Community quality-of-care scorecards help countries track indicators for patient satisfaction and how well health services respond to community needs. This structured process is especially effective at identifying and resolving quality-of-care problems, such as health worker attitudes, medication availability, waiting times, and referral systems.
Here are examples from Kenya and Ethiopia that show how community scorecards mobilise communities to improve patient experience and service delivery.
Community quality-of-care scorecards
Community quality-of-care scorecard tools are social accountability mechanisms that bring together community members from diverse sectors and socio-economic backgrounds, ages, and genders to provide quarterly feedback on quality of care.
These community scorecard tools are used to:
- collect feedback from community members to assess the quality of care
- increase accountability
- create joint actions to improve local health services, enhance community ownership and engagement
Community members, health workers, partners and government officials work together to carry out the actions to resolve problems identified in the scorecard tool process. In many cases, communities find local resources to carry out the actions.
Kenya: Transforming patient experience through staff training and medicine availability
In Machakos County, Kenya, few patients were being referred from the community to health facilities. The scorecard process showed that many community health volunteers were not visiting households or providing services.
To address this, health officials asked community health assistants to closely monitor community health volunteers and ensure they visit households and provide services in their areas.
Community discussions also showed that people were unhappy with the quality of services at health facilities. They reported:
- disrespectful health workers
- medicine shortages
- long waits to receive services
The county health team addressed these challenges by providing additional staff training on customer care, time management, and stock management to ensure availability of medicine. These actions have increased community referrals and the number of people seeking services at health facilities.
Ethiopia: From community feedback to systemic reform in medicine access
In Oromia Region, Ethiopia, the community scorecard process often highlighted problems with access to medicine. Many patients could not get the medicines they needed because health facilities often ran out.
Instead of staying a local issue, the community scorecard created clear evidence that could be shared with higher levels of the health system. This evidence helped mobilise resources from the regional government and partners, including the Susan Thompson Buffett Foundation.
These resources led to the creation of more than 200 community pharmacies across the region. The government also increased the budget for essential medicines in public health facilities. As a result, the availability of essential medicines rose from 56% to 80%. This example shows how community feedback, shared through a structured process, can drive big changes beyond a single health facility.
Examples from other countries
In other countries, the community scorecard process has also led to many other service delivery and patient experience improvements, such as:
- purchasing new ambulances and maintaining existing ambulances to improve patient referral systems
- hiring health workers to meet the specific needs of a segment of the community to improve health worker responsiveness
- the establishment of gender-specific facilities to respond to patients’ privacy needs
Conclusion
Experience from different countries shows that community scorecards are a powerful tool for improving service delivery and patient experiences, meeting the needs and expectations of the communities they serve. By providing a clear way to collect feedback, generate evidence, and plan actions together, the community scorecard process supports improvements ranging from changes in staff behaviour at one facility to reforms in medicine supply.