Country-level scorecard tool introduction

What country-level scorecard tools are

Country-level scorecard management tools are country-owned tools used to:

track national and sub-national health performance
identify bottlenecks or gaps
increase accountability
enhance decision-making to drive action

A country-level scorecard tool provides a snapshot of a country’s health performance through:

a colour-coded scorecard tool to help track performance of priority indicators
using existing quarterly data from routine sources such as DHIS2 and other health management information systems
integrating the scorecard tool into existing accountability and management processes

Latest scorecard data
The ALMA Scorecard Hub includes access to published scorecard tools from several African ministries of health.

View the latest scorecard management tools

Types of country-level scorecard tools

Each country-level scorecard tool is made up of several indicators used to assess national health priorities. At the African Leaders Malaria Alliance (ALMA), we have helped 40 countries across Africa introduce country-level scorecard tools. There are currently:

40 malaria country-level scorecard tools
29 RMNCAH country-level scorecard tools (reproductive, maternal, newborn, child and adolescent health)
8 NTD country-level scorecard tools (neglected tropical diseases)
2 nutrition country-level scorecard tools
1 country-level scorecard tool that combines malaria and NTDs

Using the Scorecard Web Platform to manage country-level scorecard tool

The Scorecard Web Platform is an online service you can use to manage your scorecard tool. The web platform lets countries:

view and analyse their colour-coded scorecard tool
visualise the data with charts and graphs
monitor the progress of actions with the Action Tracker
track implementation of workplans with the Workplan Manager

You can access the web platform through a web browser (such as Chrome, Safari or Firefox) or through the mobile app for Android devices and iPhone and iPad.

We created the web platform at ALMA. We continue to maintain, support and update the online service. African ministries of health can use it for free. Contact us to request access to the Scorecard Web Platform.

Benefits of country-level scorecard tools

There are many benefits to introducing a country-level scorecard tool. The tool benefits a range of people in different roles. These include:

Roles	Benefits
Political leaders (such as heads of state and government, ministers of health, MPs and local chiefs	Made aware of progress, gaps and best practices Use political power and resources to support health programmes that matter most Can see real-time data on the Scorecard Web Platform’s mobile app
Ministry of health directors and managers	Made aware of progress, gaps and best practices Held accountable before leadership and peers for performance Use the Scorecard Web Platform’s Workplan Manager to track key milestones implementation to shape programming
International and in-country partners	Conduct joint analysis in collaboration with relevant programmes on potential bottlenecks Propose and implement action items Prioritise support and assess the impact of investments
Community representatives	Provide information on the quality of care Prompt community action on underperforming indicators

How the country-level scorecard tool works

There are 4 stages to the country-level scorecard tool process. By following these 4 stages and integrating the tool into existing accountability structures, the scorecard tool can have a sustainable future.

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

Populate the scorecard tool with data from existing sources
Review and plan solutions to problems within existing management processes
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: Populate the scorecard tool with data from existing sources

On a regular basis (such as once every quarter), the scorecard management tool is updated with the latest data.

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 within existing management processes

The scorecard management tool is discussed within existing management processes (such as quarterly review meetings at national and sub-national levels). During these meetings:

the scorecard tool and indicators are reviewed
actions are created to respond to underperforming indicators
actions are assigned to specific people
actions are documented in action plans for accountability

We recommend entering actions into the Scorecard Web Platform’s Action Tracker for better monitoring, transparency and accountability.

Stage 3: Carry out the actions

Government officials and partners work together to carry out the actions created in stage 2.

Stage 4: Monitor progress of the actions

Government officials 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 country-level scorecard tools

The indicators on country-level scorecard tools can vary from country to country. Countries generally choose indicators that reflect their priorities based on their national health strategies.

Indicators should be easy to understand and have data available to monitor. Some examples of indicators include:

the proportion of the targeted population who received long-lasting insecticidal nets (LLINs)
the proportion of malaria cases detected by surveillance systems
number of malaria deaths per 100,000 persons per year

Examples of countries using country-level scorecard tools

At ALMA, we have helped 40 countries across Africa introduce country-level scorecard tools. Here are some examples of malaria and RMNCAH scorecard tools.

Zambia’s experience with malaria country-level scorecard tools

During scorecard analysis, officials saw the proportion of pregnant women receiving 3 doses of intermittent preventive treatment of malaria in pregnancy (IPTp) through antenatal care was low for all districts of Luapula Province. On the colour-coded scorecard tool, this indicator was red showing it was not on track.

With this issue identified, provincial health office advised districts to use results-based financing to procure sulfadoxine-pyrimethamine locally. This led to the intermittent preventive treatment of malaria in pregnancy coverage increasing from 42% to 83% in the province.

Kenya’s experience with RMNCAH country-level scorecard tools

When reviewing the scorecard, officials found that the full immunisation rate in infants was declining in Bungoma County.

Officials worked with partners to resolve this issue. They made sure all immunising facilities offered daily immunisation services and improved community outreach. This led to an increase from 48% to 82% in immunisation coverage.