Abstract:

Background: The maternal mortality ratio (MMR) has decrease by 38%, from 342 deaths per 100,000 live births in 2000 to 211 deaths per 100,000 live births in 2017. Despite the improvement, low-income countries continue to shoulder a high burden of deaths related to childbirth and pregnancy complications. The community Score Card (CSC) is a locally customized tool that allows various users to easily display collected data and use it for planning, decision-making, and strategic prioritizing. This study aims at evaluating the role of the community scorecard in improving maternal, newborn, and child indicators in Bariadi District, northern Tanzania.

Methods: A Checklist in a retrospective study to collect data before and after the rollout of CSC in two districts in the Bariadi district of Northern Tanzania. Data was collected from a standard health management information system database. A 32-likert scale questionnaire was conducted among Council Health Management Team members. For the qualitative design, data was derived from (i) key information as a few members of the Council Health Management Team members, (ii) focus group discussions with members of the Ward Development Council, and (iii) minutes of the Ward Development Council meeting.

Results: Significant changes in maternal, newborn, and child health indicators in areas where CSC was in use were evidenced. Pregnant women giving birth in health facilities increased from 106.1% to 120%, and the availability of essential drugs increased from 87% to 96% (p = 0.003). ANC services, the presence of safety blood, Emergency Obstetric Care (CEmONC) services, Dyfed Drugs and Alcohol (DDA) services ranged from 46.7 to 66.6% (p=0.003), and universal anesthetic machines ranged from 33.3% to 66.6% (p = 0.001). The number of health care workers for neonatal services has also increased from 29 to 40. During the KII, some of the KIs described CSC as an important tool that helps in service and improvement of customer care services for clients, particularly mothers and their children.

Conclusion: Services delivery, ANC visits throughout 12 weeks, deliveries attended by traditional birth attendants (TBA), and the accessibility of transportation varied by district, these appear to be performing poorly across all study districts. Even in the community, there is no ownership of the process related to the CSC because the high-level leaders have not sent a direct message to the community regarding the CSC. That way, it wasn’t discussed in WDC meetings. In addition, the execution of the CSC procedure is complicated.