Effects of a Community Scorecard on Perception and Utilization of Health Services

More than a decade of conflict has weakened the health system in the DRC and diminished its ability to respond to the needs of the population. Community scorecards have been conceived as a way to increase accountability and responsiveness of service providers. This study used qualitative methods to examine the effect of this approach in two provinces of eastern DRC. Between June 2012 and November 2013, 45 stories of change in the health system were collected from village development committee, health committee, and community members and healthcare providers in 25 sites using the ‘Most Significant Change’ technique. Stories were analyzed qualitatively for content related to the types and mechanisms of change observed. The most salient changes were related to increased transparency and community participation in health facility management, and improved quality of care. Quality of care included increased access to services, improved patient–provider relationships, improved performance of the service providers, and improved maintenance of physical infrastructure.