There are many reasons why a referral doesn't happen at all or does not happen in time, including the following:

• Lack of proper counselling to the mother, father and other caregivers, so they don't realise how serious the problem is.
• Far distance and lack of means of transportation to the health facility.
• The family has not saved the financial resources to make the journey.
• Health facilities are not attractive to some patients. Often they don't have proper supplies of essential medicines and equipment, or they lack the correctly trained person for the service required. Hence, due to the poor reputation of some health facilities, parents may be reluctant to go to them.