanon providing a wide range of services, allows to identify those gaps, challenges and bottlenecks in referrals, and provides recommendations to improve referrals effectiveness and accountability. These recommendations feed into discussions with inter-agency actors to review referral procedures and processes across Lebanon for improved coordinator of multi-sector service provision.
In this report, RIMS data from July to October 2019 has been analysed to better comprehend the factors that influence multi-sector referrals using speed, timeliness, and accuracy as indicators, and assess the effectiveness of referral pathways.
This report has been developed by the RIMS team and complements RIMS Snapshots produced every four months demonstrating trends in referrals. Another analytical report will be published in March 2020 to build upon key findings found in referral data and continue to provide evidence-based recommendations to inform referral management and effectiveness.
Summary of Key Findings and Recommendations
• Referrals significantly increased during the reporting period, particularly to WASH,
Livelihoods and Protection, potentially due to more active RIMS partners conducting referrals on RIMS, reported increases in movement restrictions on Syrian refugees driving an increase in needs, and better coordination efforts on behalf of partners organisations, therefore increasing referral and strengthening referral pathways.
• Most referrals are conducted in districts with most Syrian refugees registered with UNHCR, however presence of services, socio-economic and contextual factors, and capacity for referrals management also influence the number of referrals conducted in each district and therefore, access to services.
• Being in direct contact with aid workers of technical expertise, also known as selfreferrals, shows persons of concern are more likely to receive the service.
Trainings on safe identification and referrals is essential for all individuals in contact or potential contact with persons of concern, including community focal points who often play a role in the referral process by referring persons of concern to service providers.
• Discrepancy and gaps were identified in the inter-agency service mapping, which calls for an improved cross-sector service mapping exercise, bringing together regularly updated information of services providers across all sectors in each district of Lebanon, with detailed information on eligibility criteria, and clear focal points for referrals.
• Gaps in referrals management were also identified in certain districts and for certain sectors, however, it is essential that organisations within each sector appoint enough individuals to manage referrals with a wide area of coverage, regardless of their actual areas of operation, in order to facilitate access to services nation-wide and for all sectors.
• Gaps in service provision interrupt referral pathways and affect service provision, as demonstrates the temporary gap in shelter services in July and August in the North, which affected the number and efficiency of referrals to shelter. With frequent interruption/resumption of services due to changes in the funding landscape, it is important to establish clear referral processes between organisations, with back up agencies who can step in to manage the referral and provide the service should other agencies reach their targets or temporarily suspend their operations, in order to mitigate these operational challenges.
• Effectiveness of referrals slightly decreased during the reporting period in terms of speed, timeliness and accuracy of referrals, however, response to referrals significantly improved. Timely follow up and service delivery continues to be challenging due to many factors such as prioritization of cases, gaps in services, achieved targets by organisations, and beneficiairies’ response to services.
• The most common reason cited for Not Eligible referrals is differences in assessments of protection risks by different agencies, as well as sending the referral to the wrong sector/sub-sector, which demonstrates the importance of clarifying protection risks and eligibility criteria amongst protection actors, and with non-protection actors in order to improve the accuracy of referrals.
• Referrals that are ultimately declined (No Service Delivered/Not Eligible) take the longest time to receive this final status, as service providers focus on updating the status of the referrals that they will Accept. This significantly lengthens the time of the referral process for persons of concern whose referral is declined, and therefore of timely service provision. Individuals managing referrals need to respond and follow up to all referrals in a timely manner, in order to ensure timely re-referrals and service provision.
• Only half of the Accepted referrals are Successfully Closed, demonstrating a significant gap in service delivery. While a variety of factors explain this gap, it is essential that organisations mitigate the factors which they have control over to ensure that the service is actually provided, and re-refer the person in a timely manner if the service cannot be delivered. Similarly, inter-agency tools should clarify the difference between Accepted and Successfully Closed statuses, for more accurate feedback on referrals and improved accountability to service providers and persons of concern.
• Access to services is partly reduced with less referrals conducted in times of crisis, and a higher proportion of referrals declined by the receiving agency or with No Feedback Received, which requires for coordination agencies to develop contingency referral processes based on the service providers still providing services during times of crisis, in order to ensure continuity in service provision.
• Referrals and service provision is significantly influenced by the quality of services and the behavior of the persons of concern, which demonstrates the importance of proper feedback and complaints mechanism to review the quality of services provided.