Designing for Scale and taking scale to account: lessons from a community score card project in Uganda
Loading...
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
International journal for equity in health
Abstract
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.
Methods: 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.
Results: 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.
Conclusion: 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.
Description
Keywords
Community Score Cards, Scale up, Accountability, Theory of change
Citation
Kiracho, E. E., Aanyu, C., Apolot, R. R., Kiwanuka, S. N., & Paina, L. (2021). Designing for Scale and taking scale to account: lessons from a community score card project in Uganda. International journal for equity in health, 20(1), 1-11. https://doi.org/10.1186/s12939-020-01367-1