Sustainability with the Community Score Card

“When the communities sit down and then they talk, they come up with the solutions that would work, not things that are just made up to say just to end the story.”

“There is no other support but we can help our community change.” That’s what one youth group has to say about why they are still using Community Score Card (CSC) years after CARE stopped implementing the project.

Local officials are still using the tool because, “when the communities sit down and then they talk, they come up with the solutions that would work, not things that are just made up to say just to end the story.”

People are still using the CSC because it gives them a sense of ownership and hope over healthcare in their communities. “it gives us a sense of pride in our work,” says one community health group. That pride and ability to drive change keeps people solving problems long after CARE leaves.

It’s rare to get a chance to find out what’s still working years after CARE stops a project, but the team in Malawi got a chance to check in on the Community Score Card work 2.5 years after the project finished, and the team saw that most people were still using the CSC process. They were able to publish new evidence about how impacts can last. Even better, many groups had modified it to make sure it could still work without CARE’s support, or to meet new needs. Nearly 2 years into the COVID-19 pandemic, communities—especially youth groups are still using the CSC to solve problems in the health systems, including making sure COVID-19 vaccines get to the people who need them.

What changes lasted?

  • More mothers live. Most groups point to the fact that fewer mothers die now that health systems are better. One person says, “That is why now we rarely have cases of maternal mortality; it is because people have a sense of ownership and responsibility (…) to follow up on and address issues that affect them…” People also say more women are using family planning, more women are giving birth at health centers, and more men are supporting their partner’s reproductive health—all actions that help women live through childbirth.
  • Young people feel more self-reliant. Youth groups point to having better skills, more respect in the community, and a greater ability to change their circumstances. One youth group member says, “The objective of this youth club is empower young people to take part in the community development activities. At the same time, empowering the youth to become self-reliant.”
  • Governments are more transparent. Community members say better transparency goes all the way to the top. “[Members of Parliament] are more open in the way they manage the [community development fund]. When they start projects, they make sure that they complete them because now community members are able to track how the funds flow.”
  • New people use the CSC. Even while the project was happening, new groups—like young people and district health officials—were using the CSC to solve problems and bring people together for better health. Even though that wasn’t the original project focus, people saw so much value in the tool that they used it without external support. Those groups are still working with the CSC, even in COVID-19.
  • People feel ownership and empowered to fix problems. Even in groups that aren’t using the tool any more, community groups said the process helped them understand that they could solve problems and make changes.
  • Health officials can get more done. Health workers like the tool because it helps frontline staff take action to improve the situation in their communities. It also makes it possible to serve more people. In one district, the community groups that mobilized around CSC helped them reach 6 more communities to provide services than they could reach without community engagement and support. In general, health workers think CSC means more of their projects succeed and they have a better relationship with the people they serve.

How did it happen?

  • People made the process their own. Many groups are using the CSC process, and they have modified it to meet their own needs. Sometimes that means operating over a longer timeline—more than 6 months—to make sure they can follow through on processes. Sometimes it means using different formats or setting up different dialogues with people to get a diverse range of opinions.
  • Demonstrating success was critical. People who felt that CSC worked and generated positive change for them during the original project were much more likely to continue using it even after the project was over.
  • Create space for all voices. “everyone got to speak their mind, it helped people to change.” By creating safe ways for community members to share their experiences—especially in small groups where just women or just youth can talk—helps surface perspectives from groups that are often overlooked or marginalized. Being able to say what they need, and have someone listen to them and take action—creates trust and willingness to continue the process. · The government supported the work. CARE ran the Maternal Health Alliance Project (MHAP) with support from the Malawian Ministry of Health. That level of buy in, and connections and funding to implement community action plans, helped the process last long after CARE left.
  • Having a neutral third party start the process built trust. CARE served as neutral organizer who could build connections and trust during the project itself. That gave everyone a way to come to the table and connect (and the fact that CARE paid for transportation and soft drinks during the meeting didn’t hurt). It was a critical role to get the ball rolling. It’s something to keep an eye on, because the few groups that didn’t continue with CSC said that they struggled to keep those connections after CARE left. It’s important to show community groups how we’re convening and making connections so they can do that on their own.

Want to learn more?

Check out the article from the Health Policy and Planning journal.