Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh

Abstract

Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare providers, and government personnel, document reviews and meeting observations were used in analysis. Results The study showed that participants were enthusiastic and willing to take part in the CSC intervention. They perceived CSC to be useful in raising awareness about health in the community and facilitating structured monitoring of CC services. The process facilitated building stronger community ownership, enhancing accountability and stakeholder engagement. The participants identified issues around service provision, set SMART (specific, measurable, attainable, relevant and time-bound) targets and indicators on supplies, operations, logistics, environment, and patient satisfaction through CSC. However, some systematic and operational challenges of implementation were identified including time and resource constraint, understanding and facilitation of CSC, provider-user conflict, political influence, and lack of central level monitoring. Conclusion The findings suggest that CSC is a feasible and acceptable tool to engage community and healthcare providers in monitoring and managing health facilities. For countries with health systems faced with challenges around accountability, quality and coverage, CSC has the potential to improve community level health-service delivery. The findings are intended to inform program implementers, donors and other stakeholders about context, mechanisms, outcomes and challenges of CSC implementation in Bangladesh and other developing countries. However, proper contextualization, institutional capacity building and policy integration will be critical in establishing effectiveness of CSC at scale.

Participatory approaches in primary health care related implementation research in low-and middle-income countries: A narrative review

“…Description of studies: All the articles were published between 2002 and 2021. Two studies were RCTs [ 17 , 18 ], five were qualitative in design [ [19] , [20] , [21] , [22] , [23] ], three were quasi-experimental [ [24] , [25] , [26] ] two were cross-sectional studies [ 27 , 28 ], and one was program implementation [ 29 ]. Almost all the studies were in the African region (four studies in South Africa, two in Ghana, and one study in Sudan, Nigeria, Malawi, Tanzania, and Burkina Faso, and DRC each) and, only two were from South Asia (Bangladesh, Pakistan).…”

Influence of community dialogues on social accountability in the health system in Nairobi County, Kenya

“…Unlike debates, community dialogues emphasized listening to deepen understanding, the development of common goals, and the expression of participants' opinions on courses of action. 19 The frequency of holding community dialogue is important however, the quality of these forums need to be emphasised.…”

“…25 To achieve a successful community dialogue, studies have recommended a more balanced representation of stakeholders in this forums, including adolescents and consideration of issues of power differentials related to age, profession, and gender. 19,20,26 In addition, meaningful community dialogue forums require use of powerful tools such as community scorecards, citizen report cards, and chalkboards. 14,19,20 However, this study lacked evidence on the use of such tools in the study sites.…”

“…19,20,26 In addition, meaningful community dialogue forums require use of powerful tools such as community scorecards, citizen report cards, and chalkboards. 14,19,20 However, this study lacked evidence on the use of such tools in the study sites.…”

The use of legal empowerment to improve access to quality health services: a scoping review

“…Legal empowerment is closely allied to several other approaches to social justice including social accountability, social inclusion, human rights advocacy and strategic litigation [ 24 , 25 ]. The closest, social accountability, has been widely used in the health sector, for example through the use of community scorecards or community monitoring [ 26 , 27 ]. These strategies rely on people leading a collective effort to claim accountability for the provision of public goods that are existing state obligations, and tackling some of the structural constraints to service provision.…”