Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya
Abstract Background Women seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their ser...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-022-14388-y |
| _version_ | 1828164258545795072 |
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| author | Dickens Otieno Onyango Katherine Tumlinson Stephanie Chung Brooke W. Bullington Catherine Gakii Leigh Senderowicz |
| author_facet | Dickens Otieno Onyango Katherine Tumlinson Stephanie Chung Brooke W. Bullington Catherine Gakii Leigh Senderowicz |
| author_sort | Dickens Otieno Onyango |
| collection | DOAJ |
| description | Abstract Background Women seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention—the Community Score Card (CSC)—in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision. Methods We implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics. Results The involvement of community health volunteers and supportive community members – as well as the willingness of some providers to consider changes to their own behaviors—were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services. Conclusion Successful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC – or other social accountability efforts – can result in improved contraceptive access. |
| first_indexed | 2024-04-12T01:22:43Z |
| format | Article |
| id | doaj.art-1047ddcf5bea4817bf60539893585c34 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-12T01:22:43Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-1047ddcf5bea4817bf60539893585c342022-12-22T03:53:43ZengBMCBMC Public Health1471-24582022-10-0122111810.1186/s12889-022-14388-yEvaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, KenyaDickens Otieno Onyango0Katherine Tumlinson1Stephanie Chung2Brooke W. Bullington3Catherine Gakii4Leigh Senderowicz5Kisumu County Department of HealthDepartment of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel HillDepartment of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel HillCarolina Population Center, University of North Carolina at Chapel HillInnovations for Poverty Action-Kenya (IPA-K)Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of WisconsinAbstract Background Women seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention—the Community Score Card (CSC)—in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision. Methods We implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics. Results The involvement of community health volunteers and supportive community members – as well as the willingness of some providers to consider changes to their own behaviors—were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services. Conclusion Successful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC – or other social accountability efforts – can result in improved contraceptive access.https://doi.org/10.1186/s12889-022-14388-ySocial accountabilityContraceptionQuality of careKenyaMystery clientsSub-Saharan Africa |
| spellingShingle | Dickens Otieno Onyango Katherine Tumlinson Stephanie Chung Brooke W. Bullington Catherine Gakii Leigh Senderowicz Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya BMC Public Health Social accountability Contraception Quality of care Kenya Mystery clients Sub-Saharan Africa |
| title | Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya |
| title_full | Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya |
| title_fullStr | Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya |
| title_full_unstemmed | Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya |
| title_short | Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya |
| title_sort | evaluating the feasibility of the community score card and subsequent contraceptive behavior in kisumu kenya |
| topic | Social accountability Contraception Quality of care Kenya Mystery clients Sub-Saharan Africa |
| url | https://doi.org/10.1186/s12889-022-14388-y |
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