Community Score Card experience in Ntcheu,Malawi Maternal Health Alliance Project Team (CARE Malawi & CARE US)

Presentation Outline 1.Project Background 2.Intervention & Evaluation 3.Evidence of impact

Health providers face challenges in providing quality care Women face barriers in accessing and utilizing family planning & maternal health care The problem?

Maternal Health Alliance Project in Ntcheu Intervention: Community Score Card (CSC)  social accountability approach innovated by CARE in 2002 Goal: develop & test broadly applicable approaches to improve family planning, PMTCT and maternal health implementation and outcomes. MWWa/MHAP ( ) Supported by Sall Family Foundation in USA Location: Ntcheu district, Malawi T/As covered: Njolomole, Ganya, Phambala, Champiti, Makwangwala, Masasa, Mpando Target: Initially a randomised control trial study with: -10 intervention health facilities with catchment communities --10 control sites

Our Aim? Test the Community Score Card’s effectiveness at improving health access, utilization and quality provision. Government of Malawi invited CARE to conduct the research in Malawi

PHASE II: Conducting the Score Card with the Community PHASE IV: Interface Meeting and Action Planning PHASE I: PLANNING AND PREPARATION PHASE III: Conducting the Score Card with Service Providers Repeat cycle PHASE V: Action Plan Implementation and M&E Catchment Community Health providers Local gov’t & decision makers CSC Intervention?

PHASE II: Conducting the Score Card with the Community PHASE IV: Interface Meeting and Action Planning PHASE I: PLANNING AND PREPARATION PHASE III: Conducting the Score Card with Service Providers Repeat cycle PHASE V: Action Plan Implementation and M&E Catchment Community Health providers Local gov’t & decision makers Methodology IndicatorScoreSample Reasons for Score 1- Referral system – availability of transportation for pregnant women from health center to hospital 45 Ambulance is rarely available in cases of emergency Providers make clients use public transport 2- Availability of transport from the community to the health facility 20 Long distance to health facility Sometimes women delay doing to the facility during delivery 3- Availability of resources (i.e. drugs, supplies, space) 50 HIV test kits stock outs occur regularly Clients told to buy medication which should be free 4- Availability and accessibility of health services (MNH, FP, PMTCT) 80 Most service are available FP long acting term methods provided rarely No MNH services provided in community 5- Availability and accessibility to information 80 The messages are only available at the health facility not in the community 6- Level of male involvement in MNH, FP, PMTCT 50 Few men accompany their wives to antenatal care Most men refuse HIV test 7-Level of youth involvement in reproductive health issues 10 There are no youth clubs so most youth have little information on family planning, MNH or youth friendly services 8-Reception of clients at the facility 40 Some health workers have good attitudes and respect clients Some women are shouted at during delivery 9- Relationship between providers and communities 40 There is no health advisory committee or village health committee Meetings between health providers and clients is rare

Indicator1 st Score 5- Availability and accessibility to information 73% 6- Level of male involvement in MNH, FP, PMTCT 40% 9- Relationship between providers and communities 44% Example Actions: Train community health workers to deliver MNH services and information, Form Community action groups

hem. Community Health Workers (Health Surveillance Assistants trained in Maternal and Newborn Health bringing information and services closer to the community : 64 Community action groups were formed and trained which support the work of Health workers sharing Inormation.

Indicator1 st Score 5- Availability and accessibility to information 73% 6- Level of male involvement in MNH, FP, PMTCT 40% 9- Relationship between providers and communities 44% Example Actions: Community formed a ‘Secret Men’ group for male to male peer support and education on MNH

Community formed ‘Secret Men Group’ so then men could benefit from peer education on the ‘secret’ top maternal health so they could better support their partners to achieve good health outcomes: Secret men’s work has led to more men accompanying their wives to antenatal care visits and engaging in birth planning

Indicator1 st Score 5- Availability and accessibility to information 73% 6- Level of male involvement in MNH, FP, PMTCT 40% 9- Relationship between providers and communities 44% Example Actions: District clarified roles and responsibilities and one health facility came up with their own staff ‘Code of Conduct’: the community members now understand the constraints and limitations the system face, they understand the relationship is a two way and understand they have a role to play as well.

ueling hours with little recognition. District clarified roles and responsibilities and one health facility came up with their own staff ‘Code of Conduct’, DHMT reactivated Health centre advisory committees which acts a s a bridge between providers and users …at Kasinje Health Center women are no longer mopping the floors and cleaning the bed sheets after delivery!, more staff were deployed to ease work load at this facility and others

Many additional CSC generated actions taken across the 10 CSC sites….

Intervention Sites Progress ( )? 57,000+ Community members reached across 10 sites 13 Issues or ‘indicators’ addressed 3-4 Score card cycles at each site MANY, MANY local solutions identified and actions taken!

Example of Score Card indicator improvements across all intervention sites

For more information contact: Thumbiko Msiska MHAP Project Manager & Sara Gullo Senior Technical Advisor Sexual, Reproductive & Maternal Health