In this guide, we will examine how countries can integrate the scorecard review into their existing accountability mechanisms to strengthen this accountability and drive action. We will also look at country best practices, highlighting several ways countries have managed to integrate the scorecard review in accountability mechanisms at national and subnational levels. Adding the scorecard to the agenda of key review meetings is essential to draw the attention from administrative and political leaders to the priorities needing to be addressed.
Identify key stakeholders who must be engaged in the scorecard review
To integrate the scorecard review into existing accountability mechanisms, it is necessary to first identify who are the key stakeholders to involve in the scorecard review.
- Sub-national political leaders (such as provincial governors and district commissioners)
How you can engage political leaders
- Present the scorecard to the Minister of Health during routine senior management meetings and/or present in cabinet meeting
- Send it quarterly to their offices with an analysis
- Organise an orientation briefing to explain new stakeholders to the scorecards (such as governors)
- Give them access to the Country Scorecard app for Android devices and iPhone and iPad
In Mozambique, the scorecard is used as part of regular monitoring mechanisms for malaria (for example, as part of Zero Malaria Starts with Me) at the national and provincial level. The Mozambican malaria scorecard is shared with the President’s office as well as governors of all provinces of the country. The scorecard is sent in different formats: paper, email, and by WhatsApp to ensure a wide dissemination. National and provincial teams produce quarterly reports with action recommendations for the provinces.
- Director of the National Malaria Control Programme (NMCP), NTD and RMNCAH programmes
- Directors of Planning and Evaluation (M&E and DHIS2 leadership)
- Regional and District Health Management officers and teams
How you can engage programme directors
- Programme Managers can review the scorecard quarterly, discuss actions and are responsible for tracking the implementation of key actions
- Give them access to the Country Scorecard app for Android devices and iPhone and iPad
- senior management meetings
- sub-national level meetings such as district coordination meetings and health facility supervision meetings
- RMNCAH Technical Working Group (which brings together all development and government partner institutions working on RMNCAH-related topics)
- Members of national parliaments
- Members of sub-national parliaments
- Members of parliamentary networks and committees
How to engage parliamentarians
- Organise a scorecard orientation briefing
- Create accounts for them on the Scorecard Web Platform so they can see the latest data at the national-level and in their constituencies
- Help them download the Country Scorecard app for Android devices and iPhone and iPad
In Tanzania, the National Malaria Control Programme (NMCP), with support from ALMA, has partnered with the Tanzanian Malaria Parliamentarian Committee (TAPAMA) to enhance advocacy efforts for malaria elimination. Together, they trained 60 members of parliament on the use of the Country Scorecard mobile app. The parliament IT department was also trained on the use of the app to enhance data-driven advocacy. After the training, several members of parliament made references to the need to sustain malaria efforts in speeches in parliament. Learn more about Tanzania’s experience in this video.
In Kenya, in the constituency of Siaya County, members of the county assemblies (MCA) have all been trained in the scorecard tool. Shortly thereafter, the assembly accelerated the adoption of a decree on health services resulting in significant budget increases in favour of health infrastructure, better staffing and the operationalisation of existing but underutilised infrastructure.
- Technical partners
- Financial partners
- Civil society organisations
How to engage partners
- Organise a scorecard briefing session
- Create ‘viewer’ accounts on the Scorecard Web Platform so they can see the scorecard data
- Present the scorecard in routine partner meetings (such as Technical Working Groups etc)
- Present the scorecard decentralisation plan to partners to get their support
- Present the analysis of the scorecard and the planned actions, and highlight any resource gaps
In Congo, scorecard tool was used to advocate for more resources, leading WHO/ESPEN to increase their 2020 contributions. The scorecard is now included in the Ministry of Health semi-annual and annual reports and shared with the ministry, departments, districts stakeholders and partners. The scorecard was also incorporated into the 2019 NTD annual report, which is shared with government institutions and partners.
Using the scorecard to present gaps identified during its analysis, the NTD programme mobilised funds from the government. From 2020, a budget line on NTDs was created with a pledge of 100,000 million CFA francs (almost US$170,000) to support the four NTD programmes. The country also mobilised additional funds for mass drug administration (MDA) targeting schistosomiasis and soil-transmitted helminthiasis as well as to map these diseases in 2021.
- Community leaders, organisations and members
How to engage community members
- Present the scorecard during community meetings such as townhalls and village council meetings
In Uganda, the scorecard has been effectively used to identify challenges in uptake of services, and for joint problem-solving with communities. As such, in Mukono, scorecard reviews have been integrated into routine sub-county dialogues (known as barazas). Barazas are a social accountability mechanism where the local government interacts with communities to discuss public service delivery.
Scorecard discussions are led by the District Secretary of Health and communities provide insights into reasons for performance. Scorecard discussions with communities have led to identification of causes of, and solutions for, low performance of immunisation, antenatal care (ANC) and postnatal care (PNC), among others. Interventions that have resulted include targeted health messages to address community misconceptions, improvement of health facility conditions and adjustments to community level services to address identified needs.
Identify the best accountability forums where the scorecard can be integrated for review and action
To integrate the scorecard into existing accountability mechanisms, it is necessary to identify the most appropriate forums where the scorecard can be permanently added to the agenda.
- Cabinet meetings and ministerial meetings
- Meetings with partners, such as technical working groups (TWGs)
- Meetings with parliamentary networks
Develop an explanatory sheet or ‘cheat sheet’ to explain technical indicators and facilitate understanding of the scorecard with non-technical and high-level stakeholders
Region, county and district
- Governors or county/regional directors
- Regional or district health management committee meetings
Develop a summary presentation to focus on performance issues and bottlenecks. The analysis of the scorecard should also present the proposed actions and the budget required for their implementation. This can also be used for advocacy to mobilise resources from partners.
- Community meetings, townhalls, village councils
- Community and health facility management committees
Organise a workshop with the community – with the support of local partners – can be organised to discuss the performance of a particular health facility and the scorecard can be used to facilitate discussion.
Identify focal points
At each level, responsibilities must be clearly established for the scorecard process. Therefore, it is necessary to identify the person or group responsible for:
- quarterly production of the scorecard
- sharing of the scorecard
- updating the action tracker
- preparing the scorecard to be sent to leadership and presented at existing management forums
Appointing a national focal point has been one of the main success factors for several countries. The focal point is often responsible for the dissemination of the scorecard. The focal point will also often oversee the decentralisation of the scorecard, to strengthen and expand its use. The focal point will also be able to organise training on the scorecard and ensure the scorecard administrators create accounts in the Scorecard Web Platform for stakeholders at all levels, including national, regional and district levels.
In Kenya, the scorecard is updated directly from DHIS2 at the national level. Every quarter, once the scorecard is updated, the national officer sends an email to each county officer to tell them the scorecard has been published. The counties then analyse the scorecard at county performance review meetings and sub-county data review meetings and agree on follow-up actions. These actions are then documented in the Action Tracker tool on the Scorecard Web Platform. The County Health Management Team (CHMT) also organises regular performance review meetings – in the presence of partners – to review scorecards and identify solutions. Implementation progress on these solutions is monitored in the Action Tracker.
In Zambia, the minister of health has appointed a national focal officer for each scorecard (malaria, RMNCAH, NTDs). See example terms of reference (ToRs).
Share the scorecard widely
The scorecard tool informs senior political leaders and technical stakeholders. The tool enables them to drive action and strengthen accountability at all levels. The more stakeholders who have access to the tool, the greater the impact of the scorecard.
Ideas for sharing the scorecard
- Distribute printed copies of the scorecard at meeting
- Download the scorecard in PDF format and share it with your colleagues and partners via email
- Create a WhatsApp group to share and chat about the scorecard
- Publish it on the Ministry of Health website or on another public website
- Share in a quarterly health newsletter or bulletin distributed to a wide range of stakeholders including partners
- Share on the ALMA Scorecard Hub (how to share your scorecard on the Scorecard Hub)
- Several countries (including Burkina Faso, Eswatini, Ghana, Kenya, Mozambique, Rwanda and Zambia) have already shared their scorecards on the ALMA Scorecard Hub.
- Mozambique shares its malaria scorecard widely. Each quarter, it is disseminated in different formats: print, email and WhatsApp. It is also sent to all governors, along with a letter signed by the Minister of Health.
- In Zambia, the malaria scorecard is widely shared with all provincial health officials and thousands of officers have been trained in its use and have their own accounts. The National Malaria Scorecard is also used by the End Malaria Council to drive action and accountability.
- In Guinea, the scorecard is shared with partners and with all regional focal points against malaria in a quarterly email newsletter.
Example of terms of reference (ToRs) for a scorecard focal point
The Ministry of Health of Zambia has rolled out four scorecards to strengthen evidence-based action, accountability and advocacy. The goal of scorecards is to optimise the use of existing data to ensure it translates into timely action. The Ministry of Health scorecard focal points will be responsible for ensuring the scorecards are produced on a regular basis and are institutionalised into existing management processes at all levels to strengthen its use.
Scorecard focal point terms of reference
- Oversee the timely production of the scorecard on a quarterly basis by liaising with the Scorecard Web Platform administrator responsible for uploading the data. Production should be completed by the fourth week after the end of the quarter once the routine data validation process has been completed.
- On a quarterly basis, lead a technical working group responsible for analysing the scorecard, highlighting the priorities to be addressed, identifying the root cause of the problems, and proposing actions. This work should be synthesised into a brief presentation that can be shared during meetings.
- Support integrating the scorecard as a standing agenda item in existing management meetings at national and subnational and community levels. Specifically, this can be achieved by presenting the analysis and recommended actions during existing management meetings where the actions are validated by Directors, Managers, and other stakeholders and entered the web platform’s Action Tracker for monitoring implementation.
- On an ongoing basis, monitor implementation of scorecard actions and follow up with the appropriate actors when there is an overdue action that requires additional support from the higher levels of the Ministry and partners. The progress of previously assigned recommended actions should also be discussed during existing management meetings as a standing agenda item.
- Support training national and subnational level stakeholders on the use of scorecards including adding accounts to the Scorecard Web Platform. The Scorecard Hub training material can be used to facilitate trainings and ALMA is available for guidance and support.
- Liaise with in-country partners to mobilise support for scorecard efforts, including implementation of actions and scale-up and keeping partners informed of scorecard progress.
- Liaise with other national scorecard focal points to identify opportunities for collaboration, especially on bottleneck resolution and scale up efforts, as well as integrating the scorecard into pre-service training for health workers.
- Liaise with ALMA to request technical support and discuss scorecard progress, including the documentation of best practices, implemented actions as well as the results and overall impact of those actions.