Community quality-of-care scorecards help find and fix barriers, such as infrastructure issues, that hinder service delivery. These problems include unreliable water or electricity, insufficient equipment, insufficient space for services, and the need for renovation.
Here are examples from Zambia and Ghana that show how community scorecards mobilise communities and improve health facility infrastructure.
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.
Zambia: Constructing a maternity annex to expand maternal health services
A community scoring session at Kabulamwinko Health Post in Zambia’s Kanchibiya District highlighted the absence of a maternity annex. This was limiting the facility’s ability to deliver maternal health services. Without a maternity annex, more women gave birth at home, which meant fewer safe deliveries.
With support from the Ward Development Committee, the facility secured funding from the Constituency Development Fund (CDF) to build a maternity annex. This led to improved maternal care and a reduction in home deliveries which, contributed to an increase in the percent of deliveries conducted by skilled workers in the district from 60% in Q4 2024 to 68% in Q4 2025.
In addition, the community scorecard process highlighted poor cellular network connectivity at the facility. Following community lobbying to a local MP, a network tower was installed. This helped to enhance communication and access to health information.
These examples from Zambia show how the community scorecard process can highlight important infrastructure gaps that are linked to health outcomes and channel local accountability structures toward securing the resources needed to address them.
Ghana: Addressing multiple infrastructure shortfalls across communities
Ghana’s community scorecard process has triggered significant improvements in health facility infrastructure across numerous locations around the country. For example, Daffiame Bussie Issa district in Upper Western Region, quarterly community scorecard reviews identified infrastructure shortfalls affecting service delivery in several Community-Based Health Planning and Services (CHPS) compounds. Joint action planning between communities and local and district health authorities led to resource mobilisation and advocacy across different actors leading to improvements such as:
- construction of a maternity block to improve maternal health services at Jolinyiri, Tuori and Konzonkala CHPS
- construction of staff houses for critical health staff at Jipensi CHPS
- procurement of furniture to support service delivery at Dagubaa and purchase of a new site for construction of a CHPS compound
- extending a delivery room in a CHPS compound, with community members contributing building materials
The breadth of these improvements demonstrates how the community scorecard process can generate momentum, with community members themselves contributing resources alongside formal public-sector resource mobilisation.
Examples from other countries
In other countries, the community scorecard process has also led to many physical resource improvements, such as:
- the construction of staff houses in health facility compounds to extend health facility hours
- improving infrastructure to address safety concerns, such as adding electricity around facility compounds, perimeter fences and gates
- adding partitions to wards, installing curtains, buying benches, and building waiting areas for patients to protect privacy and improve the patient experience
Conclusion
Country experiences show that the community scorecard process is an effective mechanism for identifying and resolving health facility infrastructure gaps.
By creating a clear process for communities to share their needs, assign tasks, and hold service providers and local authorities accountable, the scorecards ensure infrastructure improvements are driven by the priorities of the people who use health services.