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Piloting Community Scorecards in the Health Context

Piloting Community Scorecards in the Health Context. The Andhra Pradesh Experience. Centre for Good Governance Hyderabad. Presentation Structure. 1. Background. 2. Community Scorecard Process. 3. Project Implementation. 4. Key Findings. 5. Follow-up Activities. 6. Key Takeouts.

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Piloting Community Scorecards in the Health Context

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  1. Piloting Community Scorecards in the Health Context The Andhra Pradesh Experience Centre for Good Governance Hyderabad

  2. Presentation Structure 1. Background 2. Community Scorecard Process 3. Project Implementation 4. Key Findings 5. Follow-up Activities 6. Key Takeouts

  3. Background

  4. Primary Healthcare in AP • Primary healthcare system is the most important and often the only option for the poor and vulnerable • Under the Directorate of Health Services • 3 basic services • prevention & control of local endemic diseases • implementation of national health programs • promoting health awareness among the community • 1,570 primary health centres (PHCs) in the State -Reach of over 5.5 million rural population with each PHC catering to an approximate rural population of 35,000 • More than 2,000 professionally qualified doctors supported by paramedical staff • More than 300,000 deliveries and 30 million outpatients per annum • 6-8 sub-centers under a PHC, each of which cater to a population of about 3000-5000.

  5. Deputy DMHO Additional DMHO Superintendent Programme Officers (TB, Malaria etc) Directorate of Health Services Office Assistant Administration & Accounts Officer DM & HO Commissioner Family Welfare Addl. District Health Officer Project Director, Andhra Pradesh State AIDS Control Society PO, District Training Team District Collector DCHS Administration & Accounts Officer Commissioner Andhra Pradesh Vaidhya Vidhan Parishad PO, ITDA Administration & Accounts Officer Commissioner Tribal Welfare State Level Organization District level Organization Represents direct reporting Represents coordination Accountability Arrangements

  6. PHC Level Organisation

  7. Community Scorecard Methodology

  8. Project Implementation

  9. World Bank Centre for Good Governance IKP Team PHC 1 Community Resource Persons (CRPs) PHC 2 Community 1 Community 2 Project Implementation Arrangements

  10. Community Scorecard Process STAGE – 1 Preparatory Activities (Selection of resource persons, training design) PHASE – I STAGE – 2 Training of Resource Persons (Workshops, field visits, planning, input tracking) PHASE – II STAGE – 3 Community Assessment Community Generated Indicators & Scorecards STAGE – 4 Self Evaluation by Service Providers Self-Evaluation Scorecards STAGE – 5 Interface Meeting (Feedback and dialogue) Action Plan PHASE – III STAGE – 6 Post Implementation Activities (Analysis, advocacy, dissemination, policy changes) Project Implementation Process

  11. Training • A total of 11 resource persons trained – comprised community health workers, mandal samakhya representatives and members from the community • The training participants were divided into two groups for conducting the fieldwork – one for each mandal. • 3 day training programme that included: • Brief on the methodology of CSC • Role Play and Exercise • Field Application of the CSC methodology and • Assessment of the field exercise by the participants

  12. Coverage • 12 villages covered for the pilot - six villages in each mandal. • Users groups segregated into two broad categories • Women • Men • A total of 24 group discussions were conducted across the 12 villages. • Each group consisted of about 15-20 members

  13. Key Findings

  14. Synthesis of Findings • There are fundamental issues related to how functionaries operate - points to poor accountability and weak responsiveness. • Service delivery is further undermined by weak support services and poor infrastructure. • Low awareness among the community is another factor that needs immediate attention.

  15. Community Generated Indicators • A total of 153 indicators (counts) were generated by the community across all villages. • Out of this, Devarapalle mandal accounted for 67 counts and Golugonda for 86 counts. • Men groups generated a total of 72 responses for indicators and women groups generated 81 responses.

  16. Consolidation of Scorecards • Categorising Indicators • Estimating their importance • Calculating their composite ratings

  17. Categorisation of Indicators

  18. Incidence Profile of Indicators

  19. Importance of Indicators • The first mentioned indicator got a score of 5, the second 4, the third 3, the fourth 2 and the fifth 1. Subsequent indicators were not assigned any multiplication factor. • The aggregated score for each indicator across each group when compared with other indicators gave the relative importance of that indicator.

  20. Top Indicators:Differences across Gender / Mandal

  21. Overall Rating by Community

  22. Rating by Mandal and Gender

  23. Self-Evaluation by PHC Staff

  24. Self-Evaluation: Mandal-wise

  25. Community Assessment Vs. Self Evaluation

  26. Plan of Action

  27. Plan of Action

  28. Follow-up Activities • Dissemination workshop at the district level to share findings from the study with different stakeholders • Follow-up visit to observe changes and degree of implementation plan • State-level discussions with key stakeholders for replication in other districts and across other services

  29. Key Takeouts • Elaborate and effective planning is essential • Training of Resource Persons – right persons with right skills • Partnership with NGOs and CSOs can lend legitimacy and build sustainability • Administrative response and commitment during the process is critical • Follow-up action is critical – regular exercise and advocacy • Institutionalization through legal and administrative means is imperative

  30. Community Scorecard – Technical Aspects • The tool is still raw – requires greater refinement and standardisation • Input tracking • Generation of Indicators • Type of Information • Consolidation of Scorecards • Development of Action Plans • Facilitating the Interface meeting

  31. Why Social Accountability Traditional Accountability Mechanisms reflect Gradual atrophy and general apathy • Representative democracy • Separation of powers between Executive, Judiciary and Legislature • Separation of administration from politics • Bureaucracy and hierarchical channel of control • External accountability mechanisms such as audit, vigilance etc. • Social Accountability Mechanisms can complement and strengthen traditional accountability mechanisms for better service delivery

  32. Thank You

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