Use of scorecards to achieve facility improvements

Clinical Expertise
Sierra Leone
This Evidence for Action paper reviews the use of scorecards in improving the quality of emergency obstetric and neonatal care facilities in Sierra Leone.

This paper is part of the Evidence for Action (E4A) series published in the International Journal for Gynecology and Obstetrics (IJGO).

The article is co-authored by three members of the E4A team in Sierra Leone and the Director of the Reproductive and Child Health Department, also in Sierra Leone.


The scorecard-based assessment model was introduced in Sierra Leone following the launch of the national Free Health Care Initiative (FHCI) in 2010.

The FHCI was successful in helping to increase the use of maternal care services. However, this also meant that the availability and quality of EmONC services had to be improved to ensure the sustainability of the initiative.

How were the scorecards used?

Scorecards were used by a Facility Improvement Team (FIT) to identify the needs of selected facilities in preparing to provide EmONC. These assessments were conducted on a quarterly basis from October 2010 to July 2013.

The scorecards featured seven ‘enablers’ including water and sanitation, electricity, referrals, special equipment, blood storage and laboratory services, staffing, and drugs. These enablers were further broken down by specific criteria required for basic and comprehensive EmONC.

Overall, the indicators comprised the enabling environment in which UN-recommended signal functions of EmONC are performed.

A facility was awarded a performance rating for each enabler depending on how many of the criteria it had met. These were based on a traffic light system: green, yellow, amber, and red.

An enabler was rated green when all criteria were met, and a facility was certified as ready to provide EmONC when all seven enablers were green.


Of the government hospitals assessed between November 2010 and July 2013, over half raised their standards to green for all seven enablers. This was also achieved by almost 1 in 5 of the community health centres assessed.

The authors suggest that the ‘visual situation analysis’ that the scorecard provided of the quality of each facility helped to communicate the findings of their assessments.

The scorecards also encouraged collaboration and friendly competition between partners.

Key recommendations

The paper finishes by emphasising the importance of sustaining these improved facility standards in the future.

Key to this is identifying 1) cost-effective means of communicating findings to local health facilities and 2) a focal liaison person to coordinate communication and interventions.

The authors also suggest that FIT scorecards be used by communities in the future to encourage accountability among planners and decision-makers for the quality of services, and to help strengthen partnerships between key stakeholders.

Yilla, M., Nam, S. L., Adeyemo, A., & Kargbo, S. A. (2014). Using scorecards to achieve facility improvements for maternal and newborn health. International Journal of Gynecology and Obstetrics, 127(1): 108-112.
Use of scorecards to achieve facility improvements