Community scorecard tool introduction

What quality of care community scorecard tools are

Quality of care community scorecards are participatory tools used to:

collect feedback from community members to assess the quality of care
increase accountability
inform actions to improve local health services
enhance community ownership and engagement

Each community scorecard is made up of several indicators used to assess the quality of health services offered at the local health facility or catchment area. Examples include the:

availability of medicines
cleanliness of the facility
time a patient had to wait to receive care.

Regularly (such as once every 3 months), members of the community are invited to:

share their experiences of using local health facilities
score the indicators used to assess the local health facility’s quality of care
create joint action plans to address the issues identified through the scoring session

Community members, health workers, partners and government work together to carry out the actions to resolve problems identified in the scorecard process. In many cases, communities find local resources to carry out the actions. These actions are recorded on the Scorecard Web Platform. The web platform allows community members, government and partners to monitor progress on the actions and provide extra support for actions that are struggling.

Benefits of quality of care community scorecard tools

There are many benefits of introducing a quality of care scorecard tool to your communities. These benefits include:

members of the community are given a voice, feel empowered and becoming partners with their local government and health providers in improving health services and outcomes in their community
members of the community hold their officials and health facility management responsible for carry out and resolving identified problems
securing and finding resources for health services in the community
improving community problem solving through discussion and shared planning between healthcare providers and community members
collecting important qualitative data rarely available in the ministry of health’s routine reporting systems
community members helping to raise money and in-kind support for health facility improvements

How the quality of care community scorecard tool works

There are 4 stages to the quality of care community scorecard tool process. By following these 4 stages, community feedback can be systematically used to carry out actions that address the community’s concerns and have a positive impact on the health system.

This process happens on a regular basis (such as once every quarter). The 4 stages are:

Score indicators at the scoring session
Review and plan solutions to problems at the action plan session
Carry out the actions
Monitor progress on the actions

This 4-step cycle is repeated on a regular basis depending on your country’s needs. As actions are successfully implemented, you should see improved performance on the scorecard management tool.

Stage 1: Score indicators at the scoring session

Community members come together to discuss and vote on indicators. In some countries, community members visit the health facility before the scoring to make sure they are familiar with the context.

Community members then individually score each indicator on a paper based form. These scores are combined to create the scorecard tool.

Some countries use the Scorecard Web Platform to quickly create colour coded scorecards for easy identification of the problems and where efforts should be focused.

Stage 2: Review and plan solutions to problems at the action plan session

Data from the scorecard tool and feedback from discussions are used by community members, government officials and partners to create time-bound actions that address issues identified from the scoring sessions.

We recommend writing the action plans on paper or entering them into the Scorecard Web Platform’s Action Tracker for better monitoring, transparency and accountability.

Stage 3: Carry out the actions

Community members, government and partners work together to carry out the actions created in stage 2.

Stage 4: Monitor progress of the actions

Community members, government and partners monitor progress on the actions. They should provide additional support for actions that are not on track to make sure the issue is addressed. The progress on the actions is reported at the following scoring session (such as in 3 months’ time).

Types of indicators used in quality of care community scorecard tools

The indicators on quality of care community scorecard tools can vary from country to country. Countries generally choose indicators that reflect their priorities based on their national quality of care protocols and their community health strategies. Each indicator is usually scored on a scale. For example, in Ghana they use a score of 1 to 3 where 1 is bad and 3 is good.

Indicators should be easy to understand and scorable by community members. The most common examples include:

caring, respectful and compassionate healthcare
waiting times
availability of medicines, supplies and services
ambulance management and services
clean and safe health facilities
facility infrastructure

Examples of countries using community scorecard tools

Ghana’s experience

In thousands of communities in Ghana, community members meet every 3 months to discuss the quality of care they receive at the Community based Health Planning and Services (CHPS) compound. They vote on each indicator and then the scores are combined and recorded to produce a scorecard tool which is used for action by communities, government and partners.

In Tikrom, Ashanti region, the scorecard tool led to the community health management committee securing additional resources to purchase beds and wheelchairs for the health facility.

Ethiopia’s experience

Every quarter, community leaders bring together at least 30 community members to discuss and score the quality of care indicators. Participants use colour coded papers to vote. After the discussion, scores are combined and a scorecard is produced.

Community volunteers then present the scorecard tool to the health facility. Following this, there is a facilitated town hall discussion between health facility workers and the community members to produce an action plan to address feedback.

Progress against actions is tracked and action plans are shared at district, regional and national levels.
The quality of care scorecard tool in Ethiopia has led to several improvements including:
- increased community participation in local health issues
- reduced waiting times at the pharmacy and cashier services
- increased antenatal care through the improvement of availability and quality of home visits by community health workers
- increased facility based, skilled childbirth deliveries through introducing maternity waiting rooms