Parliamentarians play a crucial role in improving health performance

Parliamentarians have a crucial role in influencing health outcomes through their legislative and budgetary powers. Their involvement is essential for:

• advocacy
• formulating policy
• mobilising resources
• allocating these resources effectively to enhance health initiatives

Scorecard tools help empower parliamentarians to drive action

Country scorecard tools are an ideal mechanism for parliamentarians to engage with health issues. Scorecard tools are easy-to-understand, colour-coded data visualisation tools that indicate whether a health priority is performing well (shown in green), making some progress (shown in amber) or performing poorly (shown in red).

A country scorecard tool is broken down by region, county and district. This allows parliamentarians to see how their own districts are performing and compare it to other districts, as well as understanding the progress against key health targets countrywide.

As parliamentarians, we are expected to be part of the solutions. We must prioritise health for our people, especially during budget allocations. These scorecard tools enable us to have an informed say. The reproductive, maternal, newborn, child and adolescent (RMNCAH) scorecard is crucial for identifying areas of improvement.

Honourable Dr Mahteme Haite, a Member of Parliament in Ethiopia

Scorecard tools help leaders at all levels make informed, data-driven health decisions. Scorecard tools make it easier for leaders to:

• track performance
• identify bottlenecks or gaps
• increase accountability
• drive action, including resource mobilisation

ALMA supports countries with scorecards for malaria, RMNCAH (reproductive, maternal, newborn, child and adolescent health), NTDs (neglected tropical diseases), and community quality of care.

The fact that I can know the situation of malaria in my constituency and also compare it to other areas in the country makes the scorecard a priority tool in decision-making, such as for allocation of sufficient funds.

Honourable Constantine Kanyasu, a Member of Parliament in Tanzania

Training parliamentarians on scorecard tools

Over the past few years, we have developed in-person and online training courses to help parliamentarians use scorecard management tools to improve health outcomes in their constituencies.

We have now trained over 150 members of parliament from Ethiopia, Ghana, Kenya, Tanzania, Uganda and Zambia.

Our online course, designed specifically for members of parliament and their staff, is available free of charge on the Scorecard Hub. In the course, participants learn:

• the benefits of using scorecard tools for accessing priority health data and how the tools can help improve health outcomes
• how to use scorecard tools to find underperforming indicators and create actions to address the underperformance
• about the Scorecard Web Platform and how countries can use it to analyse indicator performance

Scorecards for accountability and action improve efficacy. They help us see whether we are meeting our terms of reference as leaders.

Honourable Elijah Muchima, Minister of Health for Zambia, during a scorecard training for parliamentarians in Zambia

Examples of parliamentarians using scorecard tools

Parliamentarians are already using scorecard tools to make informed, data-driven decisions and improve health outcomes in their constituencies.

Uganda – parliamentarian commitments lead to action

Following regional parliamentarian training on scorecard tools in Uganda, we have seen progress in several districts.

In Lamwo district, parliamentarians made commitments to address the underperformance of indicators they identified in the RMNCAH scorecard tool. Many of these commitments are now being implemented, including:

• Addressing the low number of women being screened for cervical cancer at family planning clinics: Parliamentarians lobbied for seconded staff and an increase in the wage bill. This led to UNFPA seconding 6 midwives to the district, while the Ugandan government recruited 24 health staff. This has led to an increase in cervical cancer screenings from 7% to 50% of women who attend family planning clinics.
• Raising awareness of local health services: Parliamentarians lobbied for radio talk shows and community engagement activities to discuss relevant health-related issues with community members.
• Addressing staff shortages at the regional referral hospital: Parliamentarians were engaged in recruiting 3 senior specialists (one radiology consultant and two gynaecology consultants).
• Addressing the high teenage pregnancy rate in the district: Local parliamentarians are working with female teachers in a multi-sectoral approach of community engagements and radio talk shows targeting teenagers with pregnancy messaging.

Ghana – mobilising over US$120,000

Parliamentarian training on scorecard tools has generated growing momentum in the use of the community scorecard tool in Ghana, especially in the Bawku West district of the Upper East region.

In the district, over US$120,000 was mobilised for improvements in local health services thanks to the leadership of assembly members and the community. These improvements include:

• introducing solar panels to improve 24/7 services at the Tonde CHPS zone (community-based health planning and services)
• constructing a maternity block at the Agatusi CHPS zone with resources mobilised from the community
• constructing ventilated and improved pit latrines for patients and staff at Galaka CHPS zone and Goziesi CHPS zone

Democratic Republic of Congo – allocating 15% of the Kwango provincial budget to health

In the Democratic Republic of Congo, scorecard tools are frequently used to advocate for health improvements and to engage policymakers and key stakeholders. The ministry of health distributes quarterly scorecards at both national and provincial levels, highlighting underperforming indicators and suggesting actions for improvement.

In Kwango province, the provincial governor participated in a recent scorecard analysis workshop. As a result, the governor allocated 15% of the provincial budget to health initiatives, including polio vaccinations.

The Gambia – allocating US$200,000 for NTD medicines

In the Gambia, following the introduction of the neglected tropical diseases scorecard, the government included NTDs in the country’s Recovery Focused National Development Plan, signed by His Excellency Adama Barrow, President of the Gambia. NTDs were also added in the ministry of health’s monitoring and evaluation framework, a plan which commits to reducing schistosomiasis and soil-transmitted helminthiasis by 75% by 2027.

Additional advocacy and scorecard training with parliamentarians has also led to increased support for NTDs. Following these efforts, the government allocated US$200,000 for NTD medicines in 2025 and committed to establishing a dedicated NTD budget line to ensure sustained domestic funding.

Conclusion

The use of scorecard tools by parliamentarians has proven effective in identifying underperformance and resolving issues. They ensure health issues remain a priority for elected officials.

The examples from Uganda, Ghana and the Democratic Republic of Congo demonstrate how easy-to-understand scorecard tools can lead to clear improvements, ranging from increased cervical cancer screenings to the construction of improved pit latrines for patients.

By championing a data-driven decision-making approach with scorecard tools, parliamentarians are driving meaningful changes that benefit their constituents.

Recommendations for countries

For ministries of health and national malaria programmes, we recommend:

• sharing scorecard tools with relevant stakeholders is important if you want them to drive impact. When scorecards are published, ensure that you share them with parliamentarians, their staff, and other local politicians, such as local councillors.
• making sure you introduce scorecard tools to new parliamentarians and other politicians when they are elected. You can contact the ALMA team to discuss training opportunities or use the ALMA Scorecard Hub guide to scorecard tools.
• publishing your scorecard tools on the ALMA Scorecard Hub to make it easier for parliamentarians and other stakeholders to access, review and analyse them. Read our guide on publishing scorecards to the Scorecard Hub.

For parliamentarians and other politicians, we recoomend:

• consulting with ministry of health staff to find out whether scorecard tools are being used for health in your country, province or district. With more than 40 African countries already using scorecard tools, it is likely that these tools are also in use where you are.
• regularly reviewing scorecard tools to assess whether implemented improvements are resulting in better performance on key indicators. Consistent monitoring also helps determine if the resources you have mobilised are being used effectively.