Kiracho Elizabeth Ekirapa, Aanyu Christine, Apolot Rebecca Racheal, Kiwanuka Suzanne Namusoke, Paina Ligia
Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205, Baltimore, MD, United States of America.
Int J Equity Health. 2021 Jan 11;20(1):31. doi: 10.1186/s12939-020-01367-1.
Planning for the implementation of community scorecards (CSC) is an important, though seldom documented process. Makerere University School of Public Health (MakSPH) and Future Health Systems Consortium set out to develop and test a sustainable and scalable CSC model. This paper documents the process of planning and adapting the design of the CSC, incorporating key domains of the scalable model such as embeddedness, legitimacy, feasibility and ownership, challenges encountered in this process and how they were mitigated.
The CSC intervention comprised of five rounds of scoring in five sub counties and one town council of Kibuku district. Data was drawn from ten focus group discussions, seven key informant interviews with local and sub national leaders, and one reflection meeting with the project team from MakSPH. More data was abstracted from notes of six quarterly stakeholder meetings and six quarterly project meetings. Data was analyzed using a thematic approach, drawing constructs outlined in the project's theory of change.
Embeddedness, legitimacy and ownership were promoted through aligning the model with existing processes and systems as well as the meaningful and strategic involvement of stakeholders and leaders at local and sub national level. The challenges encountered included limited technical capacity of stakeholders facilitating the CSC, poor functionality of existing community engagement platforms, and difficulty in promoting community participation without financial incentives. However, these challenges were mitigated through adjustments to the intervention design based on the feedback received.
Governments seeking to scale up CSCs and to take scale to account should keenly adapt existing models to the local implementation context with strategic and meaningful involvement of key legitimate local and sub national leaders in decision making during the design and implementation process. However, they should watch out for elite capture and develop mitigating strategies. Social accountability practitioners should document their planning and adaptive design efforts to share good practices and lessons learned. Enhancing local capacity to implement CSCs should be ensured through use of existing local structures and provision of technical support by external or local partners familiar with the skill until the local partners are competent.
规划社区记分卡（CSC）的实施是一个重要过程，尽管鲜有文献记载。马凯雷雷大学公共卫生学院（MakSPH）和未来卫生系统联盟着手开发并测试一个可持续且可扩展的CSC模式。本文记录了规划和调整CSC设计的过程，纳入了可扩展模式的关键领域，如嵌入性、合法性、可行性和所有权，以及在此过程中遇到的挑战和应对措施。
CSC干预包括在基布库区的五个次县和一个镇议会进行五轮评分。数据来自十次焦点小组讨论、与地方和国家以下层面领导人的七次关键 informant访谈，以及与MakSPH项目团队的一次反思会议。更多数据从六次季度利益相关者会议和六次季度项目会议的记录中提取。采用主题分析法对数据进行分析，借鉴项目变革理论中概述的结构。
通过使该模式与现有流程和系统保持一致，以及地方和国家以下层面利益相关者及领导人有意义且具战略意义的参与，促进了嵌入性、合法性和所有权。遇到的挑战包括推动CSC的利益相关者技术能力有限、现有社区参与平台功能不佳，以及在没有经济激励的情况下难以促进社区参与。然而，根据收到的反馈对干预设计进行调整后，这些挑战得到了缓解。
寻求扩大CSC规模并考虑规模因素的政府，应在设计和实施过程中，让关键的合法地方和国家以下层面领导人有战略意义且有意义地参与决策，从而敏锐地使现有模式适应当地实施环境。然而，他们应警惕精英俘获并制定缓解策略。社会问责从业者应记录其规划和适应性设计工作，以分享良好做法和经验教训。应通过利用现有的地方结构，并由熟悉该技能的外部或地方伙伴提供技术支持，直到地方伙伴有能力胜任，来确保增强当地实施CSC的能力。
