Nov 2016 – Oct 2019

AFRICAN LEADERS MALARIA ALLIANCE (ALMA) SCORECARDS & ACCOUNTABILITY MECHANISM

Africa map

Country

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

Other funders

  • 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.

Impact

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: 

  • Evidence-based 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 districts.
  • Quality 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 services.     

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.

Data quality:
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.