RT Journal Article
SR Electronic
T1 Implementing a Social Accountability Approach for Maternal, Neonatal, and Child Health Service Performances in Ethiopia: A Pre-Post Study Design
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 123
OP 135
DO 10.9745/GHSP-D-20-00114
VO 9
IS 1
A1 Mesele D. Argaw
A1 Binyam Fekadu Desta
A1 Elias Mamo
A1 Melkamu G. Abebe
A1 Deirdre Rogers
A1 Anteneh Demelash
A1 Aklilu A. Ayele
A1 Zinabu Reda
A1 Amare S. Tareke
A1 Alemu M. Erfo
A1 Wegayehu W. Wonjalo
A1 Temesgen A. Bele
A1 Assefa Ayede
A1 Lidya G. Abebe
YR 2021
UL http://www.ghspjournal.org/content/9/1/123.abstract
AB Key FindingsThe average community scorecard measurements on health workforce behavior toward patients, availability of services, patient waiting time, facility infrastructure, ambulance service, and cleanliness and safety of the health facility significantly improved over 1 year at primary health care units.Of the 10 key maternal neonatal and child health performance indicators measured, 9 were found to improve as a result of implementing the community scorecard approach.Key ImplicationsThe implementation of a community scorecard approach enhances a culture of social accountability, transparency, and engagement of citizens in planning, implementing, and evaluating maternal, neonatal, and child health services. In addition, it improves the negotiation capacities and involvement of both community members and health workers, resulting in increased availability and utilization of health service.Program managers and development partners should continue their support for the government- led social accountability interventions to ensure the sustainability of improvements in maternal, neonatal, and child health outcomes.Background:Social accountability approaches, such as the community scorecard (CSC), can improve the performance of health systems in low-income countries by providing a mechanism for obtaining and incorporating community input. This longitudinal study assessed the effects of CSCs implemented by primary health care units (PHCUs) on health system performance in Ethiopia.Methods:This study used a pre-post design and was conducted from October 2018 to September 2019 in 159 PHCUs in 31 districts in Amhara and Southern, Nations, Nationalities and Peoples' regional states. The data were extracted from a routine health information management system database at baseline, midterm, and endline stages over 12 months for statistical analysis. The effects of implementing CSCs on health system performance were evaluated against selected key performance indicators (KPIs).Results:The CSC measurement results were based on input from 38,556 community representatives. The mean CSC score with standard deviation (±SD) was 60.8%±12.5%, 66.3%±10.8%, and 70.6%±10.0% at baseline, midterm, and endline, respectively. The mean KPI score was 54.9%±17.4%, 61.9%±15.1%, and 67.6%±14.6% at baseline, midterm, and endline, respectively. The average CSC and KPI values were positively correlated (r>0.37). Using a nonparametric Friedman's test, we found a statistically significant difference in CSC and KPI scores at baseline, midterm, and endline (P=.001). Post hoc analysis with Wilcoxon signed-rank tests was conducted with a Bonferroni correction and the results showed higher CSC and KPI values from baseline to midterm and from midterm to endline (P<.017).Conclusions:The use of CSCs in Ethiopia contributed to the health system's performance in terms of maternal and child health services. The responsiveness of health workers and utilization of basic health services by community members were found to increase significantly with CSC use. We recommend continued implementation of the CSC intervention at PHCUs.