Background
In 2018, the Ministry of Health of Ghana and the Ghana Health Service, with support from ALMA, developed a Community Scorecard (CSC) to enhance the health sector’s ability to gather public feedback on the delivery of health services, guide decision making processes between service providers and community members, and empower communities to take a more active role in health systems. The community scorecard is fully integrated into Ghana’s Community-Based Health Planning and Services (CHPS) initiative, the national community strategy which aims to deliver essential community-based health services with the active involvement of communities. It is now rolled out to approximately 25% of the country’s CHPS zones.
How it works
Ghana’s Community Scorecard consists of nine indicators rated by community members each quarter during CHPS meetings. Each quarter, the scoring is done by a minimum of 15 members of the community with the support of the Community Health Management Committee (CHMC), comprised of community leaders responsible for the wellbeing of the CHPS zone. After the scoring session, the community uses the scorecard to facilitate discussions and generate community health action plans. The scoring sessions and action plans are uploaded to DHIS2 and the scorecard web platform, giving all levels access to community feedback, and enhancing accountability at all levels.
Impact
Community empowerment and action
The CSC mechanism has led to greater community involvement and local contributions to improve local infrastructure and service delivery. As an example, in Ashanti region, the CSC assessment found that the maternity block and facility compound were in poor condition. As a result, the CHMC quickly organized volunteers and contributed money to repair the building, buy supplies and improve waste management.
Systems strengthening
The CSC has helped to mobilise community support for Ghana’s Community-based Health Planning and Services initiative. The CSC monitoring and accountability tool has ‘re-engaged communities to see themselves as contributing to the quality of service-delivery at their CHPS compound’. The CSC also provides important client feedback to national, regional, and district level health managers, allowing them to identify gaps in the health system and systematically address bottlenecks.
Service delivery improvements
The CSC has also been described as ‘instrumental in important decision making at the lower level to improve healthcare services as well as catalyse actions by district officers. As an example, in Oti Region, it was noted that pregnant women were not attending antenatal care (ANC) regularly at the CHPS compound. An action plan was drawn to intensify ANC services at the CHPS compound and provide community education on the importance of these services. ANC attendance improved as a result.
Key success factors
- Strong support from high-level government leaders
- Fully integrated into the country’s community health strategy
- The CSC approach is complementary to the country’s existing Reproductive, Maternal, Newborn, Child and Adolescent (RMNCAH) Health and malaria scorecards
- Community Scorecard training is being integrated into routine Community Health Workers’ training and in the training of materials have been included in the University of Ghana’s school of Public Health curriculum for long-term sustainability