1. CARE’s experience with Community Score Cards What works and why?

2. Research methodology and motivation Four qualitative case studies of CARE Community Score Cards (Ethiopia, Malawi, Rwanda and Tanzania) – Analysis of CARE documents, programme reports & impact evaluations – Process-documentation and political economy analysis Opportunity to compare a single form of programme across contexts: – How does it adapt? – How do its impacts vary? – What lessons can be learned for future programming? 2

3. Country contexts Ethiopia – Large country with federal structure characterised by ethnic fragmentation and a strong central state that places an emphasis on top-down monitoring and supervision Rwanda – Small, unitary state with coherent central government and a developmental focus that emphasises strong accountability for performance Malawi – Highly fluid political system characterised by multi-party democracy without a dominant party, strong patronage politics and without a strong and coherent state Tanzania – Multi-party democracy with a hegemonic ruling party that is increasingly fragmented and reliant on patronage politics, undermining state strength and coherence Variety of sectors – education; food security; gender-based violence and women’s empowerment; health; infrastructure; and water, sanitation and hygiene (WASH). 3 #hashtag

4. Documented impacts InstrumentalInstitutional 4 New infrastructure e.g. new health clinic Changes in resource allocations Improvements in frontline staff performance Changes in attitudes (users- providers) Improved trust (users and providers)

5. Documented impacts 5 Source: Wild and Wales with Chambers (Forthcoming) ‘Mid-point’ instrumental–institutionalInstrumental Improved trust and mutual respect Changed attitudes and behaviours Altered working practices Improved discipline Reduced corruption Changes in resource allocation Infrastructure construction or rehabilitation Ethiopia Improved relationships between service users, service providers and local authorities Increased sense of community ownership over services [SU] Agreement to ration water usage from improved sources [SU] Chlorination of water sources [SP/LG] Reversed systemic errors in salary payments [SP/LG] WASHCO oversight [SU/LG] Increased WASHCO activity [SU] Water point [SU/LG] Malawi Improved relationships between service users, service providers and local authorities Greater politeness to service users [SP] Transfer of aggressive staff [LG] Ending of attempts by primary education advisor to extort funds from parents [SU/LG] Altered use of revenues from fines for non- health facility births [SU] Staff house [SU/LG] Health centre [SU/LG] Rwanda Improved relationships between service users, service providers and local authorities Challenged ‘culture of silence’ over GBV [SU] Greater politeness to service users [SP] Creation of mobile HIV and reproductive service [SP] Alterations in staff schedules and deployment [SP] Staffing for new nurseries [SU] Hiring of community members [SP] Additional staff [LG] Ambulance [LG] Water pipeline [SU/LG] Health centre [LG] Road rehabilitation [LG] Nurseries [LG] Tanzania Improved relationships between service users, service providers and local authorities Increased usage of health facility for births [SU] Men more engaged in health decisions of wife and children [SU] Patients more presentable when visiting health facilities [SU] Greater politeness to service users [SP] Creation of after- hours service [SU/SP/P] Transfer of aggressive staff [LG] Head teacher dismissal [SU/LG] Additional staff [LG] Health centre resources [LG/P] Health centre [SU/LG] Staff houses [SU/LG] Health centre infrastructure [SU/LG]