10 May 2022

As part of Universal Health Coverage (UHC) commitment monitoring, we want to tell the real stories of UHC as experienced by people across the globe. This story looks at social accountability groups in Ethiopia.

Photo of Weyzero Ayane Hassen sitting outside a health facility

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 the Social Accountability Group. Members included 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 centre on selected key issues of health system delivery at a grass-roots level. The tool was adapted to the local context and tailored to fit the language and literacy level of the 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.

Three women and one health care provider in a waiting room

Ayane, who was born and raised as a local dweller, has been serving as a voluntary social mobilization agent for the last five years. Speaking to “Save the Children” team, Ayane explained that she and with four community representatives attended a two-day training co-hosted by ‘Save the Children’. Following this, members of the social accountability group held a community conference with the catchment population to identify and prioritize the perceived health service delivery gaps and process bottle necks. Many challenges were pinpointed, including:

  • Inappropriate use of ambulance services
  • Rude and unprofessional treatment of mothers during labour and delivery by health workers
  • Absence of health workers meant to be on duty
  • Frequent shortages of drugs and supplies
  • Irregularity of outreach immunization services
  • Poor management of solid and hazardous wastes within the health facility

Based on this feedback, Ayane and her colleagues worked with the health centre management to conduct a performance assessment. The health centre 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 with the Woreda health office for additional follow up and support. Since then, the Social Accountability Group has been tracking the progress through follow-up visits and a bi-annual community conference. 

After a year, notable changes in the health centre performance were observed; particularly those identified by the community. This included 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, there was a decreased rate of staff absenteeism and outreach immunization services were conducted regularly.

Note: This story may have been edited for clarity and shortened for fit on the UHC2030 webpage.

Category: Civil society and communities

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