The functions of reference hospitals may be broadly categorized into; the direct clinical services provided to individual patients and the community within the hospital, and other set of broader functions only indirectly related to patient care.

A country with proper and adequate medical care services should have enough reference hospitals so as to offer wide range of services to the society.

Likewise in Rwanda, there is need increase on the number of reference hospitals and equip them with medical instruments required for the treatment of people.

Currently we King Faisal hospital, Butare university teaching hospital (CHUB) and Kigali university teaching hospital (CHUK) as the main reference hospitals in the country.

The trio is regarded as the best medical centers that offer a variety of medical services but they still need a lot of effort to improve on their medical services.

People have always complained of poor medical services rendered to them from our main hospitalization centers but this is because our hospitals still lack enough medical experts and enough equipment for usage.

The ration of doctors to patients in the country is very low, medical equipments are also not enough compared to the number of patients who are required to use them and some hospitals like CHUK lack enough rooms for their patients.

This is why the surgery department and internal medicine department of the Kigali teaching hospital is ever congested with patients suffering from a wide range of diseases.

At CHUK, many patients from the north, East and some times western part of the country are transferred to the oldest and most famous hospital in the country (CHUK).

King Faisal does not get the same number of cases as CHUK because many patients cannot afford their ward hospitalization bills and on addition the rates at which medical services are rendered in King Faisal are higher than that at Kigali central hospital (CHUK).

Butare University hospital handles all urgent and major medical cases from the Southern part of the country and this is why it currently offers better and quick services as compared to the Kigali central or teaching hospital.

However, some departments’ lat Butare hospital have been hit by low number of medical specialist simply because most of them have preferred to work in town.

The number of general medical practitioners at CHUB is higher than any hospital in the country due to the fact that it has a direct link with the faculty of medicine and recruits newly graduated doctors very easily.

The primary function of the reference hospitals is to provide complex clinical care to patients that can be reffered from lower to higher levels. It is important to understand however, that there are no agreed international standards with specific services provided in secondary or tertiary hospitals in developing countries.

The exact range of services offered tends to vary substantially even between tertiary hospitals within the same country due to various historical backgrounds and economic status of the hospital location.

Today, the ministry of health is trying to improve the quality and accessibility of reference hospital services through development plans that will try to ensure that hospitals at each level move toward providing a comprehensive set of clinical services.

The ministry should first of all develop a target for services at various levels of clinical services ranging from tertiary hospitals in sectors, secondary hospitals in district and the reference hospitals at the national level.

If clinical hospitals at Tertiary and secondary level are equipped with enough medical equipments and expertise, I think reference hospitals will get optimum space for work.
Referral hospitals may perform a number of functions that provide the level of population health benefits through direct involvement in public health interventions.

For example responding to the problem of HIV/AIDS epidemic, hospitals can create and heighten the awareness of reducing the incidence of occurrence and increase the prevention of the disease outbreaks.

Today, reference hospitals in Rwanda have scaled up services to prevent mother to child transmission and initiates the follow-up of mothers and babies from clinics, which is a good follow up for our medical health services.

Today reference hospitals acts as focal point and proof for disease control and specific health promotion as well as education on health activities. Patients do not only get treated at the hospital but also get advice on how to make their own health supervision and follow-up.

The Prevention of mother to child AIDS transmission has acted as a good proof for improved health services rendered by our hospitals though the program is still a complex one to integrate in all health clinics around the country. 
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