Community Scorecard (CSC) is one of the social monitoring tools that the Ethiopian federal Ministry of Health has shown interest in applying to help communities claim their right to quality basic services. However, the commitment wasn’t yet implemented in the Somali region until “Save the Children” administered a grass-root level social accountability mechanism through a pilot study in the region.
In 2019, “Save the Children” in collaboration with the Somali region’s health bureau began a pilot intervention to assess the state of health services in 45 rural villages served by the Awebere health center. The intervention, initiated a capacity building training of the community representatives called ‘Social accountability group’ represented from women, youth, teachers, religious and community leaders. In consultation with the community leaders, an evaluator scorecard was adopted to assess the performance of the regional health center on selected key issues of health system delivery at a grass-root level. The tool, which had been adopted in local context was tailored to fit the language and literacy level of the SAGs (social accountability group). On the other hand, the health services also developed their own self-evaluation scorecards based on the indicators. In both cases, the stakeholders suggested measures for improvement. After both sides fill in their scorecards, an interface meeting was held for brainstorming ideas for improvement as well as assigning responsibilities for each action item within a given time frame. Through the repeated process, the improvement of the services can be monitored and assessed.
Weyzero Ayane Hassen Ije, a 36 years old mother of six and a member of community councils. Ayane, who was born and raised as a local dweller, has been serving as a voluntary social mobilization agent for the last 5 years. Speaking to “Save the Children” team, Ayane explained that she, along with four community representatives attended a two-day training co-hosted by ‘Save the Children’. Following this, members of the social accountability group held community conference with the catchment population to identify and prioritize the perceived health service delivery gaps and process bottle necks. Many challenges were pinpointed, particularly: the inappropriate use of ambulance service, the rude and unprofessional health workers’ treatment to mothers during labor and delivery, the health workers duty absence, the frequent stock outs of drugs and supplies, the irregularity of outreach immunization services and the poor management of solid and hazardous wastes within the health facility.
Based on these feedbacks, she and her fellow colleagues conducted a performance assessment along with the health center management using standard checklist. Finally, the health center management accepted the councils’ feedback positively and developed a joint action plan. Consequently, members of the council shared the copy of the assessment findings and corresponding action plan to Woreda health office for an additional follow up and support. Since then, the SAG members have been tracking the progress through follow-up visits and a bi-annual community conference. After a year, notable changes in the health center performance was observed; particularly those identified by the community. This included a significant improvement in the ambulance service after some serious administrative changes as well as a decrease in the rate of interruption of essentials drugs, vaccines, supplies and reagents. Additionally, a decreased rate of staff absenteeism and outreach immunization service were conducted regularly.
Note: Each story has been edited for clarity and in cases, shortened for fit on the UHC2030 webpage.