Influence of community scorecards on maternal and newborn health service delivery and utilization

Abstract

Introduction The community score card (CSC) is a participatory monitoring and evaluation tool that has been employed to strengthen the mutual accountability of health system and community actors. In this paper we describe the influence of the CSC on selected maternal and newborn service delivery and utilization indicators. Methods This was a mixed methods study that used both quantitative and qualitative data collection methods. It was implemented in five sub-counties and one town council in Kibuku district in Uganda. Data was collected through 17 key informant interviews and 10 focus group discussions as well as CSC scoring and stakeholder meeting reports. The repeated measures ANOVA test was used to test for statistical significance. Qualitative data was analyzed manually using content analysis. The analysis about the change pathways was guided by the Wild and Harris dimensions of change framework. Results There was an overall improvement in the common indicators across sub-counties in the project area between the 1st and 5th round scores. Almost all the red scores had changed to green or yellow by round five except for availability of drugs and mothers attending Antenatal care (ANC) in the first trimester. There were statistically significant differences in mean scores for men escorting their wives for ante natal care (ANC) (F(4,20) = 5.45, P = 0.01), availability of midwives (F(4,16) =5.77, P < 0.01), availability of delivery beds (F(4,12) =9.00, P < 0.01) and mothers delivering from traditional birth attendants (TBAs), F(4,16) = 3.86, p = 0.02). The qualitative findings suggest that strengthening of citizens’ demand, availability of resources through collaborative problem solving, increased awareness about targeted maternal health services and increased top down performance pressure contributed to positive changes as perceived by community members and their leaders. Conclusions and recommendations The community score cards created opportunities for community leaders and communities to work together to identify innovative ways of dealing with the health service delivery and utilization challenges that they face. Local leaders should encourage the availability of safe spaces for dialogue between communities, health workers and leaders where performance and utilization challenges can be identified and solutions proposed and implemented jointly.

Facilitators for and Barriers to the Implementation of Performance Accountability Mechanisms for Quality Improvement in the Delivery of Maternal Health Services in a District Hospital in Pwani Region, Tanzania

“…This finding implies that in the past experiences of using a paper-based system for recording keeping, there were setbacks such as incomplete data, which was resolved with the installation of HMIS. The study by Mboera [24] supports this finding by showing the importance of using HMIS when comparing performance in health service coverage and monitoring trends such as maternal mortality trends. It also shows that the presence of HMIS at a facility supports the systematic receiving and reporting of feedback and enhanced quality reports.…”

“…Studies exploring barriers to performance accountability have been limited in scope [21,22]. Firstly, most of these studies have been conducted outside Tanzania [23][24][25] and have had a predominant focus on enablers with relatively less attention on the barriers [19,22,26]. The few that focused on barriers to the implementation of performance accountability mechanisms explored staff-related limitations with less attention on the contextual constraints.…”

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

“…14,22 Previous research has shown that community dialogues are more successful when everyone participates. 17,21 A study in Uganda used community scorecards and dialogues to enable community leaders and communities to collaborate and identify innovative solutions to health care delivery and utilization challenges. Local leaders in their study created safe spaces for dialogues where performance and utilization issues could be identified and collaborative solutions implemented.…”

“…Local leaders in their study created safe spaces for dialogues where performance and utilization issues could be identified and collaborative solutions implemented. 17 In Mozambique, use of participatory communication techniques allowed for the correction of misinformation through consensus building in their study. 21 These findings showed that community dialogues are more effective when all stakeholders participate in identifying issues and jointly proposing solutions.…”

“…Most of community dialogue research has concentrated on participation in health promotion and service utilization, rather than community involvement and empowerment in health service governance. 17,20,24 For example, a research conducted in Kenya, South Africa and Zambia used community dialogues to engage community members and health providers in discussions about family planning. 26 Similarly, a study in Zambia used the approach to facilitate discussions on how to achieve quality care in family planning and contraception provision, guided by ground rules agreed upon by the various stakeholders.…”