Skip to main content

Table 3 Community scorecard and action plan, Sarqol basic health center, 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
Clinic building 9 5 5 Request for clinic wall was not processed. Clinic was informed that the PPHD and NGO only had a budget for minor repairs.
Ambulance 0 0 0 Expectation for all clinics to have an ambulance. Later learned that BPHS does not provide ambulances for BHC, but indicator remained in CSC.
Equipment 9.5 5 4 Although usable, the delivery table is damaged. A request for a new one has not been processed. RHO and MOPH delegations are aware of the problem, but have failed to address it.
Staff punctuality 10 10 10 Supervisor and midwife reside at clinic and are available at all times.
Patient consultation 10 10 10 Appropriate care provided in each department.
Patient wait time 10 10 10 Only patients with complex conditions wait an extended time period.
Community scorecard
Medicines 0 0 0 Previously, the medicines arrived late and community members were not aware of options. Now all medicines are available and effective.
Ambulance 0 0 0 Urgent need for an ambulance, as clinic is located in a remote area. However, the BHC remains ineligible for an ambulance due to BPHS regulations.
Clinic building 9 5 7 Clinic has no wall, but it is fairly large and now has more rooms.
Patient beds 5 4 10 Beds available, but staff does not admit patients. Only one bed in delivery room. Additional beds were provided for patients and escorts.
Laboratory 0 0 0 Clinics staff do not have access to laboratories, but this is not a requirement for BHCs under the BPHS guidelines.
Waiting time 10 10 10 Patients do not wait and are examined in the order of arrival
Patient counseling 10 10 10 Patients counseled in a sympathetic manner and provided treatment plans.
Accurate exam 10 10 10 Patients are examined accurately.
Staff punctuality 10 10 10 Staff arrives at clinic at 7:30 AM daily and serves the community throughout the night. Doctor and nurse are both present at all times.
Clinic cleanliness 10 10 10 Support staff maintains a clean clinic. Sandals provided for patient use.
Action plan       
Indicator Action Proposed Who? Date Observations
Availability of medicines Staff raised community awareness of the types of medicines and ensured there were no stock outs Staff, CHS, shura Staff discussed BPHS guidelines and shared list of medicines with shura to ensure sufficient supply
Infrastructure, Clinic wall Governor, PPHD and NGO, processing request. PPHD 6 m Insufficient resources to meet construction requests
Laboratory facilities Shura request to supervisor Governor; PPHD and NGO process request. Supervisor shura, NGO, PPHD 3 m Mediation held with community and shura to illustrate that this was not required in guidelines
Replace old equipment Supervisor submit request to NGO to replace delivery table and extra bed for escorts supervisor midwife, NGO 1 m Ongoing negotiations and new equipment promised for next year. Midwife/supervisor’s wife facilitated five more beds.
  1. RHO Regional Health Officer