Community Score Card

Community Scorecard for COVID-19 Vaccines in Malawi

The significant amount of misinformation surrounding COVID-19 has deteriorated trust in governments and health systems, leading the World Health Organization to claim it as an “infodemic.” As the massive vaccine roll-out efforts launch, systematic trust-building and social accountability approaches are vital to ensure that civil society can hold governments accountable for equitable and people-centered vaccine roll-out that reaches the last mile. CARE knows that epidemics, like COVID-19 and Ebola, start and end with communities, which is why we are working to build meaningful citizen engagement into national vaccine roll-out frameworks to increase trust, accountability, and information dissemination.
CARE’s Community Score Card
The Community Score Card (CSC) was developed by CARE Malawi in 2002 and has been effectively used in a wide range of settings and sectors to ensure that public services are accountable to the people and communities they serve. CSC has demonstrated impact on power-shifting and improving service quality and trust building within and between communities and government actors. When COVID-19 arrived in Malawi during March 2020, CARE adapted CSC for remote use. The remote CSC includes an SMS platform and WhatsApp groups through which groups of men, women, youth, community and religious leaders, and service providers could voice their concerns and hesitancies about the vaccine and other health services. The CSC helped to identify major concerns around the vaccine and aided stakeholders in creating locally-driven solutions to combat vaccine hesitancy and misinformation.
Building on these early experiences, from May to June 2021, CARE further implemented a pilot project designed to support efficient and equitable COVID-19 vaccine roll-out in three locations in Malawi: Kandeu and Chigodi health facility catchment populations in Ntcheu district and the New Hope Clinic health facility catchment population in Ngolowindo in Salima district. In all three locations, key stakeholders included groups of women, men, youth, community leaders (chiefs and religious), district health management teams, and health personnel (including health surveillance staff, health facility staff in-charge, and the health center management committee). CARE Malawi’s CSC team led the implementation of the pilot with support from CARE USA and digital support from Kwantu. Read More...

Community Scorecard in Emergencies Learning Brief

To be effective and equitable towards global populations, humanitarian organizations must adhere to the core standards and principles on quality humanitarian response. Since the inception of ideas on the centrality of local participation in aid in the early 2000s and the more recent evolution of that concept into accountability towards affected populations, the humanitarian community has sought to turn this doctrine into reality.
Accountability in humanitarian response requires that organizations carry out their efforts in an ethically and legally responsible manner that is inclusive of the communities they are seeking to serve. Of UNICEF’s nine Core Humanitarian Standards (depicted here to the right), three specifically refer to mechanisms of accountability towards affected peoples: response is based on communication, participation and feedback; complaints are welcome and addressed; actors continuously learn and improve. In practice this could include centralizing the voices of affected peoples by engaging communities in needs and performance assessments and decision-making. Achieving this is often hindered by the constraints inherent to conflict settings such as lack of localization of assistance, communication between actors, and exploration of needs.
CARE’s Community Score Card
Seeking to actualize these principles of community participation and accountability into our programming, CARE developed the Community Score Card as part of a project aimed at developing innovative and sustainable models to improve health services. Working in crisis settings requires an understanding of the lived experiences of people, the power dynamics, and micro-politics that inform humanitarian response approaches. It also requires bridging the gap between civil society organizations, local and national governments, international non-governmental organizations, and impacted communities. Social accountability approaches do this by connecting citizens with those responsible for providing services. The Community Score Card (CSC) is a participatory social accountability mechanism for assessment, planning, monitoring and evaluation of services. Designed for ease of use and adaptation into any sector with a service delivery scenario, the CSC brings together users and providers of a particular service or program to jointly identify service utilization and provision challenges, mutually generate solutions, and work in partnership to implement and track the effectiveness of those solutions in an ongoing process of quality improvement. The CSC has five phases: (I) planning and preparation; (II) conducting the scorecard with the community; (III) conducting the scorecard with service providers; (IV) interface meeting where the all parties present their findings in the presence of duty-bearers and then jointly develop action plans; and (V) monitoring of the action plans and evaluation of overall process. Read More...

Support for Service Delivery Integration- Services (SSDI-Services) Endline

SSDI-Services was the flagship project for USAID/Malawi’s health office. The project was implemented from November 8, 2011 to March 7, 2017 under a cooperative agreement, valued at USD 89 million. Active project implementation occurred over a 4.5-year period from April 2012 to December 2016, with the preceding and following months focused on startup and closeout activities respectively.

SSDI-Services provided financial and technical assistance to the Malawian Ministry of Health (MoH) to deliver, refine, and scale up high-impact interventions contained in the Essential Health Package (EHP). The EHP includes globally proven and cost-effective interventions to address key causes of illness and death in Malawi. SSDI-Services implemented interventions under the following program areas: maternal, newborn, and child health (MNCH); family planning (FP); malaria; nutrition; HIV/AIDS; and sanitation and hygiene.

SSDI-Services was implemented by a consortium comprising Jhpiego as lead, CARE, Plan International, and Save the Children. The project focused on increasing access to, and strengthening the delivery of, EHP services both at the health facility and in the community. It leveraged the work of both SSDI-Communication and SSDI-Systems to improve health-seeking behavior and the quality of health services by addressing the informational needs of both service providers and their clients. It also addressed systems issues that may hinder the provision of high-quality Read More...

Ghana Strengthening Social Accountability Mechanism (GSAM) final

USAID/Ghana contracted Social Impact, Inc. to conduct an impact evaluation of USAID’s Ghana Strengthening Accountability Mechanisms (GSAM) program, which aims to increase accountability of local District Assemblies in Ghana. This randomized-controlled trial, impact evaluation tests the effect of two distinct efforts to increase accountability and improve service delivery outcomes at the district level. One-hundred and fifty of Ghana’s districts were matched and randomized into one of three groups: a top-down treatment group that received performance audits conducted by the central government Ghana Audit Service (GAS); a bottom-up treatment group that received civil-society organization (CSO) led scorecard campaigns; and a control group that did not receive either intervention.
Through surveys with citizens, local administrators, and local politicians and through a review of administrative data, we find that both CSO and GAS programming generally reduce citizen satisfaction with projects and services, but this is largely driven by districts that receive negative audit reports. That citizens are correctly attributing bad audit performance to poor-performing DAs is encouraging from the point of view of accountability. This progress with citizens has not, however, translated into many substantial changes in how administrators or politicians manage projects or project budgets. Neither GAS nor CSO programming improve transparency or corruption. GAS programming does reduce the incidence of partisan manipulation of public resources by politicians, and it also increases the perception of partisan manipulation among administrators. This is consistent with GAS sensitizing administrators to partisan manipulation and reducing its actual incidence among DA politicians.
CSO programming increases citizen-reported consultation on recent development, and administrators in CSO districts spend, on average, three hours more responding to constituents. Reasons that the intervention did not have a stronger impact on district officials includes (1) natural limits to the number of citizens reached by the intervention, (2) limited district government capacity and frequent turnover, and (3) local government dependence on federal budget transfers. Read More...

Hamenus Mortalidade no Risku ba Inan (HAMORIS – 2017-2021) Midterm Report and Summary CI Timor-Leste

The Hamenus Mortalidade no Risku ba Inan Sira (HAMORIS) project is funded by the Australian Government and implemented by CARE International Timor-Leste. Focused on the municipalities of Ermera and Covalima, the project aims to address the high number of women who die during childbirth in Timor-Leste, which has one of the highest rates of maternal death in the world, by improving their access to and use of quality maternal health services. The HAMORIS project was launched in July 2017 and has been extended until June 2022. This is the midterm report and findings. Please also find a summary in English as well as Tetum. Read More...

STORIAN BLONG YUMI PROJECT EVALUATION

The purpose of this evaluation is “to assess whether or not the Community Scorecard (CSC) approach as adapted to Vanuatu through the Storian Blong Yumi pilot (SBY) project offers a viable model for community-centred social accountability in Vanuatu and to document lessons from the pilot for future application”.
The Storian Blong Yumi project (SBY) tested the Community Scorecard approach for the first time in the Pacific, applying the CSC to Sexual and Reproductive Health services delivered by Vanuatu MoH health facilities serving 4 communities in Tafea Province.
The Storian Blong Yumi pilot of the CSC model in Vanuatu demonstrated results in the following areas, most strongly in the first two areas:
Stimulating dialogue between service providers and communities and overcoming social taboos to open up discussion within the community on SRH issues. Across all groups, including young men, who were the group that proved most difficult to engage, participants valued the process of community discussion. This dialogue appears to have been the basis for establishing better understanding and relationship between service providers and community members. This in turn seems to have laid the foundations for increased access to services by community members and responsiveness by service providers.
Increasing awareness of the SRH services available within their local health facility. Across groups of older and younger men and women in all locations people were aware of what family planning and STI services were available to them and what the role of the health staff were. in all locations, people who participated in the evaluation were more aware of what family planning and STI services were available to them and what the role of the health staff were. Men in all locations reported that they didn’t previously know what happened in the health centre regarding SRH, but now they have a better understanding. Read More...

Learning from the SAFE Justice Community Score Card: Final Learning Report

The SAFE Justice Community Score Card process was a local adaptation of Community Score Card models used globally and in Nepal in other sectors. Its design was led by CARE Nepal, through a participatory process with DFID and IP-SSJ partners, and focused on GBV response services provided by the Nepal police and Judicial Committees. This report details the final reflections of CARE Nepal and partner project staff on how the process worked and what could be strengthened in future. It also provides a set of recommendations for the sustainability and institutionalization of the CSC in the justice sector.

The CSC models introduced within SAFE Justice and in Search for Common Ground’s Pahunch project (around the same time) were the first to be trialed in the justice sector in Nepal. The CSC model CARE has implemented through SAFE Justice was informed by CARE’s extensive global experience with CSCs, but is also heavily based on the outputs of a co-design workshop with CARE Nepal, Search for Common Ground Nepal, SAFE Justice partners, and DFID Nepal, in Kathmandu in August 2017.1 This local model was documented and set out in a bespoke manual (SAFE Justice Community Score Card: A Field Guide for Nepal),2 and that manual was then updated and re-issued based on findings from a review and adaptation process in 2018, and then again based on the final reflection process outlined in this report (in August 2019).3
Overall, the chosen sectoral focus of the justice sector, and in particular the application of the CSC model in the midst of Nepal’s transitioning subnational governance structure, was an ambitious choice within SAFE Justice. Despite this, the process has demonstrated strong positive results, particularly in terms of improved police-community relations and community awareness of, and connection to, the new Judicial Committees.
However, the context did necessitate a particularly flexible and adaptive approach, in order to shift the structures and stakeholders involved with the CSC, in step with major political changes. While the CSC was not set up as a formal ‘pilot’ per se, CARE tried to treat it as such, scheduling deliberate junctures to reflect on the functioning of the model, hear from frontline staff on what is working and what is challenging, making and documenting concrete adaptations along the way. Read More...

Journey for the Advancement of Transparency, Representation, and Accountability (JATRA)

This 39 page report highlights the final evaluation findings from the Journey for Advancement for Transparency, Representation and Accountability (JATRA) project, which aimed to strengthen participatory governance processes in the public finance management systems of 15 Union Parishads in Nilphamari and Gaibandha districts of Northwest Bangladesh so that they are more transparent and accountable. This project was funded through the Global Partnership for Social Accountability (GPSA), established by the World Bank. Read More...

Keeping Girls At School Program Impact Evaluation rwanda edoag care final report

The Keeping Girls At School (KGAS) program is an initiative of CARE Rwanda aimed at reducing the number of girls who drop out of secondary school and increasing the share of girls that transit from lower to upper secondary education. CARE Rwanda and its implementing partners worked in 30 schools, across three districts in the Southern Province. The KGAS initiative has three main channels through which it aims to reduce dropout rates among adolescent girls: i) Providing mentorship opportunities for girls within the context of Girls Clubs; ii) Engaging girls in voluntary savings and loans (VSL) and income-generating activities; and iii) Establishing a Community Score Card (CSC) system that allows girls to comment on and influence institutions affecting their education
experience. [This 86 page document highlights the results of the KGAS program] Read More...

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