Enhancing Governance and Health System Accountability for People Centered Healthcare: An
Exploratory Study of Community Scorecards in Afghanistan
BMC Supplemental Files
Table S1: Community Scorecard and Action Plan, Bakhtan Basic Health Center, Nangarhar province
CSC Round
1
2
3
Indicators
Provider scorecard
Damaged water tank
Waiting area
No public bathroom
Window screens
Suction machine
broken
Accurate exam
Community health
supervisor fuel, top up
card
CHW referral forms
Community scorecard
Waiting area
Electricity
No toilet for patients
Clinic staff punctuality
Behavior with patients
Indicator
Waiting area
Public toilet
Water tank repaired
No window screens
Accurate exam
Community health
supervisor fuel, top
up card
CHW referrals
Staff attitudes
towards patients
Staff punctuality
Explanation
4
5
10
8
10
10
2
1
8
7
10
10
Water tank repaired
Waiting area constructed, equipped with concrete seats
Toilet constructed, necessary tools brought by HN-TPO
Screens installed on clinic windows
9
10
10
Suction machine repaired by staff of the clinic
7
10
10
3
3
3
7
10
10
4
5
0
7
9
9
7
5
10
10
10
9
10
10
10
Number of health education sessions increased with help from Shura-e-Sehi and
community members. Accurate exams are being conducted
Request made to HN-TPO, as items were not part of policy. Offered to provide
bicycles instead. Not practical solution. Bakhtan BHC reported that its request for a
bicycle was approved.
Neglected. Greater attention paid to the referral sheets
Waiting area constructed, equipped with concrete seats
Directorate of electricity in Nangarhar invited elders to sign an MOU for electricity
Toilet constructed, necessary tools brought by HN-TPO
Clinical staff is now punctual
Attitudes/behaviors towards patients improved. No complaints made.
ACTION PLAN
Action Proposed
Who?
Date
Observation
Shura to request during 1st meeting and send approval CIC, Shura, HN2m
Completed
to NGO responsible for BPHS in Nangarhar
TPO, PPHD
Shura approve request and select a place for
CIC, Shura, HN2.5m
Completed
construction in collaboration with community
TPO, PPHD
CIC to address it with NGO and PPHD
CIC, Shura, HN20
Completed
TPO, PPHD
days
CIC should request nets from Shura and send approval CIC, Shura, HN1.5m
Completed
to HN-TPO for action
TPO, PPHD
Facility staff should include issue in weekly meeting
CIC, Shura, HN2.5m
Completed
agenda and follow through accordingly
TPO, PPHD
To be included on clinic’s agenda during next meeting
CIC, HN-TPO
2.5m
Incomplete
and information sent to the HN-TPO
Shura to raise the issue during their meeting and facility
staff consider it during their daily performance
Shura to raise the issue during meetings and follow-up
with facility staff
CIC to discuss issue during the weekly meeting in
presence of HN-TPO
HC staff, Shura,
CHWs
HC staff, Shura,
HN-TPO
CIC
2.5m
Completed
2.5m
Completed
2.5m
Completed
Table S2: Community Scorecard and Action Plan: Kuz Kunar Comprehensive Health Center, Nangarhar province
CSC Round
1
2
3
Indicators
Provider scorecard
No window screens
Laboratory
refrigerator
Imbalanced salaries
Clinic hygiene
Community scorecard
Availability of
medicines
Waiting area
Ltd access to
therapist
Ltd night duty staff
Patient exam
Staff attitude
High patient volume
Staffing levels
Medical equipment
Indicator
Waiting area
Clinic hygiene
Availability of
medicines
Window screens
Physiotherapist
available
Night duty
Patient volume
Perception of staff
attitudes
Explanation
9
0
10
5
10
8
9
9
10
9
10
10
Nets were ultimately installed and have spare nets for future use
No major incidents of blood transfusion in the clinic. Have an ambulance for referral
if necessary.
Committed to national salary policy of the Ministry. Request that HN-TPO revise the
contracts so that the salaries align
Attention paid to hygiene and windows cleaned
4
5
5
Inadequate and patients and providers dissatisfied with the availability
5
5
6
5
8
8
Temporary solution – clinic staff still seeking permanent solution
Now comes to clinic twice a month
5
5
7
Clinic staff providing health education to communities requesting that women in
labor be brought to clinic in the evening hours
8
7
10 Adequate clinic examination
6
4
9.5 Males are satisfied. Females believe that they have to provide them with complete
medicine and behave more professionally.
4
4
6
Will send request to PPHD through shura-e-sehi to upgrade to district hospital
10 10 10 Fully staffed and punctual
10 10 10 Complete equipment
ACTION PLAN
Action Proposed
Who?
Date
Observation
Separate male and female waiting areas for patients CIC, shura,
2.5 m
Completed
developed in coordination with CIC, CHS and shura
CHS
Hygiene discussed at weekly staff meetings and
HF staff
1.5m
Following net
progress followed-up
installation,
hygiene
improved, but
issues arose
recently.
Clinic staff should request adequate medication
CIC, pharm
2.5m
Completed
based on HMIS reports
tech
CIC should identify and request nets from HN-TPO
CIC, HN-TPO
15 days Completed
To be addressed via the shura and approved by CIC CIC, shura,
2.5m
Completed
and sent to HN-TPO for further action
HN-TPO
Raised by CIC during weekly meetings, emphasizing CIC, HN-TPO,
2.5m
Completed
need for a schedule based on requests of the HNshura
TPO and shura
Requests to upgrade to district hospital should be
CIC, shura,
2.5m
At interface,
made via the shura and district governor office
district
promised to invite
governor
Shura and
request upgrade
CIC should monitor patient flow to assess provider
Clinic staff,
2.5m
Completed
behavior
shura, HN-TPO