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Table 4 Community scorecard and action plan, Kalafghan Comprehensive Health Center, Takhar

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
Female doctor and nurse 9 8 4 No female doctor or nurse. Midwife overburdened, female patients cannot share many issues with male doctor. Increased to 8, as female nurse was hired, and decreased to 4 in last round as no female doctor was hired.
Medicines 10 10 10 all medicines are available and arrive to the clinic on time. List expanded and efforts undertaken to make staff aware of essential medicines
Waiting area 5 8 6 No suitable waiting area for males or females. A tent was provided by NGO staff, but winters are extremely cold and a metal roof is required
Medical equipment 8.5 4 9 Inadequate and dysfunctional equipment (i.e. sphigmonometer, stethoscope, blood pressure cuff). In R3, the clinic received two BP monitors.
Bathroom and guard room 0 1 3 Not selected in round 1. In round 2, location identified for the construction of bathroom for delivery room, round 3 construction initiated. A list of potential donors for the guardroom has been generated.
Staff behavior 9 9 10 Patients satisfied with services provision. No difference between wealthy and poor. Staff behavior is good and they guide the patient to appropriate department
Patient wait time 8 8 9 No suitable waiting area. Thus, not all can be counseled. CHC should be upgraded to DH. High patient volume with no female doctor and counseling takes more time.
Education 9 9 9 Well-organized plan for each section. Proper prescribing. Still request more education.
Staff Punctuality 9 9 10 Sometimes the staff do not attend clinic due to long distance and bad weather. In Round 2, all staff present during working hours and punctual.
Community scorecard
Clinic staff 9.5 8.5 7.5 Solved all problems. Should have received a 10. Understand the need for a female doctor after reviewing the BPHS.
Waiting area 4.5 9 6.5 No proper waiting area - particular problem in summer and winter. Tent with few chairs.
Medicines 4 6.5 9.5 Same white tablet for all patients. Now patients are more aware of the type and quality of medicines.
Night staff 9.5 9.5 9.5 Solved all our problems when children were wounded. Staff is always available for treatment.
Laboratory services 8 9 9.5 Laboratory technicians’ knowledge and skills were initially poor until they received the necessary training. As a result, laboratory tests have improved for urine, sputum and blood.
Health education 9.5 9.5 10 Midwife is kind and provides advice during check-ups. On-time consultation provided to all and she speaks in simple language. Patients’ now have improved knowledge about health.
Accurate exam 9.5 9.5 9.5 Patients are satisfied with the quality of care provided by the midwife. If she is not available, the doctor does not check accurately. Progress has been made and every patient is now examined appropriately according to illness.
Staff punctuality 9.5 10 10 Patients reported overall satisfaction with staff performance, despite problems with absenteeism. Even on holidays and in the evenings, they are available and punctual.
Action plan       
Indicator Action Proposed Who? Date Observations
Female doctors Shura request that supervisor, NGO and PPHD directorate hire female doctor supervisor, shura, CAF, PPHD 6 m In a remote area, hiring of female doctor is difficult. Cultural barriers, such as rejection of non-Uzbek staff.
Waiting area Shura request tent for male waiting area. Shura, supervisor and NGO staff request funds from community members via CBHC officer supervisor, shura, NGO, PPHD 3 m Community approached for donations. Promised to contribute, but not follow through. Budget remains insufficient.
Inadequate or old equipment Supervisor request to replace BP monitors. CBHC officer report progress to supervisor and shura supervisor, NGO, shura, HP staff 2 m Initially MOPH did not allocate budget, now integrated in the budget. NGO provided 2 BP monitors
Guard- and bath- rooms constructed Shura requests additional funds for construction from NGO through supervisor supervisor, shura, NGO, CMs 6 m Restroom constructed. Shura and supervisor received commitments from donors for guardroom.
Wait time decreased Shura/ supervisor request that NGO promote CHC to DH to hire a female doctor. shura, NGO, CMs 6 m Population is small; thus, upgrade request will be impossible to process
Accurate examination supervisor request staff provide exams of sufficient duration and use appropriate equipment HF staff 3 m Due to staff shortages and no female physicians, this is not possible.
Staff availability supervisor request night staff be monitored by NGO, CBHC officer and supervisor. supervisor, NGO, shura 3 m Staff satisfied with evening shifts.
Laboratory services supervisor request training for laboratory technicians. Patient satisfaction monitored. supervisor, NGO, shura 6 m BPHC distributed job descriptions to community. Community satisfied.