Community Score Card Process in Gambia: Brochure

Key Activities of the CSC ProcessThe National Community Score Card Process entailed two broad phases.Phase 1: National Orientation /Awareness Creation and TrainingStage Activities134NationalworkshopRefresherTrainersStep-downtrainingPhase 2: Community Score Card Piloting• Trained a large number of developmentpractitioners on elements and methodology ofparticipatory monitoring and community score card• Field practice of the CSC methodology inSerekunda Health Center and Mohammendan lowerbasic schoolTrained individuals/corporate trainers who conductedtraining for facilitators at the divisional level ontechniques of the CSC processTrained targeted facilitators at the divisional andcommunity levels on the CSC process and methodologyStage Activities1234567Selection of facilitiesCommunityMobilization andSensitizationInput TrackingCommunityPerformanceScorecardService ProvidersSelf EvaluationInterface Meeting(a conferencemeeting of bothservice providersand users orbeneficiaries)Advocacy anddisseminationIn all, 59 education and 15 health facilities wereselected across the six main divisions in thecountry for the pilot programCommunity Score Card Process• Facilitators organized the community and serviceproviders through facility heads and communityor traditional leaders• Preliminary session of both services providersand users or beneficiaries was held to discuss theCSC objectives, methodology, significance andexpectations• Facilitators determined with service providers thegovernment entitlements for each facility• Both service providers and beneficiariesdiscussed facility entitlements, and completedinput tracking matrix –comparing expectedamenities with what were actually providedBeneficiaries or the community developed facilityperformance assessment indicators and used the groupgenerated and standard indicators to evaluate theadequacy of amenities in the health and educationfacilitiesBy way of performance assessment, service providersevaluated their own performance using standard andgroup generated indicators• Performance assessments and observations ofeach focus group were methodically discussed• Problems inhibiting quality performance in thefacilities were collated and harmonized• Recommendations and feedback to serviceproviders were proposed• Action plans were mutually developedProject completion report will be widely publishedand a National workshop on the CSC report will beheldto elicit stakeholders feedback, and plans will bedevised to institutionalize the CSC methodologyStand.Indicators forAssessingfacilityperformanceAvailabilityof TeachersEDUCATION FACILITIESStandard and Group Generated IndicatorsSome Key Indicators Generated by Groups toAssess Facility PerformancePupils Staff Parentsfood programteachershousingCleanEnvironmentFurniture transportation discipline disciplineLearningmaterialsToiletfacilitiesteachingmaterialspupilattendancePunctualitylearningmaterialstoiletfacilitiesphysicalinfrastructureLearningmaterialsHealth servicesGoodadministrationPupils favoredamenities that induceconducive atmospherefor physical andacademic developmentTeachers believed infactors that enhancequality performance ofteachers and pupilsParents were much moreconcerned with thesafety and academicperformance of theirwardsSatisfaction with Primary Education Services in the Six Divisions – Central River, North Bank,Upper River, Lower River, Western and Kanifing Metropolitan Council8070605040302010080706050403020100CR NB URD LR WD KMCTearchers BenchesToiletTextBooksPerformance Assessment: Lower and Upper Basic Schools ComparedSatisfaction with Education ServicesLB UB LB UB LB UB LB UB LB UB LB UBCR NB URD LR WD KMCTeachers Benches Toilet Text BookAn analysis of survey data showedmarked differences in overall performanceof schools across the six regions‘Adequate teachers’ received more than70% approval rating in all regions exceptKMC (an urban area and more likely toattract more pupils than availableteachers)‘Adequacy of school facilities’ includingfurniture, core text books and toiletranked below 40% in each regionToilet facilities are either non- existentinadequate or appalling in NB, URD, LRDand WDPupils enrolment and school facilitiesi ll i KMCLevel of services providedvaried considerably betweenLower and Upper basic schoolsThe satisfaction rating ofavailability of teachers ishighest in Lower basic schoolsProvision of furniture was moresatisfactory in LBs than in UBsThe most visible area of equalperformance in LB and UB waspoor provision of toiletStandardIndicatorsHEALTH FACILITIESStandard and Group Generated IndicatorsSatisfaction with Health Services in the Six Divisions – Central River, North Bank,Upper River, Lower River, Western and Kanifing Metropolitan Council100806040200Group Generated IndicatorsStaffCommunity/patientsStaff Running water StandardinfrastructureAmbulance ElectricitysupplyElectricitysupplyDrugs CleanCleanenvironment environmentEssentialequipmentsFurniture StaffaccommodationPerformance Assessment (standard indicators)CRD NBD URD LRD WD KMCBoth health workers andpatients/community favoredhealth performance indicatorsthat facilitate quality andeffective service delivery.Beyond these, however, serviceproviders would want conditionsthat enhance capacity andconvenience to deliver servicebe included in the performanceindicators.StaffAmbulancedrugsEquipmentThe overall level of satisfaction with the adequacy of health facilities was not vastlydifferent compared with performance assessment for education.Availability of StaffThe survey indicated weak staff capacity with less than 30% satisfactory rating ofadequacy of staff at health facilities across the regions.EquipmentAvailability of Essential Equipment received less than 15% satisfactory rating in allregions exception KMC. It was recognized that lack of regular supply of electricity andwater affects the provision of essential equipment. For instance, about 40% of thehealth facilities involved in the CSC process did not have regular supply of electricity,20% relied on solar panel for energy and 40% used generator-supplied energy. Theseprovisional sources of energy have inherent limited capacity and high maintenance cost.DrugsAlthough the overall rating for availability of drugs was fairly encouraging (40%overall), the community felt that drugs were almost always in short supply exceptessential drugs like anti-malaria drugs which were available during malaria seasonAmbulanceAbout 69% of the health services surveyed had at least one ambulance although about30% of them were in deplorable condition. Availability of ambulance, therefore,received the highest rating in CRD, NBD, and LRD but zero percent rating in KMC.

Recommendations from Service Providersand the Community for Improving Performance inHealth FacilitiesEstablish a health committee representing the community and healthstaff to develop strategies and rules for enhancing efficient and effectivehealth services delivery in the communityHealth Committee should ensure government meets entitlementpackages including adequate supply of drugs, water, electricity,equipment, training and supply of health workersHealth Committee should champion an agenda for promoting cleanlinessand clean habit in and around health centersEstablish health supplemental funding program to ease reliance ongovernment support (inadequate and unpredictable government flowshave affected the quality of services provided in the hospital). In a fewcommunities, individuals took the initiative and made voluntarycontributions to help repair broken facilities in the clinic.General Observations on the Community Score CardProcess in GambiaThere was strong support for the CSC methodologyand an expressed indication for the tool to benurtured for fostering community empowerment andparticipation at the local levelThe CSC process succeeded in extracting communitygrievances about the quality and adequacy of healthand education services at the community levelThe process created a great deal of awareness on therelevance of CRC and, empowered the community toappreciate the implementation of the communityscore card. Approximately 3,500 stakeholdersparticipated in the process at the communitylevel alone including teachers, pupils, healthworkers and the community.The pilot project revealed that both service providersand the community were adequately informed aboutthe nature of and scope of their education and healthneedsLessons Learned and Corresponding RecommendationsCommunity EmpowermentPerhaps the most important lesson learned inthe implementation of the CSC wascommunity empowerment through: interfacemeeting between service users and providersfor immediate feedback and mutuallydeveloped action plans.Community ParticipationThe CSC Process enabled maximumparticipation of a wide range of stakeholdersfrom various towns and villages. More than55 development practitioners took part in thenational refresher training and about 3,500participants were involved in the CSCprocess at the community level.Self-help spirit:The CSC process revived self-help spiritamong communities expressed largelythrough instant individual voluntary financialcontributions, and the emphasis oncommunity roles in addressing majority ofthe problems confronting facilities in thecommunity.Awareness CreationCommunity members were enlightenedabout expected quantity and quality ofselected services in the their communitiesThe Scope of the CSC ProcessThe CSC project was ambitious in terms ofcoverage. Though a pilot program, itexpanded across the entire country involving59 education facilities and 15 health services.The CSC FocusPerformance indicators were focused moreon measuring quantity and less on qualityand output of the facilitiesData Management and AnalysisData management and analysis posedchallenge for the CSC resulting in somedelays in producing survey results.This not withstanding, an evaluation ofparticipants perceptions on the entireCSC process, using post programevaluation questionnaire would haveprovided a fairly elaborate informationon the general acceptability of themethodologyAn extensive community focusedprogram of this kind requires adequatetime for consultation and sensitization.Participants indicated that extendedtime for sensitization would have beenappropriate.Importance of information sharing,dissemination of project outcomes,advocacy efforts and planning for howto institutionalize CSC and socialaccountability processes at communitylevel would further resonate withcommunity driven initiatives inaddressing development problemsInstitutionalization of the of the CSCprocess would be critical in openingopportunities for community membersto express grievances about the qualityof services providedThough nation wide coverage waslaudable, the program’s scope ought tobe considered in the context ofavailable resources and capacity. Forexample, the scale of the exercisepresented challenges which could berevisited, including balancing a focuson the use of the CSC as a datamanagement tool versus anempowerment processMeasuring adequacy of services isimportant, but a CSC process that isdesigned to measure both quality andadequacy of services would fairlyreflect community preferences inidentifying performance targetsMaking adequate provision for capacityand resource needs for datamanagement and analysis would greatlyenhance the CSC process. Qualitytraining at the beginning of exerciseand close supervision throughout theCSC exercise ought to be consideredCommunity Score CardinGambiaMonitoring and evaluating the effectiveness of poverty strategies arecritical elements in the efforts to achieve sustainable and equitabledevelopment. Under its Poverty Reduction Strategic Papers (PRSP),Gambia outlined its commitment to promoting accountability,transparency and effectiveness through broad-based communityparticipation in monitoring and evaluation. However, there are criticalchallenges that need to be addressed in order to pursue these goals moreresolutely and consistently – including the need to strengthen thecapacity of stakeholders and enhance citizen participation.In line with its broad development objectives, the government of Gambiain collaboration with the Participation and Civic Engagement group ofSocial Development Department of the World Bank, developed theAccountability and Participatory Monitoring and EvaluationProgram which seeks to broaden citizens’ capacity, create opportunityfor citizens’ participation and feedback on the quality, adequacy andefficiency of key services largely through the Community Score Card(CSC) process. The CSC is a community based monitoring tool that isa hybrid of the techniques of social audit, community monitoring andcitizen report cards. It has a strong focus on empowerment andaccountability as it includes an interface meeting between serviceproviders and the community that allows for immediate feedback.The CSC process in Gambia, though a pilot program, involved 59 publicschools and 15 health services. A large spectrum of stakeholdersparticipated in the process- there were approximately 3,500 people from650 towns and villages at the community level including teachers,pupils, health workers and community members.-------------------------------February 2005-----------------------------------For more information on Community Score Card or Participation and Monitoringtools contact:Sering Falu NjieCoordinator,Strategy for Poverty Alleviation Coordination Office (SPACO)15/16 Marina Parade Banjul, GambiaTel: 220 422 9761 Email: falugalas@hotmail.com orVisit http://www.worldbank.org/participation