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We conducted a phenomenological and participatory analytical study, for the period 2012 to 2017. Data were collected through semi-structured interviews with members of community participation bodies on their involvement in the referral system and against in Bwamanda. Quantitative data were collected through document review. Community participation was assessed according to Rifkin's model, which showed community involvement in identifying the referral system as a felt need. Positive results on service demand and supply at the health zone level were observed. These include: an improvement in the rate of service utilization at the frontline level from 14.7% in 2012 to 44.4% in 2017; maintenance of the referral rate at 5% CI: {5.4 - 5.7}; improvement in the rate of completed referrals from 62% CI: {62.5-64.8} to 90% CI: {89.4- 91.2}; improvement in counter-referrals from 38% CI: {37.5-39.2} to 78.2% CI: {77.7 - 78.7}. A reduction in maternal mortality of 627/100,000 NC.
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