Community Score Card as a social accountability Approach Methodology and Applications March 2015

What is a Community Score Card? A participatory process that empowers communities or service beneficiaries to influence quality, efficiency and accountability (effectiveness) with which services are provided at the local level- Ahybrid of Citizen Report Card & Social audit

SC Context and Rationale  T o promote efficiency of services and social accountability of service providers, that is; to influence the quality, efficiency and accountability with which services are delivered or improve quality, while ensuring participation of the primary stakeholders relevant to the service.  Community can influence decision makers/service providers to achieve service quality.

Key Principles : CSC Both parties believe in the developmental nature of the process, otherwise it can become an opportunity for preparing a list of complaints or a confrontation, or tokenism Jointly accepted set of parameters for monitoring – patient charters, Quality of Care standards, treatment protocols, program`me guidelines Orientation and capacity building of both parties. Programme flexibility to incorporate new suggestions

Steps in Conducting a community Score Card The community scorecard process consists of six key stages 1.Preparatory Groundwork 2.Organization of the Community Gathering 3.Developing an Input Tracking Matrix 4.Community Scoring of Performance 5.Self-Evaluation by Service Providers and 6.Interface Meeting

How Does CSC Methodology Work? The Community Score Card 2. Performance Scorecard by Community 3. Provider Self Evaluation Scorecard 4. Interface Meeting 5. Action/Follow-up 1. Input Tracking

How to view Accountability Empowering the poor and serving them Also from the perspective of – “Making services work for the poor”. Why Because the problem is not just lack of resources, but also, and sometimes more seriously, that the resources allocated and expenditures incurred do not yield the desired outcomes at the ground level for various reasons

Step 1: Input Tracking?  Information gathering on expected quality and quantity of factor inputs (such as health workers, drug, infrastructure, equipment, PHC funds) and comparing the actual inputs with the entitlement  The aim: to identify gaps in factor inputs and inform discussion on service improvement strategies between providers and users Name of InputEntitlement/ PlannedActualRemarks/ Evidence Health Workers Drugs Infrastructure &Equipment Working hours (time) PHC Funds Services provided Patient Rights Completed By: Implementation team (in collaboration with facility staff and community members) Completed By: Implementation team (in collaboration with facility staff and community members)

Performance Assessment Performance of the public service through focus groups (our marginalised groups taken into consideration) Example Community Members Health Workers Women’s Group Men’s Group

Step 2. Performance Scorecard by Community The Performance Scorecard by Community allows community members: To score their assessment of the public facility according to their own priority criteria. To explain their scores and suggest actions for improvement. Indicator BadSatisfactoryGoodExplanation/ Comments Completed By: Community members (assisted by facilitation team) Completed By: Community members (assisted by facilitation team)

Perfomance Criteria In the focus group discussion for developing criteria, to note the difference between ‘criteria’, ‘indicators’ and ‘inputs’. A criterion is a broad performance assessment category that is usually qualitative, but can be subjectively scored. E.g. ‘transparency’ or ‘attitude of staff ’ would be performance criteria

Indicators An indicator is a measurable or quantitative measure of performance – measures a particular performance criteria. Eg. ‘whether budget was shared’ or ‘whether the staff is polite to the patients’ would be indicators of the above criteria.

Inputs contnd… Finally, inputs are measurable quantities that determine and influence performance, but are in themselves not measures or aspects of performance of a service. Eg. ‘Healthcare Equipment’ could be an important input or determinant of performance, but by itself is not an indicator of performance.

Perfomance criteria contnd… Usually the discussion on performance criteria will throw up not only criteria, but several indicators and inputs and it is up to the facilitating team to be aware of what is what. As a first cut, our focus is only on what are strict performance criteria. Performance indicators, and service inputs could possibly enter the scorecard as sub- criteria, but often their place is in the ‘reasons for scores’ column

Step 3: Self-Evaluation Scorecard by Facility Staff The Self-Evaluation Scorecard allows the public facility staff (providers) to score themselves, according to their own criteria. For example:  Attitudes of staff  Management of the facility/services  Quality of the services  Active community participation IndicatorBadSatisfactoryGoodExplanation/ Comments Attitudes of staff Management of the facility/services Quality of the services Active community participation Completed By: The Facility Staff(providers) (assisted by facilitating team) Completed By: The Facility Staff(providers) (assisted by facilitating team)

Action Planning Matrix What can we do to make things better? Who will do this?When will they do this? (short run and long run) Actions proposed

Interface Meeting The Interface Meeting brings together both community members and Service providers (facility staff) to discuss the results of the scorecards. During this facilitated discussion a mutually agreed reform agenda and action plan is developed. Community Members Scorecards Health Facility Scorecards Interface Meeting Interface Meeting Reform Agenda (Action Plan) Reform Agenda (Action Plan) Completed By: Facility Staff (providers) & Community Members Completed By: Facility Staff (providers) & Community Members

Importance of the Community Score Card Greater Accountability  Promotes sustained engagement of beneficiaries in improving service performance  Increases provider responsiveness to beneficiary preferences  Increases opportunities for providers to engage beneficiaries as partners in service process Empowerment  Gives voice to the marginalized groups to influence the accountability of service delivery  Provides the comfort zone for all categories of beneficiaries to contribute to the effectiveness of the public services through focus group discussions  Brings citizens’ energy to service improvement  Increases community ownership and responsibility for programs and services Improved Service Outcomes  Increases service effectiveness through sustained monitoring  Increases community responsibility and ownership, as a result, more people willingly contribute more time and energy to service improvement

Skills required to conduct a community score card Knowledge on decentralized governance A clear understanding of the policy environment Technical competences in research and documentation Excellent facilitation skills A neutral person ( Non political, religion, cultural etc)

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