Community Score Card
Sara Gullo, CARE USA
QUESTIONS WE WILL ADDRESS IN THIS
SESSION
1. COMMUNITY SCORE CARD (CSC)
BACKGROUND?
2. WHAT IS THE CSC METHODOLOGY?
3. CSC...
COMMUNITY SCORE CARD (CSC)
BACKGROUND?

3
October 20, 2013
What is theory of change that guides
CARE’s governance and health work?
‘Theory of Change' to guide and
underpin CARE's go...
What is the Community Score Card (CSC) ?
The CSC is a participatory governance tool…
that brings together community member...
What is the History of the CSC at CARE?

CARE Malawi
develops CSC
•Project - Local Initiatives
for Health
•Overall aim – d...
WHAT IS THE CSC METHODOLOGY?
CSC Process

PHASE I: PLANNING AND PREPARATION

PHASE II: Conducting the Score Card with the
Community
Community Score Car...
CSC Process --- PHASE I:Planning and Preparation
Health facility &
catchment communities

District partnership

Train CSC ...
CSC Process

PHASE I: PLANNING AND PREPARATION

PHASE II: Conducting the Score Card with the
Community
Community Score Car...
CSC Process --- PHASE II: Conducting the Score Card
with the Community  Issue generation
Focus Group Participants

Focus ...
CSC Process --- PHASE II: Conducting the Score Card
with the Community  Indicator development
Scorecard template
Indicato...
CSC Process --- PHASE II: Conducting the Score Card with
the Community Score Card Consolidation
Consolidated Community Sc...
CSC Process

PHASE I: PLANNING AND PREPARATION

PHASE II: Conducting the Score Card with the
Community
Community Score Car...
CSC Process --- PHASE III: Conducting the Score Card with
Service Providers
Nurses

Indicator

Score

Reason

1.

-MNH ava...
CSC Process

PHASE I: PLANNING AND PREPARATION

PHASE II: Conducting the Score Card with the
Community
Community Score Car...
CSC Process -- PHASE IV: Interface Meeting & Action Planning
………………………………………
Action Item

Process

Resourc
es

Joint Actio...
CSC Process

PHASE I: PLANNING AND PREPARATION

PHASE II: Conducting the Score Card with the
Community
Community Score Car...
CSC Process -- PHASE V: Action Plan Imp. & M&E
Implement Action Plans…

Review & follow-up…

-Train community health worke...
CSC Process –
REPEAT

CSC INDICATORS
CSC RESEARCH & NEW RESOURCES?
CSC Research

CARE CSC Evidence Consolidation

CSC Evaluation in Malawi

CSC Sustainability Research

22
CSC Resources
CSC Toolkits
CSC Briefs & CO experiences
CSC Guidance Notes
Links:
http://governance.care2share.wikispace...
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Community Scorecard_Sara Gullo_10.16.13

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  • -
  • The CSC consists of 5 phases: I- Planning and preparation, II- Conducting the Score Card with the community, III- Conducting the Score Card with service providers, IV- Interface meeting and action planning, and V- Action plan
    -The CSC is done between a service user unit and service provider unit – in our case between the health center and catchment area
    -CSC process is not a one off process but done repeatedly every 6 months
  • The CSC consists of 5 phases: I- Planning and preparation, II- Conducting the Score Card with the community, III- Conducting the Score Card with service providers, IV- Interface meeting and action planning, and V- Action plan
    -The CSC is done between a service user unit and service provider unit – in our case between the health center and catchment area
    -CSC process is not a one off process but done repeatedly every 6 months
  • Step 2: Developing indicators
    At the Office :
    Debrief about the process and collate the findings – similar findings together
    Identify real issues and formulate major issues into indicators, grouping similar issues together under a topic
    Indicator
    It is a standard against which to measure change.
    Indicators are things we look for to see whether there has been any change.
    --Develop a matrix (“the scorecard”) for scoring the indicators and make copies for each of the groups
  • Consolidation of scores
    With representatives from focus groups share scores from all the groups
    Develop a matrix that will record scores from all the focus groups on the indicators
    Facilitate identification of a representative score (not necessarily averaging!)
    Select 2 presenters of the findings during interface meeting
  • The CSC consists of 5 phases: I- Planning and preparation, II- Conducting the Score Card with the community, III- Conducting the Score Card with service providers, IV- Interface meeting and action planning, and V- Action plan
    -The CSC is done between a service user unit and service provider unit – in our case between the health center and catchment area
    -CSC process is not a one off process but done repeatedly every 6 months
  • Generation of Issues
    Go through the provider checklist with the SP – ask the providers how they feel they are performing in providing the service
    SP can respond to questions like: What are the types of services that we offer? How do we offer them? What challenges does the SP experience in service delivery? What are the roles of communities in the service delivery, and how do they take part? What are their suggestions for improvement and maintaining strong points?
    Develop indicators
    preferably use similar method as with community
    Scoring
    preferably use similar method as with community
  • The CSC consists of 5 phases: I- Planning and preparation, II- Conducting the Score Card with the community, III- Conducting the Score Card with service providers, IV- Interface meeting and action planning, and V- Action plan
    -The CSC is done between a service user unit and service provider unit – in our case between the health center and catchment area
    -CSC process is not a one off process but done repeatedly every 6 months
  • Ensure adequate attendance and participation from communities concerned with the scored service and the SP including key decision makers for the service
    Prepare for the interface meeting by sensitizing both sides about the purpose of the meeting
    Purpose:
    To share scores generated by SU and SP so that feedback from community and SP is taken into account
    To develop concrete measures to improve low scores and maintain good services
    Reorient the gathering on the whole process followed and how this day was arrived at.
    Explain the purpose of the meeting and the methodology
    Environment should be conducive for community to negotiate agreements on improving the service with SP
    Call community representative to present the SU scorecard and the input tracking matrix followed by their prioritized list of suggestions for improvement and how to maintain the high scores
    Thereafter SP representative presents the results from their scorecard, suggestions for improvement or sustaining performance
    SP makes recommendation based on the suggestions for improvement made by SU
    Allow for an open and participatory discussion and questions for clarity.
    Ensure that personal attacks are avoided by from time to time, explaining the objective of the process.
    Facilitate open and positive dialogue between SP and SU and help them come up with realistic changes and action
    For each of the suggestions:
    Define action steps that will be taken in order to address the issue
    Define realistic deadlines for implementing the action steps
    Define who will take the leading role, who else will be involved and what they will do in implementing the actions, what external support they will need
    Keep the duration of implementing the action plan to a maximum of 6-12 months.
  • The CSC consists of 5 phases: I- Planning and preparation, II- Conducting the Score Card with the community, III- Conducting the Score Card with service providers, IV- Interface meeting and action planning, and V- Action plan
    -The CSC is done between a service user unit and service provider unit – in our case between the health center and catchment area
    -CSC process is not a one off process but done repeatedly every 6 months
  • Community Scorecard_Sara Gullo_10.16.13

    1. 1. Community Score Card Sara Gullo, CARE USA
    2. 2. QUESTIONS WE WILL ADDRESS IN THIS SESSION 1. COMMUNITY SCORE CARD (CSC) BACKGROUND? 2. WHAT IS THE CSC METHODOLOGY? 3. CSC RESEARCH & NEW RESOURCES?
    3. 3. COMMUNITY SCORE CARD (CSC) BACKGROUND? 3 October 20, 2013
    4. 4. What is theory of change that guides CARE’s governance and health work? ‘Theory of Change' to guide and underpin CARE's governance work: If citizens are empowered, if power holders are effective, accountable and responsive, Sustainable Development with Equity Expanded, Inclusive & Effective Spaces for Negotiation Empowered Citizens Accountable & Effective Power Holders  if spaces for negotiation are expanded, effective and inclusive, = then sustainable and equitable development can be achieved. 4 improvements in health coverage, quality and equity can be achieved.
    5. 5. What is the Community Score Card (CSC) ? The CSC is a participatory governance tool… that brings together community members, service providers, and local government to identify service utilization and provision challenges, and to mutually generate solutions, and work in partnership to implement and track the effectiveness of those solutions in an ongoing process of improvement Underlying Rights Based Principles  Participation and inclusion of voice  Accountability and transparency  Equity  Shared responsibility
    6. 6. What is the History of the CSC at CARE? CARE Malawi develops CSC •Project - Local Initiatives for Health •Overall aim – develop models to resolve issues of poor health service and access •Duration - 2002-2005 •Location - Malawi •Sector – Health •Application – quality improvement CSC spread •Within CARE –Tanzania, Ethiopia, Rwanda, Egypt, Cambodia, Mozambique, and others… •Beyond CARE- World bank & others…. •Sectors- Health, food security and livelihoods, education and water and sanitation programs •Applications - quality improvement, implementation improvement, planning/re – planning, M&E, internal accountability, advocacy efforts Rigorous CSC Evaluation •Duration- 2012- 2015 •Location – Malawi
    7. 7. WHAT IS THE CSC METHODOLOGY?
    8. 8. CSC Process PHASE I: PLANNING AND PREPARATION PHASE II: Conducting the Score Card with the Community Community Score Card: • Community level assessment of priority issues in one village – what are the barriers to accessibility and delivery of quality services • Develop indicators for assessing priority issues • Complete the Score Card by scoring against each indicator and giving reason for the scores • Generate suggestions for improvement = complete community Score Card for the village PHASE III: Conducting the Score Card with Service Providers • Conduct general assessment of health service provision – what are the barriers to delivery of quality health services? • Develop indicators for quality health service provision • Complete Score Card by scoring against each indicator • Identify priority health issues • Generate suggestions for improvement Cluster consolidation meeting: • Feedback from process • Consolidate scores for each indicator to come up with representative score for entire village • Consolidate community priority issues and suggestions for improvement = complete (consolidated) Score Card for the cluster PHASE IV: Interface Meeting and Action Planning Interface meeting: Action planning: • Community at large, community leaders, committee members, health center staff, district officials and process facilitators • Communities and health center staff present their findings from the Score Cards • Communities and health center staff present identified priority health issues • Prioritize the issues together (in a negotiated way) • Develop detailed action plan from the prioritized issues – agreed/negotiated action plan • Agree on responsibilities for activities in the action plan and set time frames for the activities   PHASE V: Action Plan Implementation and M&E • Execute action plan • Monitor and evaluate actions • Repeat cycles to ensure institutionalization
    9. 9. CSC Process --- PHASE I:Planning and Preparation Health facility & catchment communities District partnership Train CSC facilitators Focus area selection CSC intro to health workers CSC site selection CSC intro for community Community Mapping
    10. 10. CSC Process PHASE I: PLANNING AND PREPARATION PHASE II: Conducting the Score Card with the Community Community Score Card: • Community level assessment of priority issues in one village – what are the barriers to accessibility and delivery of quality services • Develop indicators for assessing priority issues • Complete the Score Card by scoring against each indicator and giving reason for the scores • Generate suggestions for improvement = complete community Score Card for the village PHASE III: Conducting the Score Card with Service Providers • Conduct general assessment of health service provision – what are the barriers to delivery of quality health services? • Develop indicators for quality health service provision • Complete Score Card by scoring against each indicator • Identify priority health issues • Generate suggestions for improvement Cluster consolidation meeting: • Feedback from process • Consolidate scores for each indicator to come up with representative score for entire village • Consolidate community priority issues and suggestions for improvement = complete (consolidated) Score Card for the cluster PHASE IV: Interface Meeting and Action Planning Interface meeting: Action planning: • Community at large, community leaders, committee members, health center staff, district officials and process facilitators • Communities and health center staff present their findings from the Score Cards • Communities and health center staff present identified priority health issues • Prioritize the issues together (in a negotiated way) • Develop detailed action plan from the prioritized issues – agreed/negotiated action plan • Agree on responsibilities for activities in the action plan and set time frames for the activities   PHASE V: Action Plan Implementation and M&E • Execute action plan • Monitor and evaluate actions • Repeat cycles to ensure institutionalization
    11. 11. CSC Process --- PHASE II: Conducting the Score Card with the Community  Issue generation Focus Group Participants Focus Group Discussion . Women Men Youth Local leaders Vulnerable groups 1. What is going well? 2. What is not going well? 3. What improvement is needed? Issues Identified •Lack of space in maternity-no waiting home, few delivery beds •Poor male involvement and support •Family planning myths and norms •Favoritism when treating clients •Disrespectful treatment of women •Poor relationship between health workers and communities •Poor DHMT supervision and response to other issues •Shortage of staff •Shortage of drug supplies, gloves, test kits for HIV, hospital linen •Payment for services that are supposed to be free •Health facility hours
    12. 12. CSC Process --- PHASE II: Conducting the Score Card with the Community  Indicator development Scorecard template Indicator development Indicator 1. 6. Availability and accessibility to information (MNH, FP, PMTCT) Level of male involvement in MNH, FP, PMTCT Level of youth involvement in reproductive health issues Reception of clients at the facility Relationship between providers and communities Health seeking behavior 7. Fertility levels 8. Commitment of service providers 2. 3. 4. 5. Score Reason
    13. 13. CSC Process --- PHASE II: Conducting the Score Card with the Community Score Card Consolidation Consolidated Community Score Card Community 1 Consolidated Score Card Community 2 Consolidated Score Card 13 October 20, 2013
    14. 14. CSC Process PHASE I: PLANNING AND PREPARATION PHASE II: Conducting the Score Card with the Community Community Score Card: • Community level assessment of priority issues in one village – what are the barriers to accessibility and delivery of quality services • Develop indicators for assessing priority issues • Complete the Score Card by scoring against each indicator and giving reason for the scores • Generate suggestions for improvement = complete community Score Card for the village PHASE III: Conducting the Score Card with Service Providers • Conduct general assessment of health service provision – what are the barriers to delivery of quality health services? • Develop indicators for quality health service provision • Complete Score Card by scoring against each indicator • Identify priority health issues • Generate suggestions for improvement Cluster consolidation meeting: • Feedback from process • Consolidate scores for each indicator to come up with representative score for entire village • Consolidate community priority issues and suggestions for improvement = complete (consolidated) Score Card for the cluster PHASE IV: Interface Meeting and Action Planning Interface meeting: Action planning: • Community at large, community leaders, committee members, health center staff, district officials and process facilitators • Communities and health center staff present their findings from the Score Cards • Communities and health center staff present identified priority health issues • Prioritize the issues together (in a negotiated way) • Develop detailed action plan from the prioritized issues – agreed/negotiated action plan • Agree on responsibilities for activities in the action plan and set time frames for the activities   PHASE V: Action Plan Implementation and M&E • Execute action plan • Monitor and evaluate actions • Repeat cycles to ensure institutionalization
    15. 15. CSC Process --- PHASE III: Conducting the Score Card with Service Providers Nurses Indicator Score Reason 1. -MNH available at health center -No community based MNH 2. Level of male involvement in MNH, FP, PMTCT 10 -Men do not go for HIV testing with wives -men do not present themselves for counseling on PMTCT, Level of youth involvement in reproductive health issues Reception of clients at the facility Relationship between providers and communities 20 -Youth not welcome in clinic for FP issues 25 -Sometimes clients are turned away -No formal queuing system 20 -Women do not listen to providers -traditional leaders and community do not take our advice; we are strangers to their community 6. Health seeking behavior 30 -Women come to ANC late -Women do not follow-up for PMTCT 7. Fertility levels 20 -Women start childbearing too early -Women have too many births 8. Commitment of service providers 35 -Providers do not come to work on time -Providers don’t provide 24/7 care -Providers not compensated for work 9. Attendant 60 3. HSA Availability and accessibility to information) Availability of supervisory support (for the health center) 20 -Supervisors only meet with staff 1-2 times a year -Supervisors are not responsive to health center needs -Supervisors do collect reports and provide supplies - Do not use standard tools for supervision 4. 5. Environ. Health officers Guards
    16. 16. CSC Process PHASE I: PLANNING AND PREPARATION PHASE II: Conducting the Score Card with the Community Community Score Card: • Community level assessment of priority issues in one village – what are the barriers to accessibility and delivery of quality services • Develop indicators for assessing priority issues • Complete the Score Card by scoring against each indicator and giving reason for the scores • Generate suggestions for improvement = complete community Score Card for the village PHASE III: Conducting the Score Card with Service Providers • Conduct general assessment of health service provision – what are the barriers to delivery of quality health services? • Develop indicators for quality health service provision • Complete Score Card by scoring against each indicator • Identify priority health issues • Generate suggestions for improvement Cluster consolidation meeting: • Feedback from process • Consolidate scores for each indicator to come up with representative score for entire village • Consolidate community priority issues and suggestions for improvement = complete (consolidated) Score Card for the cluster PHASE IV: Interface Meeting and Action Planning Interface meeting: Action planning: • Community at large, community leaders, committee members, health center staff, district officials and process facilitators • Communities and health center staff present their findings from the Score Cards • Communities and health center staff present identified priority health issues • Prioritize the issues together (in a negotiated way) • Develop detailed action plan from the prioritized issues – agreed/negotiated action plan • Agree on responsibilities for activities in the action plan and set time frames for the activities   PHASE V: Action Plan Implementation and M&E • Execute action plan • Monitor and evaluate actions • Repeat cycles to ensure institutionalization
    17. 17. CSC Process -- PHASE IV: Interface Meeting & Action Planning ……………………………………… Action Item Process Resourc es Joint Action Plan -Train -Training 1. HSAs provide community based MNH Respons ible Time frame DMHT 2 months (Feb 2013) 17 (DHMT) 2. Build maternity waiting home -Gather donated materials -Set building day -Build waiting home -In kind Communit y 5 months (May 2013) 3. Youth ambassadors for reproductive health Other NGOs & Service Providers HSAs in CBMNH -Youth ambassado rs trained -Training (FPAM) FPAM NGO 3 months (March 2013) 4.Registration and ticket system in place for clinic line -Print numbers -None DHMT 1 month (Jan 2013)
    18. 18. CSC Process PHASE I: PLANNING AND PREPARATION PHASE II: Conducting the Score Card with the Community Community Score Card: • Community level assessment of priority issues in one village – what are the barriers to accessibility and delivery of quality services • Develop indicators for assessing priority issues • Complete the Score Card by scoring against each indicator and giving reason for the scores • Generate suggestions for improvement = complete community Score Card for the village PHASE III: Conducting the Score Card with Service Providers • Conduct general assessment of health service provision – what are the barriers to delivery of quality health services? • Develop indicators for quality health service provision • Complete Score Card by scoring against each indicator • Identify priority health issues • Generate suggestions for improvement Cluster consolidation meeting: • Feedback from process • Consolidate scores for each indicator to come up with representative score for entire village • Consolidate community priority issues and suggestions for improvement = complete (consolidated) Score Card for the cluster PHASE IV: Interface Meeting and Action Planning Interface meeting: Action planning: • Community at large, community leaders, committee members, health center staff, district officials and process facilitators • Communities and health center staff present their findings from the Score Cards • Communities and health center staff present identified priority health issues • Prioritize the issues together (in a negotiated way) • Develop detailed action plan from the prioritized issues – agreed/negotiated action plan • Agree on responsibilities for activities in the action plan and set time frames for the activities   PHASE V: Action Plan Implementation and M&E • Execute action plan • Monitor and evaluate actions • Repeat cycles to ensure institutionalization
    19. 19. CSC Process -- PHASE V: Action Plan Imp. & M&E Implement Action Plans… Review & follow-up… -Train community health workers on MNH issues -Reflection session with district gov’t partners 19 October 20, 2013 -Train CSC committees -Follow-up on action plan implementation, keep diary, review health facility data
    20. 20. CSC Process – REPEAT CSC INDICATORS
    21. 21. CSC RESEARCH & NEW RESOURCES?
    22. 22. CSC Research CARE CSC Evidence Consolidation CSC Evaluation in Malawi CSC Sustainability Research 22
    23. 23. CSC Resources CSC Toolkits CSC Briefs & CO experiences CSC Guidance Notes Links: http://governance.care2share.wikispaces.net/Community+Score+Card+CoP http://health.care2share.wikispaces.net/alliance

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