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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Medical equipment 7 6 7 Outdated medical equipment needs to be replaced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