Health Systems and Population Studies Division, Universal Health Coverage, icddr,b. 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
IMPACT study, ARK Foundation, Gulshan, Dhaka, 1212, Bangladesh.
Int J Equity Health. 2020 Nov 2;19(1):149. doi: 10.1186/s12939-020-01266-5.
The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh.
This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention.
Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs.
CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers' accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.
孟加拉国政府启动了社区诊所（CC），以扩大公共卫生服务的覆盖范围，并计划通过社区参与来运营这些设施。然而，社区诊所的服务利用率仍然很低。有证据表明，社区记分卡是通过服务提供者和受益人之间定期的界面会议来增加卫生机构服务利用的有效工具。我们调查了社区记分卡（CSC）是否能提高孟加拉国农村地区社区诊所提供的卫生服务的利用率。
本研究于 2017 年 12 月至 2018 年 11 月进行。从孟加拉国一个农村分区查卡里亚选择了三个干预和三个对照社区诊所。2018 年 1 月至 10 月，在干预社区诊所中，通过社区小组和社区支持小组引入了社区记分卡。通过在运营时间观察社区诊所、关键人物访谈、焦点小组讨论和从 DHIS2 收集数据。比较了干预和对照地区的社区诊所服务利用情况，在社区记分卡干预前后。
在实施社区记分卡干预后，社区对社区诊所服务的认识、诊所运营时间的利用以及医疗服务提供者的问责制都有所提高。干预社区诊所的基本医疗服务利用率，包括计划生育服务、产前护理、产后护理和基本卫生服务都有显著提高。
社区记分卡是通过确保社区意识和参与以及服务提供者的问责制来提高社区诊所提供的服务利用率的有效工具。决策者和有关当局可以采取必要措施，通过将其纳入社区诊所，将社区记分卡纳入卫生系统。
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