The Referral Systems Assessment and Monitoring (RSAM) Toolkit was developed to assist health and program managers in obtaining and using information regarding the performance of referral systems. These systems play an increasingly important role in the health systems of developing countries as result of the recent impetus toward service integration. Regular assessment and monitoring of referral systems should aim to assure that the underlying processes are functioning properly, that providers are linking clients to the services they need, and that clients are able to access a comprehensive package of health and related services. The RSAM Toolkit consists of a series of tools that can be used as is or adapted to the specific design and purpose of the referral system in question. The toolkit provides clear, step-by-step instructions to assist managers in deciding which component to implement; which tools to use; how to adapt the tools; how to use the tools for data collection; and how to analyze, interpret, and use the information generated.