The primary health-care system does not operate in isolation. It is part of a larger system involving other services and sectors, and so can be considered as the gateway to the wider health system. Through assessment and referral, individuals are directed from one primary care service to another, and from primary services into secondary and other health services, and back again.Secondary care is medical care provided by a specialist or facility upon referral by a primary care physician (Nicholson 2012). It includes services provided by hospitals and specialist medical practices