Background
The Ministry of Health convened a national consultation on 19 June 2026 at the National Maternal and Child Health Center to discuss adoption of a color-coded pregnancy risk record and associated referral protocols. The Ministry of Health issues clinical guidance for maternal and neonatal care and coordinates referral pathways across health centers, district and provincial hospitals, and national referral hospitals.
The consultation presented a three-tier color classification—red, orange and green—to align clinical risk assessment with clear referral actions and receiving-facility expectations. A color-coded risk classification assigns priority levels to pregnant women and specifies referral timing and destination based on assessed clinical risk; the consultation also recommended strengthening pre-referral SBAR communication, facility-level monitoring teams, and continuous training for frontline staff.
Key Developments
Participants included leadership from eight national hospitals, national maternal and child health centers, provincial maternal and child health departments, district health office chiefs, hospital directors, health center chiefs, and training program staff. The meeting reported total participation of 2,300 people, with 30 attending in person and 2,270 joining remotely.
The working group set out operational definitions used during the session: red indicates highest-risk pregnancies requiring immediate transfer to national or CPA3-level provincial hospitals without delay; orange indicates medium risk requiring transfer to district or provincial hospitals with appropriate specialist capacity; and green indicates low or no immediate risk where care and delivery may continue at health centers under close follow-up. The session produced three primary recommendations: (1) create monitoring and evaluation teams at municipal and provincial hospitals to track implementation at health centers; (2) standardize pre-referral SBAR communication to clarify receiving-facility readiness; and (3) expand in-service training and dissemination of clinical guidance on antenatal risk screening.
Institutional Role
The Ministry of Health was identified as the coordinating authority to promote system adoption across facility levels and to support training and dissemination through national programs and training centers. Provincial and municipal hospitals were recommended to establish teams responsible for ongoing monitoring, evaluation, and coordination with referral sites and referring health centers.
Operational Implications
Health centers and frontline providers are advised to integrate the color-coded pregnancy record into routine antenatal screening, to follow the specified referral destinations for each color code, and to use pre-referral SBAR communication to notify receiving facilities. Hospitals receiving referrals are advised to clarify reception capacity in advance and prepare to accept patients according to the designated urgency levels associated with each color code.
