Table 1 Key Community Score Card Implementation Processes

Preparatory ground work (planning meetings,

Community mobilization and sensitization and

input tracking matrix preparation)

Planning meetings: this involved meetings at district and sub-county levels with the political, technical, community leaders, health facility management and other stakeholders to solicit buy-in for the CSC project and select intervention locations. It also involved development of training materials and training of the CSC facilitators and coordinators.

Community mobilization and sensitization: Through the district and sub-county political and technical leadership, the participants for the community scoring were identified and mobilized. Radio spot messages were also aired and patient charters printed and pinned up in different locations within the intervention area to sensitize the different stakeholders about their roles and responsibilities in MNH.

Input tracking matrix preparation: The health workers, District Health Team and technical support team from MakSPH conducted in-put tracking by looking at the standards required for different health facility levels vis-à-vis what was available on ground. They tracked; infrastructure, equipment, and staffing. This tracking was conducted once at the beginning of the project.

Health facility Scoring

During the facility scoring, the health workers of the 5 selected health facilities listed their priority MNH indicators; scored them using color codes and developed a facility score card as well as a work plan for improvement. These were later presented in the interface meetings. This was repeated quarterly.

Community scoring

Community scoring was done through 20 Focus Group Discussions (10-female, 10-male) with selected community members from all parishes in six sub counties in the intervention area. Each group comprised of 12 Focus Group Discussions (FGD) participants. In the first community score card meeting (round one) they identified and prioritized the indicators and then they scored the indicators using colors and developed work plans for improvement. In the subsequent rounds two and three they met and scored the indicators. In rounds four and five, the scoring was done during the interface meeting that happened at parish level.

District scoring

The district scoring session was attended by 20 participants who discussed district performance as per the quarterly RMNCAH score card generated by MoH and developed a work plan for improvement. The DHT members also discussed MNH issues that had been raised by the communities during the scoring sessions.

Interface meetings

In Round one of scoring, five interface meetings were held at sub-county level. During scoring rounds; 2, 3, 4 and 5, interface meetings were held at parish level totalling to 25 meetings in order to strengthen participation of community members. Participants at interface meetings included community members, health workers, DHT members, political and technical leaders, and other stakeholders.

During Round three of scoring, local council members started doing mobilization for the interface meetings in an attempt to improve attendance and participation of community members.

Dissemination

After each scoring round, stakeholders were briefed about findings from different sub-county and district Score Cards and workplans. The stakeholders included; district and sub-county political and technical leaders, health workers, civil society organisations (CSOs), community leaders, and Health Unit Management Committees (HUMCs).

Monitoring and evaluation

The monitoring and evaluation activities comprised of feedback meetings and follow up meetings. After each scoring round, feedback meetings were arranged as a forum for facilitators from all the sub-counties to meet and discuss their scores and work plans. They also discussed, the gaps and challenges that had been identified and proposals to address them going forward. DHT members and the Makerere University School of Public Health (MakSPH) research team guided the feedback meetings. Fifteen [14] follow up meetings (one per Sub-county per scoring round for rounds one, two and three) were carried out with different sub-county councils and stakeholders who were responsible for oversight of implementation of agreed upon activities in the CSC work plans for their sub counties.