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The report is a tool to help national and district-level managers quickly assess the status of and constraints to referral of severely ill children from first-level care to secondary and tertiary levels of care. The assessment uses a cross-sectional study design that includes a review of medical records, interviews with caretakers of children less than five years of age, interviews with health providers, and focus group discussions with caretakers. Prevalence estimates describe referral care patterns of caretakers and providers, referral and counter-referral relationships, frequency of self-referral to higher levels of care, caretaker barriers to compliance with referral, and provider barriers to compliance with referral guidelines. Assessment results are for use by Ministries of Health and other partners to design national- and district-level interventions to improve the successful referral of severely ill children.