Referral system
In TMK, referrals are common due to primary facilities lacking equipment and skilled personnel. Most residents avoid referrals due to financial constraints and transportation barriers. The present lack of transportation facilities incurs significant financial burden on residents, resulting in most refusing referrals despite the need for specialist care which is unavailable in majority of the villages.
Some community members and health workers also discussed communication constraints and the attitude of doctors as a hindrance in the success of referrals.

According to the local community, this system can be improved by providing free transport and consultations for referred patients. Better communication between the patient and health facilities involved, via computerization of the referral system, is required. Most importantly, there is an urgent need to equip health facilities in TMK to deal with emergencies, which will reduce referral rates and enable people to receive treatment at lower costs from nearby facilities.