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- Reply rate:
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- Full-time (40 hrs/wk)
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Activity report in USAID funded project
USAID Afya Yangu –
Reproductive, Maternal,
Newborn, Child and
Adolescent Health (RMNCAH)
Community Score Card [CSC] Meetings Report
Region: Tanga
Council: Korogwe DC
Activity Dates:
24th February to 03rd March, 2024
Report submission date: 17th March, 2024
i
Acknowledgements
First and foremost, we express our sincere gratitude to the Almighty for the blessings of life and health that have
enabled us to conduct this invaluable community score card meetings for improving RMNCAH service delivery
and utilization. It is through His benevolence that we have been given the opportunity to complete the activity
successful, and we are truly grateful for this privilege.
BAKAID Tanzania expresses its genuine thankfulness to USAID for the funding that has been instrumental in the
successful implementation of all activities within the USAID Afya Yangu RMNCAH project. We would also like to
extend our appreciation to Jhpiego, the project lead, for their exceptional support in facilitating various activities.
This includes the comprehensive 3-day ToT training conducted last year (PY2) which focused on equipping
technical staff from CSOs with the necessary skills for facilitating community score card meetings and the
implementation of 7 community score card meetings conducted in 2024 at 7 villages whose dispensaries
experienced poor performance in RMNCAH indicators.
We wholeheartedly express our honest appreciation for the technical assistance rendered by the TCDC team
under the guidance of SBC Advisor Mr. Deogratius Rimoy and SBC RTO Ms. Patricia Placid Mkude, as well as
the BAKAID management, for their efforts that have ensured seamless logistics for the successful participation
of our technical staff.
We would like to extend our heartfelt gratitude to the CHMT members (DHPco, DRCHco, and DNuo) for their
unwavering dedication and commitment in the preparation and implementation of the community score card
meetings.
The community score card meetings encompassed several stages and engaged numerous stakeholders
throughout its planning and execution. BAKAID Tanzania expresses its heartfelt gratitude to all the stakeholders
who actively contributed to the successful preparation and implementation of the training activity, resulting in the
achievements highlighted in this report.
ii
Abbreviations
ANC
Antenatal Care
CHMT
Council Health Management Team
CHW
Community Health Worker
CSC
Community Score Card
DHPco
District Health Promotion Coordinator
DRCHco
District Reproductive and Children Health Coordinator
DTO
District Technical Officer
HCP
Health Care Provider
iCHF
Improved Community Health Fund
RMNCAH
Reproductive, Maternal, Newborn, Child and Adolescent Health
SBC
Social Behavior Change
TBA
Traditional Birth Attendant
VEO
Village Executive Officer
iii
Contents
Acknowledgements ............................................................................................................................................................ii
Abbreviations ..................................................................................................................................................................... iii
Executive Summary ........................................................................................................................................................... v
Background Information..................................................................................................................................................... 5
Objectives of the community score card meetings............................................................................................................ 2
Overall objective: .......................................................................................................................................................... 2
Specific objectives: ....................................................................................................................................................... 2
Place and dates ................................................................................................................................................................ 3
Target Individuals/population ............................................................................................................................................ 3
Tools used ........................................................................................................................................................................ 4
Accomplishment ............................................................................................................................................................... 4
Challenges and or lessons learnt...................................................................................................................................... 5
Challenges: .................................................................................................................................................................. 5
lessons learnt: .............................................................................................................................................................. 5
Agreed way forward and recommendations ..................................................................................................................... 6
Agreed way forward...................................................................................................................................................... 6
Recommendations........................................................................................................................................................ 7
Annexes:............................................................................................................................................................................ 8
Annex 1: Action plans per village ...................................................................................................................................... 8
Tamota Dispensary (Tamota Village)- Lutindi ward...................................................................................................... 8
Kwakibomi Dispensary (Kwakibomi Village)- Mgwashi ward...................................................................................... 13
Tewe Dispensary (Tewe Village)- Mpale ward ........................................................................................................... 16
Kigwasi Dispensary (Kigwasi)- Kalalani ward ............................................................................................................. 18
Buiko Dispensary (Buiko Village)- Mkomazi ward ...................................................................................................... 20
Nanyogie Dispensary (Nanyogie Village)- Mkomazi ward .......................................................................................... 22
Changalikwa Dispensary (Changalikwa Village)- Magamba kwalukonge ward.......................................................... 24
Annex 2: Events in Photos (Pictures) ............................................................................................................................. 27
iv
Executive Summary
In 2023, some health facilities experienced poor performance in RMNCAH indicators, particularly in facility-based
delivery and the initiation of ANC within the first trimester. To address these gaps, between February 24 to March
03, community scorecard meetings were organized and conducted to collectively assess and tackle the
challenges faced by these facilities. These meetings aimed to engage community members, healthcare
providers,LGA leaders, and other stakeholders in a participatory process to enhance RMNCAH outcomes in
7 selected health facilities by identifying and addressing barriers to facility-based delivery, early ANC initiation,
and other RMNCAH indicators.
DRCHco selected the following health facilities with 2023 percentages of the facility-based delivery in the bracket;
Kwakibomi dispensary (10.3%), Tamota dispensary (16%), Tewe dispensary (31%), Changalikwa dispensary
(30.5%), Buiko dispensary (8%), Nanyogie dispensary (20%), and Kigwasi dispensary (19%).
To ensure the objectives of CSC meetings are met, a total of 245 people were reached representing
important groups of service users (women, men, youths/adolescents, and marginalized groups), service
providers as the individuals responsible for delivering RMNCAH services at health facilities, also include CHWs
and TBAs, also leaders and influential people involving local government officials, dispensary service
management committee, the village health committee, religious leaders, traditional leaders, and other influential
people.
From the community scorecard meetings, the following were the observations; harmful social and gender
norms, as well as unethical practices by healthcare providers, have been identified as significant barriers to the
effective utilization of RMNCAH services. Specifically, in the Maasai community at Changalikwa, Kigwasi, and
Nanyogie, these norms negatively affect health-seeking behaviors and limit access to RMNCAH services.
Healthcare providers engaging in dishonest practices, including inappropriate language, charging for free
services, and selling drugs and medical equipment that should be provided at no cost, further undermine trust
and access to essential RMNCAH healthcare services. Additionally, religious and traditional misconceptions
perpetuated by leaders contribute to decreased utilization of facility delivery services, while the shortage of
healthcare providers in some dispensaries leads to inadequate coverage, impacting the quality of healthcare
services.
Addressing these issues is crucial to ensuring equitable and effective delivery of RMNCAH services and
safeguarding the well-being of individuals and communities. Joint efforts are required to comprehensively address
these challenges affecting the health facilities and the communities they serve.
Background Information
In 2023, it was observed that there are some health facilities which demonstrated poor performance in RMNCAH
indicators, particularly in the areas of facility-based delivery and the initiation of Antenatal Care (ANC) within the
v
first trimester. Recognizing the critical importance of addressing these gaps, the decision was made to convene
community scorecard meetings in order to collaboratively assess and address the challenges faced by these
health facilities. This proactive approach aims to engage community members as service users, healthcare
providers, LGA leaders, and other relevant stakeholders in a participatory process geared towards improving the
RMNCAH indicators and ultimately enhancing the overall RMNCAH outcomes within these communities.
DRCHco, through annual data for 2023, selected 7 health facilities with poor performance in 2023 from 7 villages
where community scorecard meetings would be held with the aim of fostering inclusive and participatory
approaches to improve RMNCAH indicators. By engaging the local community members, health facility staff, and
key stakeholders, these meetings seek to identify and address the multifaceted challenges that contribute to the
low rates of facility-based delivery, early ANC initiation, and utilization of other RMNCAH indicators. Through this
collaborative process, the goal is to gain insights into the specific barriers faced by the communities and co-create
targeted actions that are sensitive and contextually relevant in addressing the challenges.
DRCHCo selected the following health facilities with percentages of the facility-based delivery in the bracket;
Kwakibomi dispensary (10.3%), Tamota dispensary (16%), Tewe dispensary (31%), Changalikwa dispensary
(30.5%), Buiko dispensary (8%), Nanyogie dispensary (20%), and Kigwasi dispensary (19%).
The initiative to hold community scorecard meetings reflects a commitment to promoting accountability and
transparency within the local health systems. By providing a platform for open dialogue and constructive feedback,
these meetings serve as a catalyst for empowering communities and fostering a sense of ownership over the
RMNCAH indicators. Furthermore, by leveraging the collective wisdom and expertise of diverse stakeholders, the
aim is to develop sustainable strategies that can lead to tangible improvements in facility-based delivery and
timely ANC initiation, ultimately contributing to the overall well-being of mothers and children in these underserved
communities.
Objectives of the community score card meetings
Overall objective:
To positively assess, monitor, and give feedback on the quality and effectiveness of RMNCAH services at 7 health
facilities with poor performance in RMNCAH indicators. This process aimed to improve service delivery by
fostering collaboration and accountability between service providers and the community (service users).
Specific objectives:
To constructively assess RMNCAH services delivery: Evaluate the quality of RMNCAH services and
the utilization of services by the community so as to identify the reasons behind the poor performance of
health facilities in RMNCAH indicators.
2
To identify priority needs: Identify and prioritize areas for improvement based on the community's
perspectives and experiences.
To promote Accountability: Hold service providers, the dispensary service management committee
and the village health committee accountable for their performance and responsiveness to community
needs and concerns.
To empower Communities: Empower citizens to actively participate in decision-making processes and
contribute to improving the quality of RMNCAH services.
To enhance Transparency: Foster transparency by openly sharing information about service
performance and engaging in constructive dialogue between stakeholders.
To develop collaborative action plan: Community (services users), LGA officials, service providers,
and the CHMT to develop a collaborative action plan to address the identified gaps and improve the
RMNCAH service delivery.
Place and dates
Dates
24th February, 2024
26th February, 2024
27th February, 2024
28th February, 2024
29th February, 2024
02nd March, 2024
03rd March, 2024
Ward
Mkomazi
Mkomazi
Lutindi
Kalalani
Mgwashi
Mpale
Magamba kwalukonge
Village
Buiko
Nanyogie
Tamota
Kigwasi
Kwakibomi
Tewe
Changalikwa
Health Facility
Buiko Dispensary
Nanyogie Dispensary
Tamota Dispensary
Kigwasi Dispensary
Kwakibomi Dispensary
Tewe Dispensary
Changalikwa Dispensary
Target Individuals/population
The involvement of these diverse target groups ensures a holistic and inclusive approach to assessing and
improving RMNCAH service delivery within a community. The target groups for the community score card typically
include:
Community Members: Engaging the local community is essential for the success of the community
score card. This can involve a diverse range of community members including women, men,
youths/adolescents, and marginalized groups.
Service Providers: These are the individuals responsible for delivering RMNCAH services at health
facilities, also include CHWs and TBAs.
Leaders and influential people: Involving local government officials, dispensary service management
committee, the village health committee, religious leaders, traditional leaders, and other influential people
help in fostering accountability and transparency in the delivery of health services.
3
Tools used
The tools used in community score card meetings typically include:
Score chart/ clients satisfaction feedback emojis: These were used to rate and assess the
performance of different services.
Facilitation guides: These provide a structured framework for the meeting facilitator to effectively lead
discussions and activities (indicators guideline from the ministry of health).
Action planning templates: These help in outlining specific actions and timelines for addressing
identified issues and improving services.
Accomplishment
Planning and Preparation:
This stage was the foundation of the CSC process, including operational planning components such as identifying
7 health facilities with poor performance in RMNCAH indicators, identifying the facilitators (3 CHMTs, i.e., DHPCo,
DRCHco, and DNuo), getting buy-in from service providers, local leaders, and other key stakeholders, and
building understanding, commitment, and trust among all parties.
Conducting the CSC with the community:
Trained BAKAID technical staff in collaboration with CHMTs led focus group discussions with 3 groups of service
users (women, youths, and men), 1 group of service providers, and 1 group of local leaders and influential people.
Interface meeting:
The previous stages were all building towards the interface meeting. At the interface meeting, service users,
leaders, and service providers were encouraged to share and discuss their scores and then decide on a shared
score and develop the joint action plan for all the indicators that got scores of 1, 2, and 3. Scores were shared,
with justifications for scoring given by each group, and then a final score was agreed upon and used as the basis
for the action plan. Finally, actions for improving service and priority issues for action were agreed upon.
The number of people involved in community scorecard meetings is as specified in the table below:
A total of 245 people engaged in community scorecard meetings, consider the disaggregation below,
Village
Buiko
Nanyogie
15-19 years
Male Female
0
2
0
4
20-24 years
Male Female
1
7
7
1
25+ years
Achievement
Male Female
Total-
4
Tamota
Kigwasi
Kwakibomi
Tewe
Changalikwa
0
0
0
0
0
1
2
0
0
1
3
3
0
3
0
7
2
4
3
2
-
-
-
Challenges and or lessons learnt
Challenges:
Communication barriers: Many Maasai participants of community scorecard meetings at Nanyogie,
Kigwasi, and Changalikwa did not know the Swahili language fluently, so we had to have a Maasai
translator who knows the Swahili language fluently.
lessons learnt:
Harmful social and gender norms in Maasai community at Changalikwa (Magamba kwalukonge ward),
Kigwasi (Kalalani ward), and Nanyogie (Mkomazi ward) negatively impact health seeking behaviors and
often limit clients’ access to and use of RMNCAH services including ANC within first trimester of gestation,
facility-based delivery, and postnatal care.
HCPs who fail to uphold honesty and compliance with their professional obligations significantly impede
the utilization of RMNCAH services. Their actions, such as using inappropriate language with clients,
charging for services that should be free, and selling drugs and medical equipment that should be
provided at no cost when available at health facilities, including delivery kits and FP services, undermine
the trust and access to essential RMNCAH healthcare services. This non-compliance not only violates
guidelines and regulations but also erodes the fundamental principles of healthcare provision. It is
imperative to address these unethical practices to ensure the equitable and effective delivery of RMNCAH
services, safeguarding the well-being of individuals and communities.
The impact of religious and traditional misconceptions perpetuated by religious and traditional leaders on the
utilization of facility delivery services are profound. Religious and traditional leaders propagate misconceptions
about women getting RMNCAH services from male attendants, particularly in relation to ANC and facility-based
delivery services. This results in a decreased utilization of ANC and facility delivery services, leading to an
increased risk of complications during childbirth and a higher maternal and infant mortality rate. The presence of
only male HCPs in some dispensaries in Korogwe DC is due to the severe shortage of HCPs, resulting in
inadequate coverage that fails to meet even 50% of the demand.
Despite staff reshuffles that have taken place in some health facilities a few months prior to the community
scorecard meetings, the performance of these facilities remains unsatisfactory due to the opium that have
5
built up in the community over the poor health services that were provided before. This lingering impact
has been observed at the Buiko, Nanyogie, Kigwasi, and Changalikwa dispensaries, where the
community scorecard meetings have revealed a persistence of challenges stemming from the
accumulation of dissatisfaction within the community. This situation underscores the need for
comprehensive joint efforts to address the matter affecting these health facilities and the communities
they serve.
Agreed way forward and recommendations
Agreed way forward
Two feedback meetings will be held for each village to discuss feedback on the implementation of the
action plan after one month (for those actions that require short-term implementation) and after three
months (for those actions that require long-term implementation).
All issues that need to be addressed in collaboration with CHMT, including disciplinary issues and HCP
charging clients contrary to government instructions, will be worked on within two weeks after the
community score card meetings.
Ensuring that harmful social norms and traditions limit the access to and utilization of RMNCAH services
provided at health facilities is dispelled by the community; LGAs, HCPs, CHWs, TBAs, traditional leaders,
influential people, and religious leaders should have a task force to provide comprehensive education in
their congregations; HCPs should support community leaders to have messages that describe the
benefits of using RMNCAH services provided at health facilities (ANC and facility delivery) and the
adverse health effects of not utilizing those services as recommended by health professionals.
LGAs at village and ward levels should ensure they work collaboratively to address the challenges (which
are within their control) that limit HCPs from providing services at all times and with quality. Those
challenges include the presence of a security guard and the repair of some infrastructure, such as toilets.
Since transportation has been a challenge in all areas where community score card meetings were held,
LGAs through meetings and other legal means, should find bidders for the M-MAMA program to support
access to transportation for pregnant women and newborns during emergencies.
In the collaborative efforts between the HCP and the Village LGA office should leverage the village meetings as a
platform to alleviate citizens’ fear and reinstate trust in the services offered at the health facility. Furthermore,
emphasis should be placed on the presence of HCP dedicated to providing exemplary customer care. The
testimonies of individuals who have experienced improved service delivery subsequent to the recent reorganization
of the HCP can also be utilized to bolster this initiative.
6
Recommendations
For those wards (Kalalani, Mgwashi, and Mpale) with poor performance in RMNCAH indicators and no
CHWs who implement SBC community-based interventions of the USAID Afya Yangu-RMNCAH project,
should be considered to ensure the community gets education and gets rid of harmful social norms and
traditions that limit access to and utilization of RMNCAH services.
Activities like Afya Gulio should be done in one of the most challenging wards as a platform to provide
RMNCAH education to the community greatly affected by harmful social norms and traditions, especially
in the wards with Maasai community.
Council should adopt community score cards as a key essential tool in assessing the provision of quality
RMNCAH services at facilities. This will help to understand the gaps that hinder the various efforts that
are being made at the community level to encourage the community to utilize services at the facility level.
7
Annexes:
Annex 1: Action plans per village
Tamota Dispensary (Tamota Village)- Lutindi ward
S/N Indicator
1.
Score
Description
Action Plan
Use of inappropriate language to The CHMT will diligently follow up on
clients by one of the HCPs.
the allegations made against the
Senior citizens (the elderly) are not respective HCP and take appropriate
Reception of patients/ clients.
2
given priority in the provision of health
services.
Responsible
Person
Timeline
CHMT (DHPco
and DRCHco)
March 15, 2024
HCP, CHMT, and
the LGA
February 28, 2024
onward
action. The findings and actions
taken in response to the allegations
will be communicated during the first
feedback meeting.
2.
Service delivery.
The dispensary is not opened on time
HCPs instructed to adhere to the
consistently; it is opened earlier only
when a certain HCP is present.
3.
guidelines, and ensure that the
dispensary regularly opened from
07:30 hrs. to 15:30 hrs and the
3
effectively follow up will be made to
ensure the time is observed to
enable clients to get services as
they should.
Awareness of Comprehensive Reproductive Health and Maternal Care from Preconception to Postpartum for Women, and Children Under 5.
During pregnancy
Many pregnant women start ANC clinics The CHMT will diligently follow up
beyond the first trimester because,
on the allegations made against the
apart
from
other
expenses
during
the
respective HCP and take
1
initiation of ANC, pregnant women are
appropriate action. The findings
8
charged for each ANC clinic visit. As a
result, those who are unable to afford
this cost often delay starting the ANC
clinic.
During delivery
1
Education about vaccination is not
After delivery
3
4.
Users' contribution to health services.
always provided.
CHMT (DHPco
and DRCHco)
March 15, 2024
HCP to start providing education to
mothers after giving birth to help
them raise infants based on
healthy practices.
HCPs
February onward
There are traditions and customs that LGA leaders, religious leaders,
Existence of restrictions/ barriers on the
utilization of services.
3
5.
and actions taken in response to
the
allegations
will
be
communicated during the first
feedback meeting.
Many pregnant women give birth at Citizens should be aware that all
maternal health services are free,
home and in nearby centers (Bungu
and when they are charged any
HC and Lutindi Mental hospital) due to
cost, they are supposed to report
the misbehavior of the HCP.
through the procedure of submitting
In some cases, pregnant women opt to
complaints to the relevant
deliver their babies at home due to
authorities in their villages.
restrictions from the dispensary. If a
pregnant woman has not initiated ANC
at the Tamota dispensary, she is
supposed to give birth at the facility
where she initially started the ANC
clinic.
endanger the health of pregnant
women, including the excessive
workload to be termed an exercise for
expectant mothers.
The cost of contributing services is not
specified (clients are billed varying fees
for similar treatments and services).
CHWs, HCPs, and other influential
people should have a serious task
force to mobilize the community
through their congregations to
eliminate harmful social norms and
traditions that limit access to and
utilization of maternal services.
HCP should update the poster
displaying the treatment costs
following the guidelines
Village
chairperson and
religious leaders
March 31, 2024,
and will be
continuous
Facility in charge
March 31, 2024
9
provided, along with the list of
drugs and their prices duly
signed by the DMO.
A pregnant woman is charged Tsh. The CHMT will diligently follow up
2
1,500 for each ANC clinic visit. As a
result, those who are unable to afford
this cost often delay starting the ANC
clinic, and others fail to complete the
recommended number of visits.
on the allegation made against the
respective HCP about charging for
ANC services and take appropriate
action. Also, HCP should
immediately stop charging for any
maternal services because it is
against the health policy.
There is limited awareness among HCPs at the health facility and
through village meetings should
the villagers about iCHF because
provide education to the community
the awareness sessions not being
about iCHF and encourage them to
held effectively.
join, considering the benefits of the
household having insurance.
7.
The
performance
of
dispensary
Facility in charge
and Village
chairperson
March, 2024
There is no reliable transport for Due to the shortage of ambulances
Availability of transportation to the health facility for
emergency cases.
3
8.
CHMT and HCP
For CHMT (March
15, 2024)
service
management committee.
3
pregnant women when there is an
emergency; mostly motorbikes and
stretchers are used, which are not
friendly means due to the condition of
the infrastructure.
Lack of involvement of the
dispensary service management
committee in various activities at the
dispensary, as it should be.
in Korogwe DC, apart from
continuing to use ambulances when
they are not on the route, the LGA
at the village, through meetings and
other legal means, should find a
bidder for M-MAMA. This will help
to ensure reliable transportation
from their area.
Village
chairperson and
VEO
March to May,
2024
The
village chairperson, in
collaboration with VEO should
follow up on the existence of the
committee, and if it is alive, it should
be reminded on its duties;
otherwise, legal procedures for the
Village
chairperson and
VEO
March 31, 2024
10
acquisition of another committee
should be followed.
9.
The systemic process of receiving and handling
complaints.
The suggestion box exists, but it does
not meet the criteria for freedom of
receiving and storing suggestions (it
has a single lock).
The suggestion box should be
Citizens do not trust each other, a
situation that eliminates the freedom to
express
opinions
because
confidentiality in expressing opinions
is not considered. When someone
posts his or her suggestions,
dishonest citizens provide information
to the HCP about who posted those
suggestions.
There is no friendly system for
receiving and handling complaints,
including the absence of a register
book for suggestions/complaints.
The
2
10.
The availability of medical drugs, delivery kits,
equipment, and reagents
repaired by installing two locks, and
the keys of one lock should be
given to the facility in charge, and
the keys of another lock should be
given to a member of the
dispensary service management
committee.
facility in charge should make sure
there is a register book for
registering
complaints
and
suggestions.
dispensary
service
management committee should
improve the systemic process of
receiving and handling complaints
by working on all the identified
gaps.
The committee, through meetings
should provide feedback on the
actions taken to address complaints
and suggestions.
The drugs available at the dispensary
The CHMT will diligently follow up
are sold at different prices (the same
type of drug is charged at different
prices to different clients).
on the allegation made against the
respective HCP about selling
delivery kit at the dispensary and
Facility in charge
and the
chairperson of the
dispensary service
management
committee.
March 31, 2024
Village
chairperson, and
the chairperson of
the committee
March, 2024 up to
May 2024
CHMT and HCP
For CHMT (March
15, 2024)
11
Delivery kits are sold at dispensary for
2
Tsh. 21,000, contrary to government
instructions.
take appropriate action. Also, HCP
should immediately stop selling
delivery kit because it is against the
health policy.
HCP should update the poster
displaying the treatment costs
following
the
guidelines
provided, along with the list of
drugs and their prices duly
signed by the DMO.
11.
Behaviors and conduct of service providers.
3
12.
The behavior and conduct of one HCP are The CHMT will diligently follow up
unsatisfactory for the following reasons:
on the allegations made against the
The dispensary is not opened on
respective HCP and take
time consistently; it is opened earlier
appropriate action. The findings
only when a certain HCP is present.
and actions taken in response to
the
allegations
will
be
Use of inappropriate language to
communicated
during
the
first
clients by one of the HCPs.
feedback meeting.
The village health committee does not
The performance of village health committee.
3
13.
perform its duties.
Community awareness about RMNCAH.
3
RMNCAH education has not reached
the people at large.
The committee should be
reminded of its responsibilities
and ensure that it works
properly.
LGA leaders, religious leaders,
CHWs, HCPs, and other
influential people should have a
serious task force (each in
his/her position) to mobilize the
through their congregations on
the RMNCAH issues.
Facility in charge
March 31, 2024
CHMT (DHPco
and DRCHco)
March 15, 2024
Village
chairperson and
VEO
March 15, 2024
Village
chairperson and
religious leaders
March 31, 2024,
and will be
continuous
12
14.
15.
Compliance with health care exemptions.
3
The process of referral issuance
HCP and citizens do not have CHMT will orient HCPs on
services exemptions and provide
enough understanding about
them with guideline.
healthcare exemptions.
Referral forms are not used in
HCP to ensure that they use forms
during referral issuance for proper
providing referrals.
CHMT (DRCHco
and DHPco)
March 15, 2024
Facility in charge
March onward
Village
chairperson and
WEO
March to May,
2024
documentation.
No reliable transport for emergency
(no M-MAMA bidder).
3
Due to the shortage of ambulances
in Korogwe DC, apart from
continuing to use ambulances when
they are not on the route, the LGA
at the village, through meetings and
other legal means, should find a
bidder for M-MAMA. This will help
to ensure reliable transportation
from their area.
Kwakibomi Dispensary (Kwakibomi Village)- Mgwashi ward
S/N Indicator
3.
Score
Description
Action Plan
Responsible
Person
Awareness of Comprehensive Reproductive Health and Maternal Care from Preconception to Postpartum for Women, and Children Under 5.
During pregnancy
Many pregnant women are The CHMT will diligently follow up
on the allegation made against the
charged various costs when
respective HCP about charging for
starting an ANC clinic including
ANC
services and take appropriate CHMT and HCP
the charge for clinic card. As a
action. Also, HCP should
3
result, those who are unable to
immediately stop charging for any
afford the expenses due to their
maternal services because it is
economic situation often delay
against the health policy.
Timeline
March 20, 2024
starting the ANC clinic.
After delivery
Lack of education provided to the
mother after giving birth; after giving
HCP to start providing education to
mothers after giving birth to help
13
birth once her condition and the
condition of newborn is deemed
stable, she is discharged from the
hospital without further guidance or
information.
3
5.
Users’ contribution to health services.
2
6.
Clients are charged for family plan
The CHMT will diligently follow up
services (10,000 for implants with a
breakdown of 2,000 for pregnancy
tests, 3,000 for anesthesia, and
5,000 for implants, while 4,000 for
injection method with a breakdown
of 2,000 for pregnancy tests and
2,000 for DEPO), contrary to the
instructions for the relevant services
to be provided free of charge.
When pregnant women get sick,
they are charged for medical
expenses.
on the allegation made against the
respective HCP about charging for
maternal services and take
appropriate action. Also, HCP
should immediately stop charging
for any maternal services because
it is against the health policy.
The performance of community health workers in
fulfilling their duties at the community level.
Availability of transportation to the health facility for
emergency cases.
3
Not all villagers are familiar with
CHW because has not been
formally introduced during the
village meeting. (This leads to
not getting a good cooperation
from the community).
3
7.
them raise infants based on
healthy practices.
There is no reliable transport for
pregnant women when there is an
emergency; mostly motorbikes and
stretchers are used, which are not
HCPs
March onward
CHMT and HCP
March 20, 2024
Village
chairperson and
VEO
March onward
The CHW should be introduced
through the village meeting and the
people should be informed of
his/her duties.
Because CHW is doing voluntary
work, should be given the privilege
of exemption from other community
duties (Misaragambo) and various
contributions of the village.
Due to the shortage of ambulances
in Korogwe DC, apart from
continuing to use ambulances when
they are not on the route, the LGA
at the village, through meetings and
Village
chairperson and
VEO
14
8.
The
performance
of
dispensary
service
management committee.
3
9.
The systemic process of receiving and handling
complaints.
2
10.
The availability of medical drugs, delivery kits,
equipment, and reagents
2
friendly means due to the condition
of the infrastructure.
other legal means, should find a
bidder for M-MAMA. This will help
to ensure reliable transportation
from their area.
The committee does not provide
feedback on various issues of the
dispensary to the community,
including feedback on the handling
of complaints and suggestions from
the public.
The suggestion box exists, but it
does not meet the criteria for
freedom of receiving and storing
suggestions (it has a single lock).
There is no friendly system for
receiving and handling complaints,
including the absence of a register
book for suggestions/complaints.
The committee, through meetings
should provide feedback on the
actions taken to address
complaints and suggestions.
March to May,
2024
Village
chairperson and
chairperson of the
dispensary service
management
committee.
March, 2024
onward
The suggestion box should be
repaired by installing two locks, and
the keys of one lock should be
given to the facility in charge, and
the keys of another lock should be
given to a member of the
dispensary service management
committee.
facility in charge should make sure
there is a register book for
registering
complaints
and
suggestions.
The
dispensary
service
management committee should
improve the systemic process of
receiving and handling complaints
by working on all the identified
gaps.
Delivery kits are sold at dispensary The CHMT will diligently follow up
for Tsh. 25,000, contrary to
on the allegation made against the
government instructions.
respective HCP about selling
delivery kit at the dispensary and
Facility in charge
and the
chairperson of the
dispensary service
management
committee.
CHMT and HCP
March 31, 2024
March 20, 2024
15
take appropriate action. Also, HCP
should immediately stop selling
delivery kit because it is against the
health policy.
15.
No reliable transport for Due to the shortage of ambulances
in Korogwe DC, apart from
emergency (no M-MAMA bidder).
The process of referral issuance
continuing to use ambulances when
they are not on the route, the LGA
at the village, through meetings and
other legal means, should find a
bidder for M-MAMA. This will help
to ensure reliable transportation
from their area.
3
Village
chairperson and
WEO
March, 2024 to
May, 2024
Tewe Dispensary (Tewe Village)- Mpale ward
S/N Indicator
3.
Score
Description
Action Plan
Awareness of Comprehensive Reproductive Health and Maternal Care from Preconception to Postpartum for Women, and Children Under 5.
Pre-conception
Poor involvement of partners
(husband and wife) in planning and
2
using contraceptive methods.
LGA leaders, religious leaders,
During pregnancy
Pregnant mothers are delaying
CHWs, HCPs, and other influential
starting ANC clinics (mostly beyond
people should have a serious task
the first trimester), and male
2
force (each in his/her position) to
participation in ANC is poor.
mobilize the community through
During delivery
Many pregnant women are giving
their congregations to eliminate
birth at home due to the harmful
harmful social norms and traditions
norms and traditions fermented by the
that limit access to and utilization of
3
presence of TBAs and lack of
maternal services, and encourage
awareness on adverse health impacts
of home-based delivery.
Responsible
Person
Village
chairperson,
facility in charge,
and religious
leaders
Timeline
March and April,
onward
16
4.
The major obstacle to the use of
Existence of restrictions/ barriers on the utilization
of services.
2
6.
The community is not familiar with
CHWs and their roles. (This leads
The performance of community health workers in
fulfilling their duties at the community level.
3
7.
to not getting a good cooperation
from the community).
The CHW should be introduced
through the village meeting and the
people should be informed of
his/her duties.
Because CHW is doing voluntary
work, should be given the privilege
of exemption from other community
duties (Misaragambo) and various
contributions of the village.
Village
chairperson and
VEO
March onward
Village
chairperson and
VEO
March, 2024 to
May, 2024
All key
stakeholders led
by village
chairperson and
religious leaders.
March onward
There is no reliable transport for Due to the shortage of ambulances
Availability of transportation to the health facility for
emergency cases.
3
13.
RMNCAH services is the lack of
education at the community level to
dispel the misconceptions of the
community about the access to and
full utilization of RMNCAH services.
the participation of male partners in
RMNCAH issues.
pregnant women when there is an
emergency; mostly motorbikes which
are not friendly means due to the
condition of the infrastructure.
in Korogwe DC, apart from
continuing to use ambulances when
they are not on the route, the LGA
at the village, through meetings and
other legal means, should find a
bidder for M-MAMA. This will help
to ensure reliable transportation
from their area.
Mobilization to increase community A task force that will involve all key
Mobilization to increase community awareness about
health.
3
awareness about health issues has
not been done to a satisfactory level.
stakeholders should cooperate to
ensure that the community is
reached with messages that will
increase their awareness about
health issues through meetings,
faith-based congregations, and
17
other
available
gatherings.
16.
community
The facility has no electricity and The village chairperson will lead the
Working environment and availability of suitable
infrastructure.
2
needs repair.
The dispensary does not have a
watchman, this poses risk to the
safety of the facility equipment and the
safety of the HCP when a patient
needs emergency care at night like
delivery case.
process of hiring the security guard
and all other logistics regarding his
payment.
Village
chairperson
March, 2024 to
April, 2024
Kigwasi Dispensary (Kigwasi)- Kalalani ward
S/N Indicator
3.
4.
Score
Description
Action Plan
Awareness of Comprehensive Reproductive Health and Maternal Care from Preconception to Postpartum for Women, and Children Under 5.
Pre-conception
2
Many pregnant women are delaying LGA leaders, religious leaders,
starting an ANC clinic, giving birth at
CHWs, HCPs, traditional leaders
During pregnancy
2
home,
and
not
using
modern
from Maasai community, and other
During delivery
2
contraceptive methods due to the
influential people should have a
After delivery
harmful norms and traditions of the
serious task force (each in his/her
Maasai community; the influence of
position) to mobilize the community
2
TBAs has perpetuated these
through their congregations to
practices, despite the government's
eliminate harmful social norms and
strict prohibition on home-based
traditions that limit access to and
deliveries.
utilization of maternal services, and
Existence of restrictions/ barriers on the utilization
The harmful norms and traditions of
encourage the participation of male
the Maasai community greatly affect
partners in RMNCAH issues.
of services.
the
utilization
of
RMNCAH
services
2
To identify TBAs who conduct
at the health facility.
home-based delivery and provide
them with education, making them
Responsible
Person
All key
stakeholders led
by village
chairperson,
Maasai leaders,
and religious
leaders.
Timeline
March onward
18
the key to
community.
5.
Users’ contribution to health services.
3
changes
in the
There is limited awareness HCPs at the health facility and
through village meetings should
among the villagers about iCHF
provide education to the community Facility in charge
because the awareness sessions
about iCHF and encourage them to
not being held effectively.
March 31, 2024
onward
join, considering the benefits of the
household having insurance.
7.
There is no reliable transport for Due to the shortage of ambulances
Availability of transportation to the health facility for
emergency cases.
3
13.
in Korogwe DC, apart from
continuing to use ambulances when
they are not on the route, the LGA at
the village, through meetings and
other legal means, should find a
bidder for M-MAMA. This will help to
ensure reliable transportation from
their area.
Village
chairperson and
VEO
March to May,
2024
For a long time, no public meetings A task force that will involve all key
Mobilization to increase community awareness about
health.
All key
stakeholders should cooperate to
stakeholders
led
ensure that the community is
by village
reached with messages that will
chairperson,
increase their awareness about
health issues through meetings, Maasai traditional
leaders, and
faith-based congregations, and
religious
leaders.
other
available
community
gatherings.
The dispensary
dispensary
service
The facility has no electricity, this The
service
management
committee,
in
limits the HCP to provide care at
management
collaboration with the village
night when an emergency occurs.
chairperson, intends to engage committee and the
with the development partners of village chairperson
Kigwasi (TANAPA and other
were conducted to build community
awareness about health issues.
3
16.
pregnant women when there is an
emergency; mostly motorbikes and
stretchers are used, which are not
friendly means due to the condition
of the infrastructure.
Working environment and availability of suitable
infrastructure.
3
March village
quarterly meeting
onward
March to May,
2024
19
stakeholders) to seek support for
the electrical installation at the
health facility.
Buiko Dispensary (Buiko Village)- Mkomazi ward
S/N Indicator
3.
4.
Score
Description
Action Plan
Awareness of Comprehensive Reproductive Health and Maternal Care from Preconception to Postpartum for Women, and Children Under 5.
Pre-conception
2 Poor involvement of partners (husband LGA leaders, religious leaders,
and wife) in planning and using
CHWs, HCPs, and other influential
contraceptive methods.
people should have a serious task
During pregnancy
2 Pregnant mothers are delaying force (each in his/her position) to
starting ANC clinics (mostly beyond mobilize the community through their
the first trimester), and male congregations to eliminate harmful
social norms and traditions that limit
participation in ANC is poor.
access to and utilization of maternal
services, and encourage the
participation of male partners in
RMNCAH issues.
The opium derived from poor health In the collaborative efforts between
Existence of restrictions/ barriers on the utilization
of services.
2
services from HCPs shifted a few
months ago has left an impact on the
community by removing their trust in
health facilities.
Lack of education at the community
level to dispel the misconceptions of
the community about the access to
and full utilization of RMNCAH
services.
the HCP and the Village LGA office
should leverage the village meetings
as a platform to alleviate citizens’
fear and reinstate trust in the
services offered at the health facility.
Furthermore, emphasis should be
placed on the presence of HCP
dedicated to providing exemplary
customer care. The testimonies of
individuals who have experienced
improved
service
delivery
subsequent
to
the
recent
Responsible
Person
All key
stakeholders led
by village
chairperson,
facility in charge,
and religious
leaders.
Timeline
April 21, 2024
20
reorganization of the HCP can also
be utilized to bolster this initiative.
9.
The systemic process of receiving and handling
complaints.
3
13.
The suggestion box exists, but it does
not meet the criteria for freedom of
receiving and storing suggestions (it
has a single lock).
There is no friendly system for
receiving and handling complaints,
including the absence of a register
book for suggestions/complaints.
The suggestion box should be
repaired by installing two locks, and
the keys of one lock should be
given to the facility in charge, and
the keys of another lock should be
given to a member of the
dispensary service management
committee.
facility in charge should make sure
there is a register book for
registering
complaints
and
suggestions.
The
dispensary
service
management committee should
improve the systemic process of
receiving and handling complaints
by working on all the identified
gaps.
Facility in charge
and the
chairperson of the
dispensary service
management
committee.
April 20, 2024
Mobilization to increase community A task force that will involve all key
Mobilization to increase community awareness about
health.
3
awareness about health issues has
not been done to a satisfactory level.
When meetings were held, the
attendance was unsatisfactory.
stakeholders should cooperate to
ensure that the community is
reached with messages that will
increase their awareness about
health issues through meetings,
faith-based congregations, and other
available community gatherings.
All key
stakeholders led
by village
chairperson,
Maasai traditional
leaders, and
religious leaders.
Village quarterly
meeting of March
onward
21
Nanyogie Dispensary (Nanyogie Village)- Mkomazi ward
S/N Indicator
3.
4.
Score
Description
Action Plan
Awareness of Comprehensive Reproductive Health and Maternal Care from Preconception to Postpartum for Women, and Children Under 5.
Pre-conception
2
Many pregnant women are delaying LGA leaders, religious leaders,
starting an ANC clinic, giving birth at
CHWs, HCPs, traditional leaders
During pregnancy
2
home, and not using modern
from Maasai community, and other
During delivery
2
contraceptive methods due to the
influential people should have a
After delivery
harmful norms and traditions of the
2
serious task force (each in his/her
Maasai community; the influence of
position) to mobilize the community
TBAs has perpetuated these
through their congregations to
practices, despite the government’s
eliminate harmful social norms and
strict prohibition on home-based
traditions that limit access to and
deliveries. Eg. Pregnant women who
utilization of maternal services, and
are required to give birth by
encourage the participation of male
cesarean do not accept it because it
partners in RMNCAH issues.
is against their traditions.
To identify TBAs who conduct
Existence of restrictions/ barriers on the utilization
The harmful norms and traditions of
home-based delivery and provide
the Maasai community greatly affect
of services.
them with education, making them
the utilization of RMNCAH services
the key to changes in the
at the health facility.
community.
A long distance to the health facility In the collaborative efforts between
for some Maasai settlements
the HCP and the Village LGA office
2
(Boma).
should leverage the village
The opium derived from poor health
meetings as a platform to alleviate
services from HCPs shifted a few
citizens’ fear and reinstate trust in
months ago has left an impact on the
the services offered at the health
community by removing their trust in
facility. Furthermore, emphasis
health facilities.
should be placed on the presence of
Responsible
Person
All key
stakeholders led
by village
chairperson,
Laigwanan, and
religious leaders.
Timeline
April, 2024
22
HCP dedicated to providing
exemplary customer care. The
testimonies of individuals who have
experienced improved service
delivery subsequent to the recent
reorganization of the HCP can also
be utilized to bolster this initiative.
5.
Users’ contribution to health services.
3
There is limited awareness among HCPs at the health facility and
through village meetings should
the villagers about iCHF because
provide education to the
the awareness sessions not being
community about iCHF and
held effectively.
Facility in charge
March to April,
2024 onward
encourage them to join,
considering the benefits of the
household having insurance.
9.
The systemic process of receiving and handling
complaints.
3
The suggestion box exists, but it does
not meet the criteria for freedom of
receiving and storing suggestions (it
has a single lock).
There is no friendly system for
receiving and handling complaints,
including the absence of a register
book for suggestions/complaints.
The suggestion box should be
repaired by installing two locks, and
the keys of one lock should be
given to the facility in charge, and
the keys of another lock should be
given to a member of the
dispensary service management
committee.
facility in charge should make sure
there is a register book for
registering
complaints
and
suggestions.
The dispensary service
management committee should
improve the systemic process of
receiving and handling complaints
by working on all the identified
gaps.
Facility in charge
and the
chairperson of the
dispensary service
management
committee.
April 15, 2024
23
13.
Mobilization to increase community awareness about
health.
2
For a long time, no public meetings
A task force that will involve all key
were conducted to build community
awareness about health issues.
stakeholders should cooperate to
ensure that the community is
reached with messages that will
increase their awareness about
health issues through meetings,
faith-based congregations, and
other
available
community
gatherings.
All key
stakeholders led
by VEO, Maasai
traditional leaders,
and religious
leaders.
March village
quarterly meeting
onward.
Changalikwa Dispensary (Changalikwa Village)- Magamba kwalukonge ward
S/N Indicator
3.
4.
Score
Description
Action Plan
Awareness of Comprehensive Reproductive Health and Maternal Care from Preconception to Postpartum for Women, and Children Under 5.
Pre-conception
2
Many pregnant women are delaying LGA leaders, religious leaders,
starting an ANC clinic, giving birth at
CHWs, HCPs, traditional leaders
During pregnancy
2
home,
and
not
using
modern
from Maasai community, and other
During delivery
2
contraceptive methods due to the
influential people should have a
After delivery
harmful norms and traditions of the
serious task force (each in his/her
Maasai community; the influence of
position) to mobilize the community
2
TBAs has perpetuated these
through their congregations to
practices, despite the government’s
eliminate harmful social norms and
strict prohibition on home-based
traditions that limit access to and
deliveries.
utilization of maternal services, and
Existence of restrictions/ barriers on the utilization
The harmful norms and traditions of
encourage the participation of male
the
Maasai
community
greatly
affect
partners in RMNCAH issues.
of services.
the utilization of RMNCAH services
To identify TBAs who conduct
at the health facility.
home-based delivery and provide
2
them with education, making them
the key to changes in the
community.
Responsible
Person
All key
stakeholders led
by village
chairperson,
Maasai leaders,
and religious
leaders.
Timeline
March-April
onward
24
5.
Users’ contribution to health services.
3
There is limited awareness among HCPs at the health facility and
through village meetings should
the villagers about iCHF because
provide education to the community
the awareness sessions not being
about iCHF and encourage them to Facility in charge
held effectively.
join, considering the benefits of the and Village
chairperson
household having insurance.
7.
8.
There is no reliable transport for
Due to the shortage of ambulances
3
pregnant women when there is an
emergency; mostly motorbikes are
used, which are not friendly means to
pregnant women regarding the
condition of infrastructure.
in Korogwe DC, apart from
continuing to use ambulances when
they are not on the route, the LGA
at the village, through meetings and
other legal means, should find a
bidder for M-MAMA. This will help
to ensure reliable transportation
from their area.
Facility in charge in collaboration
3
The dispensary is run without a
dispensary service management
committee,
because
the
committee exists but has not yet
been launched.
The suggestion box exists, but it does
not meet the criteria for freedom of
receiving and storing suggestions (it
has a single lock).
There is no friendly system for
receiving and handling complaints,
including the absence of a register
book for suggestions/complaints.
The suggestion box should be
Availability of transportation to the health facility for
emergency cases.
The
performance
of
dispensary
service
management committee.
9.
The systemic process of receiving and handling
complaints.
3
with the village chairperson to lead
the process of launching the
dispensary services management
committee.
repaired by installing two locks, and
the keys of one lock should be
given to the facility in charge, and
the keys of another lock should be
given to a member of the
dispensary service management
committee.
facility in charge should make sure
there is a register book for
Village
chairperson and
VEO
Facility In charge
and Village
chairperson
Facility in charge
and the
chairperson of the
dispensary service
management
committee.
March, 2024
onward
March to May,
2024
March to April,
2024
March to April,
2024
25
registering
suggestions.
complaints
and
After its launching, the dispensary
service management committee
should improve the systemic
process of receiving and handling
complaints by working on all the
identified gaps.
13.
For a long time, no public meetings
Mobilization to increase community awareness about
health.
2
16.
Working environment and availability of suitable
infrastructure.
3
A task force that will involve all key
were conducted to build community
awareness about health issues.
When meetings were held, the
attendance was unsatisfactory.
stakeholders should cooperate to
ensure that the community is
reached with messages that will
increase their awareness about
health issues through meetings,
faith-based congregations, and
other
available
community
gatherings.
The infrastructure of the dispensary is
dilapidated, the condition of toilets is
unsatisfactory, there is no water and
electricity.
Absence of a cleaner in the areas
surrounding the dispensary.
After completing the community
sensitization (Msaragambo) on
the ongoing repair of primary
school toilets, the sensitization will
move to the construction of
dispensary toilets.
All key
stakeholders led
by village
chairperson,
Maasai traditional
leaders, and
religious leaders.
Village
chairperson and
VEO
March onward
March for cleaner
May for toilets
The village office should
prepare logistics to use the
CHW or any villager to help
clean the dispensary.
26
Annex 2: Events in Photos (Pictures)
Figure 1: DNuo leading the discussion of a youth group during the community scorecard
meeting at Kigwasi-Kalalani ward.
Figure 2: DHPco leading the discussion of a women group during the community scorecard
meeting at Kigwasi-Kalalani ward.
27
Figure 3: DHPco leading the discussion of a women group during the community
scorecard meeting at Buiko- Mkomazi ward.
Figure 4: Translator Ms. Namayani Paul of Nanyogie translated the customer satisfaction
feedback emoji to Maasai during the community scorecard meeting at Nanyogie village,
Mkomazi ward.
28
Figure 5: DHPco explaining how to rate the score by using the customers' satisfaction feedback
emoji during the introduction of community scorecard meeting at Tewe-Mpale ward.
Figure 6: SBC DTO in the interface meeting during the community scorecard meeting at BuikoMkomazi ward.
29
APPROVALS:
POSITION
Prepared by - SBCC Officer
NAME
Ibrahim Seif
Reviewed by - Project Coordinator
Hamimu Malilo
eSIGNATURE
DATE
Mar 23 2024
Mar 23 2024
Reviewed by - SBCC TO
Patricia Placid
Reviewed by - M&E Officer
Juliana Fredrick
Approved by - Regional Lead
Lilian Shoo
Mar 23 2024
Mar 26 2024
Mar 26 2024
30
Audit Trail
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Title
Community Score Card CSC Report - BAKAID Feb 2024
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Fingerprint
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