Community Score Cards

1. Community Score Cards Piloting of Community Score Cards in Health Sector Visakhapatnam District Andhra Pradesh

2. Context • Indira Kranti Patham (Rural Poverty Alleviation project) in AP • Project has initiated integrated approach to health and nutrition aspects and therefore, a need for piloting Social Accountability felt • Piloting of Community Score Cards in the Health Sector Context • CSCs done in 10 villages of one Mandal

3. Process Step 1 • Collection of preliminary data from the community (users) and PHC (service provider) • demography profile, poverty status of community, services available at PHC, staff and drugs availability, annual budget and expenditure Step 2 • Community assessment/ score generated • Inform community about the purpose (in the general meeting), separate meetings with men, women (SHG members who are the poorest) and youth. • Each group generates the assessment indicators and gives a score on performance of the PHC

4. Actual Community Score Card Generated

5. Process Step 3 • Self evaluation Score Card by the PHC staff • Another group sits separately with the service providers-PHC staff to help them to generate their own performance indicators on which they score themselves

6. Example of an Actual PHC Self-Evaluation Score card

7. PROCESS STEP 4 • Interface Meeting Between the PHC Staff and the Service Users • PHC Staff, ANMs, VO members, MMS members, and IKP project staff attended the interface. • Both sides presented their results and the respective suggestions for improvement. A long debate followed (with equal participation from both sides), as clarifications were sought and issues were explained from different perspectives. • Discussion culminated in an Action Plan, which comprised of the top three priorities identified by the communities as requiring immediate action.

8. Emerging Issues • Non-Availability of a Lady Doctor • 100% agreement that all women were uncomfortable discussing their gynecological problems with a male doctor and therefore were forced to go to other hospitals. This was found to significantly impact the demand for other PHC services as well • Inadequate Staffing • Universally agreed that the PHC was understaffed - community members pointed out that one PHC doctor was in charge of running two PHCs and due to this he was mostly unavailable. They also pointed out that currently there was no provision for emergency back up

9. Emerging Issues • Difficult Access • One of the villages that was supposed to be serviced by the selected PHC, was 17 kms away from the PHC with only one bus service per day – this forced the entire village to use the services of a closer local area hospital • Inadequate Drug Availability • The demand for drugs remains grossly unmet –only 10% of the actual requirement is adequately met • Impolite Attitude of Staff • The impolite behavior and shouting by PHC staff discouraged a lot of the community members from visiting the PHC frequently

10. Issues Prioritized by the Communities in the Action Plan

11. Emerging Alternative Service Delivery Models

12. Status of Action Plans • Lady doctor identified but not willing to go to the Mandal (problems still persist) • Proposal for drug depot prepared by MMS and is being processed by the IKP project • Training given to the PHC staff on attitude and behavior aspects by the Jamkhed Project (Dr. Arole)