Introduction

Community quality-of-care scorecards help identify and address barriers like cost, distance to health facilities, and low health awareness through structured conversations.

Here are examples from Ethiopia and Kenya that show how community scorecards mobilise communities and increase access to health services.

Ethiopia: Extending health insurance to the poorest households

In Sidama Region, Ethiopia, the community scorecard process found that some of the poorest households did not have health insurance and could not, therefore, access health services optimally. The cost of care was a key barrier, and the scorecard process made this clear through community feedback.

In response, district authorities raised funds from churches, mosques, and local businesses to extend a community-based health insurance scheme to the poorest households, thereby directly removing the financial barrier identified.

Ethiopia: Building additional health centres and renovating health posts to increase access to care

In parts of Sidama Region, community members also raised concerns about long distances to health facilities. As a result, the regional government built four new health centres. This sustained advocacy led the regional government to fund and construct four new health centres. These new facilities have helped to provide an estimated 100,000 additional people with significant improvements to health care in these areas.

Alongside these new facilities, the district administration mobilised community resources to renovate 227 health posts to improve the care provided to the communities they serve. These renovated health posts have led to a 25 percentage-point increase in use, from 47% to 72%.

Kenya: Community education to increase immunisation coverage

In Nyanza County, Kenya, health officials were concerned by low immunisation coverage. The community scorecard discussions highlighted that community members lacked awareness of the importance of completing the full immunisation cycle. This poor health-seeking behaviour was contributing to low immunisation coverage.

The local community health promoters (CHPs) conducted community education sessions focused on the importance of completing the full immunisation schedule.

Afterwards, complete immunisation coverage increased by 20%. Other areas adopted this approach to improve health-seeking behaviour in their communities. This example demonstrates that identifying and addressing specific barriers through community-driven education can lead to measurable improvements in coverage.

Examples from other countries

In other countries, the community scorecard process has also led to many improvements that increase access to health services, such as the:

• expansion and improvement of home visits and other community-based services, bringing care closer to people who have trouble getting to clinics
• formation of support groups for women attending antenatal care
• expansion of social insurance scheme coverage

Conclusion

This community mobilisation works because the scorecard process helps everyone share responsibility for health outcomes. The scorecard empowers communities to identify barriers and design solutions. Everyone shares responsibility.

Communities themselves contribute financial and non-financial resources to address these barriers. Evidence from community discussions helps health officials and local leaders request additional support from governments and partners. Political leaders help turn community needs into policy and budget decisions.

Country experiences show that community scorecards are an effective way to help communities overcome barriers to using health services. They pinpoint issues such as cost, distance to health facilities, and low health awareness, then provide a clear process for addressing them.