When scorecard can spark action – The case of Bungoma County

Since its introduction in November 2017, the RMNCAH scorecard has become an important tool to drive resource allocation and accountability in the health system. Designed to monitor the performance of the Bungoma department of health, the scorecard was rolled out with support of E4A-MamaYe and is increasingly used by civil society to advocate for greater resources for the health of mothers, newborns, children and adolescents.

RMNCAH data can be complex and difficult to grasp for those who are busy delivering services, let alone for community members. Interested to learn more, I met Dr. Johnstone Akatu, Director of Health, and David Wang’ila, County Health Records & Information Officer, to ask them more about the RMNCAH scorecard in Bungoma. I was struck by the importance of how data is presented and interested to know more about how the tool is useful to the decision-making process.

Q. What role do you see data playing in the health sector? Why is data and evidence important?

 Dr. Akatu: In the health sector, we usually say that an activity that is not documented is as good as not done. That’s why data is important. It shows if you are doing well or not. It assists you in improving where you are not doing well. Where you are doing well, you strive to improve so that you are excellent.

Q. What is the RMNCAH scorecard?

Dr. Akatu: The RMNCAH scorecard was designed to monitor the department of health’s performance in the different areas of care for the health of a mother, newborn, a child and an adolescent.

This tool tracks various indicators at all levels - county and sub-county - and in a visually engaging format. It uses three colours: red, amber and green, that help inform us on where we are in the delivery of health services.

Red tells you, you are doing badly and those indicators need immediate attention. Amber tells you that you are trying but you need to improve. Green says you are doing well and should strive to maintain those indicators. Just like we look at the traffic lights, when it is red it shows there is danger and when it is green you are assured of safety.

Q. Do you have an example where you have used the scorecard to support your decision making?

Mr. Wang’ila: At county level, we use the RMNCAH scorecard in stakeholders’ meetings for advocacy and resource mobilization. These meetings are attended by the CHMT leadership led by the County Executive Committee member of Health and, at times, joined by political leaders who sit at the county assembly health committee. Similar meetings are also held at sub-county level and even get input from the community members.

At one point a simple indicator like antenatal care attendance (ANC) was not very good, specifically the first and the fourth ANC visits which are tracked. After looking at it and realizing that we were not doing well on ANC we had to look for ways to involve the community health volunteers, defaulter tracing and making sure those mothers who came for the first clinic could come for the second, third and even the fourth. This action improved the ANC indicator for Bungoma county – today, as we speak, this indicator is green.

Q. How would you like to see the RMNCAH scorecard strengthened?

Dr. Akatu: The scorecard at the management level has had a good uptake but we need to roll it down to the facility level. Many facilities have only a few members who have seen the scorecard, many other staff still don’t know about it. They do not have information on how they perform, all they know is that the managers want them to improve on ANC, but they are not even aware they are being [assessed] to see how well the facility delivers on key indicators.

Mr. Wang’ila: Currently the scorecard is promoting only two major pillars which are service delivery and the Health Management Information System. I want to see the scorecard promote the pillar for health care financing. What I want to see in the future is a scorecard that approaches the health system in a holistic way.

Q. If the scorecard is used more and indicators move from red to green, what will this mean to the health of women and children?

Dr. Akatu: My expectation is to see mothers of Bungoma accessing the best care and quality services. I want to see a county where the number of first and fourth ANC visits for every mother are almost the same. We want to see all mothers delivering at health facilities with skilled health workers. Children and babies should get the care they need from birth.

Data generates transparency, accountability and…action!

Adopting a traffic light system in the scorecard opened the data up for transparency and accountability: allowing CHMT, health workers, and community members to be on par when it came to understanding progress on RMNCAH. As a consequence of this, all were prompted to act. The scorecards, displayed in county and sub county offices, demonstrated this action with increasing greens and reducing reds over time.

The commitment of Bungoma County to measuring, documenting, and accelerating progress on RMNCAH is impressive, and we encourage them to continue on this trajectory. For other decision makers, we can learn from the case of Bungoma: by not only tracking but packaging data in an accessible way, change can be instigated across all levels of the health system for better health for women, children adolescents, and babies.