The document describes the principles and process of a Community Score Card (CSC) approach. The CSC aims to create dialogue between community members and health staff to identify and address local health problems. The process involves separate focus groups with the community and health providers to identify issues, develop perception-based indicators, and assign scores. An interface meeting brings both groups together to present scorecards and jointly develop 6-month action plans. The cycle then repeats every 6 months to rescore indicators and update action plans. The CSC process seeks to empower communities and foster cooperation between community members and health staff to continuously improve local healthcare.

1. Community Score Card –
Principles and Practices
CORE Group Global Health Practitioner Conference
Collaborating for Healthy Communities: Results, Realities,
Opportunities
Baltimore, Maryland
September 29, 2017

2. Principles of the CSC Approach
• Creating dialogue and trust between
community members and health facility staff,
volunteers and leadership.
• Promoting cooperation and minimizing
personal criticism and conflict.
• Problems are identified locally, and wholly
incorporate community as well as facility staff
points of view.

3. Main features of the Community Score Card
• Is conducted at local level and community is
the unit of analysis
• Generates information through focus groups
and maximizes community participation
• Provides immediate feedback to service
providers and emphasizes immediate response
and joint decision making
• Allows for mutual dialogue between users and
providers and fosters joint monitoring

4. Who uses the CSC?
• Government health officials (local, district, and
national)
• Non-governmental organizations
• Civil society organizations
• Community-based structures and committees

5. Pre-requisites for implementation
• A partnership composed of a convening
agency, authorities, local citizens, and health
service providers. The convening/implementing
agency usually is an NGO/CSO, but also could
be government or private sector player.The
neutrality of this convening partner is crucial.
• There must be some health problem, or issue
that needs addressing.
• The capacity for ‘buy-in’ by partners is
essential.

6. Five step process
1. Planning and Preparation
2. Conducting the Score Card with the
Community
3. Conducting the Score Card with Service
Providers
4. Interface Meeting and Action Planning
5. Follow up:Action Plan Implementation, and
M&E

7. 1. Planning and Preparation
• A neutral ‘safe’ space in which to meet
• Collecting background information (identify
key players and structures, acknowledging local
sensitivities, understanding power
relationships, work with political processes,
identify basic assumed local standards, track
health facility standards and capacity, and
identify local champions to facilitate buy-in)
• Provide in-depth training and support of CSC
facilitators

8. Training facilitators
• Candidates may come from communities
themselves, health facilities or government
authorities
• Initial training may be offered to higher level
officials who will ultimately be responsible for
the continuation of the approach
• Should last seven to ten days, and include:
three days of CSC theory, three days of
practical training, and four days of practice (as
part of local implementation)

9. 2. Conducting the Score Card with the Community
• An initial community meeting is called.
Refreshments are offered to attendees of this
all day meeting, but otherwise, no incentives
are used.
• Separate focus groups (FGs) are formed, and
usually consist of women; men; youth; and
health facility staff. Special other groups may
be formed to address local issues of equity.
• FGs are led by two CSC facilitators. Multiple
facilitators will need to participate in these day
long events.

10. Content of focus groups
• Three questions related to local health are
always asked:
1. What is working well?
2. What is not working well?
3. What is needed to improve?

11. Focus group content analysis
• Written information is transferred to post-it
cards for all community FGDs, and separately
for the health facility FDG.
• Facilitators later meet to cluster these cards
around common issues.
• About 7 to 13 issues are identified that reflect
the clusters of issues raised.These issues
usually will be higher level issues than the
many discrete ones raised by the FGDs.

12. FG Content analysis (continued)
• Facilitators developed two sets of “perception-
based indicators” to share with community
members, and separately with participating
health staff and volunteers.
• Facilitators return to the same communities
and reform the same FGs. Individual
participation may vary for each group, as some
community members may be replaced by
others who previously did not attended.

13. Community score card development
• After a discussion of the indicators (and the
reasons behind their selection), groups
decided upon a scoring process to establish a
baseline estimate of performance.
• Representatives are identified for each FGD,
and together with the facilitators, they
reconsider these indicators scores, develop
composite scores for each indicator.
• Score cards are then developed that list the
indicators, their scores, and sample reasons for
each score.

14. 3. Conducting the score card with service providers
• A similar process is followed with the health
facility FGD; service providers and facilitators
review the issues and develop indicators and
composite scores.
• Prior to implementing the next step of the
CSC approach, a pre-interface meeting is held
with higher level health providers in order to
sensitize them to the issues and indicators
being raised by communities.

15. 4. Holding an interface meeting and creating action
plans
• Following these two score card processes,
facilitators identify potential actions that will
make up the two Six Month Action Plans.
• Because many issues and indicators will have
been identified, not all indicators will have an
individual action item.
• Attempts are made to create actions that will
address multiple community concerns.

16. Interface meeting (continued)
• An interface meeting is called that includes
both community members as well as health
facility participants.Additional higher level
health representatives and local government
decision-makers frequently attend.
• Both score cards are presented with the
baseline composite scores.
• Two six month action plans are developed for
the community, and the health facility.

17. Six month action plans (continued)
Each plan will include the following information:
• Action items (usually 3 to 5)
• Process (to undertake the action item)
• Resources (needed to complete the action
item)
• Time frame
Some action items may be long-term (beyond six
months), with intermediate progress measures
(such as constructing a new structure).

18. 5. Follow up
The cycle is repeated (minus the initial planning
and preparation stage) every six months:
• Communities and service providers reconvene
to discuss issues (and generate new ones, if
needed)
• They re-score the indicators and discuss
reasons for changes, and meet in an interface
meeting to review their respective score
cards, and develop/modify their action plans.

19. Challenges of the CSC process
• It requires time, and resources needed to
support the functions of a convening, neutral
organization.
• It requires good facilitation skills, with
adequate training and support.
• The indicators developed are unique to the
communities and facilities, and are not
generalizable to standardized HMIS.
• Indicators are based on perceptions, and may
be difficult to measure.

20. For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the
United States Agency for International Development (USAID), under the terms of the Cooperative
Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
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