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Table 2 Community scorecard and action plan, Siadara basic health facility, Bamyan

From: Enhancing governance and health system accountability for people centered healthcare: an exploratory study of community scorecards in Afghanistan

Indicators

CSC round

Reason

 

1

2

3

Provider scorecard

Broken water pump

5

10

10

Water pump repaired

Non-use of ICE materials

8

10

9.5

Additional IEC materials and old copies replaced with new

Damaged roof

9

8

10

Clinic’s metal roof repaired

Medical equipment

7

6

7

Outdated medical equipment needs to be replaced

Clinic cleanliness

7

9

9.5

Guard knows to prepare cleaning solution, but incinerator not available

Waiting time

9

10

10

Low patient load; Separate outpatient department for males and females

Clinic management

9

9.5

10

Function well as a team and the clinic is responsibly managed

Accurate clinical exam

7

9

9.5

If patient volume is high then consultation time is inadequate, explaining poor quality for Antenatal care, Post natal care and IMCI

Staff attitudes/behavior

10

10

10

No issues identified

Community scorecard

Water

5

10

10

Water pump repaired and safe water accessible to all

Electricity

3

6

10

Initially, no electricity. PRT installed solar panels

Medicines

7

10

10

Good quality, poor quantity. ‘White tablets’ given to all. Realized based on BPHS

Staff competencies

10

10

10

Capable staff with good attendance record

Waiting area

5

10

10

Patients forced to stand in the OPD until additional chairs were provided

Staff punctuality

10

10

10

They are always present

Staff behavior

10

10

10

Patients expressed satisfaction with staff interactions

Patient counseling

10

10

10

Good medication management and counseling

Waiting times

10

10

10

Reduced patient wait time

Clinic cleanliness

10

10

10

Clean (i.e. no flies and garbage is disposed of regularly)

Action plan

      

Indicator

Action proposed

Who?

Time

Observations

Water supply

Health council request to NGO. Supervisor will coordinate with Yakawlang governor and local NGO

supervisor, NGO,shura PPHD

3m

Multiple negotiation meetings and follow up. Staff paid for pump from salary and eventually reimbursed

IEC materials

Supervisor requests staff to prepare a list of IEC materials and forward the request to NGO

supervisor NGO

1m

Follow-up requests, but materials not received

Physical condition, roof repair and electricity

Supervisor address issue with NGO and PPHD

supervisor, NGO, PPHD

1-6m

DHO and District Governor also engaged in processing the request. Community member assist in roof repair. Installation of solar panel for electricity with council and NGO

Equipment

Supervisor submits all departments’ requests for equipment needs to NGOs

Supervisor NGO

3m

Discovered chairs in storage and transferred to waiting area. Although shura not identified in AP, remained involved in all decisions

Clinic hygiene

Supervisor to train staff on infection prevention , create a plan for the clinic, and follow up

Supervisor, HF staff

Ongoing

NGO trained staff and assisted in developing action plan. Followed-up until 100% compliance

Medicines, exams and wait time

Patient triaging to avoid ‘noise’. Time spent with patient considered

HF staff

ongoing

BPHS: ≥ 9 min with patient. Guard engaged in patient triaging and guides patients to specific area

  1. DHO District Health Officer PPHD Provincial Public Health Directorate Shura Facility council AP Action Plan