OBJECTIVES: Kenya’s health sector is faced with challenges of coping with demand for care. As part of its strategy of taking essential package for health to citizens, its envisioned that level one be linked to healthcare system.   The purpose of this study was to train CHWs on how to use referral tools to link households to hospitals. The CHWs indicated reasons for referral which was delivered to clinicians at the hospitals.METHODS: Quasi -experimental study was carried out in two sub- locations in rural Kenya where one hundred CHWs were trained on community-based-referral and counter-referral model and issued with referral tools. Each was assigned 25 households, instructed to regularly visit them in order to identify sick persons counsel and refer them to link hospitals. One hundred villages comprising 2209 households with a population of 11,000 people were covered where the referral model was implemented. Tally sheets were used to categorize referral recommendations.RESULTS: The referral recommendations made by CHWs were categorized into seven themes.  In total 168 recommendations were made on the referral slips, where every CHW made at least 1 to 2 recommendations. The study indicated that referral recommendations made for health check up accounted for 33% (55/168), referral to attend ANC clinic 16% (27/168), referral for TB and malaria treatment 18% (30/168), referral for U5 treatment 11% (19/168), referral for delivery 10% (17/168) while referral for immunization/growth monitoring and PNC clinic attendance accounted for 6% (10/168) respectively.CONCLUSIONS: It was observed that recommendations made by CHWs on the referral forms served as a link between them and clinicians at hospitals. The households felt connected to hospitals simply by delivering the referral forms bearing CHWs comments which clinicians acted upon. It is concluded that in order to ensure continuum of care from level one to dispensary ,use of referral tools should be encouraged.