Nov 2016 – Oct 2019
AFRICAN LEADERS MALARIA ALLIANCE (ALMA) SCORECARDS & ACCOUNTABILITY MECHANISM
Multiple countries – Africa
To achieve health and nutrition outcomes for mothers, babies and adolescents through improved accountability and execution.
$6,292,174 Multi-Year Grant Value
Bill & Melinda Gates Foundation -
World Health Organization
The African Leaders Malaria Alliance
(ALMA), a coalition of African Heads of State and Government, supports
countries to develop and implement scorecard accountability management tools that
track country performance on critical reproductive, maternal, adolescent, nutrition
and new-born health interventions. The scorecard management tool identifies
areas of underperformance, facilitates bottleneck analysis and the identification
of specific actions to solve underperformance. The scorecard tool is discussed
at the highest levels (including Heads of State) as well as, increasingly,
publicly disseminated for use by Ministries of Health and their partners, civil
society organization and the general public.
During CIFF’s phase one investment, ALMA successfully rolled out 25 country scorecards, leading to concrete actions around improving health and nutrition outcomes.
This three-year phase two investment is supporting ALMA to intensify the use of scorecards for action and accountability. This includes support for decentralisation, to enable evidence driven decision-making at regional, district and community level. ALMA is supporting countries to strengthen the use of scorecard tools by integrating the use of the scorecards in their routine management systems for greater impact, enhancing public sharing, updating the indicators in the scorecards to align to SDG targets including additional nutrition and adolescent health interventions and supporting activities to create community level scorecards to improve quality of care.
The grant is helping
improve maternal, child and adolescent health through improved leadership, management
and accountability of decision makers for resource allocation and service
provision. The Scorecard action and accountability mechanism has led to major
improvements in four areas:
management and decision-making: through regular (usually quarterly) review
of the scorecard at national and subnational level, major bottlenecks are
identified and corresponding actions taken. In the 29 countries that currently use the RMNCAH
scorecard management tool, the regular sharing of the scorecard has led to
significant policy and resource changes, with national and regional governments
shifting resources to under-performing areas, investing in human resources, as
well as holding training and mentoring to address quality of care issues.
Examples of actions include:
- In Samburu County in Kenya, the review of the
scorecard revealed that the percentage
of deliveries by skilled birth attendants (SBA) were low (23%). The County, using
the Scorecard tool, advocated for resources to benchmark against a neighbouring
county where skilled birth attendance was at 90%. This led to the procurement
of nine ambulances and subsequently health facility deliveries increased to 52%.
- In the Bamako
district of Mali, the review of priority Maternal Health indicator performance
at district level through the scorecard tool showed the need to improve service
delivery. As a result, districts
relocated cervical cancer
screening adjacent to
family planning clinics
and added maternal post-natal
review at the
immunization clinic. This led to
a significant uptake of these services.
- In Kilifi County in Kenya, the analysis of
the scorecard showed that Vitamin A coverage was low. Further investigation
showed that there were no stock-outs but that the reason for the poor coverage
was that vitamin A stocks were kept far from where the health workers were
dispensing. By addressing this, the indicator performance improved.
- In Zimbabwe, the analysis of the scorecard
showed similarly low vitamin A coverage in Manicaland Province. To address the
issue, the Province trained Village Health Workers in administering Vitamin A
supplementation and piloted the intervention in two districts. Subsequently, Vitamin
A coverage increased significantly and the new strategy was scaled up to all other
of care: The scorecard mechanism has been further decentralised, with
the development of ‘community scorecards’ which assess quality of care through
community dialogue and town halls, to
promote accountability and improve quality and efficiency of primary care
Transparency and Community engagement:
More countries are choosing to publish
scorecards to foster transparency and dialogue between policy makers, service
users and service providers, and to encourage use by technical partners, as
well as at political level.
Through the regular use of the scorecard tool, data quality is improving with countries performing more regular data audits and with the use of the scorecard leading to an improvement of health information systems reporting.
Improved accountability mechanisms:
Use of the scorecard tool’s built-in action tracker facilitates improved quality and efficiency of management meeting discussions and serves as an accessible system to track implementation of agreed actions linked to indicator under-performance.