How to Design Community Scorecards to Improve Health

By Courtney Tolmie

With these mixed reviews of scorecards in mind, we set out to give the traditional scorecard a makeover to fix its flaws and make it shine.

What are the key takeaways for practitioners? At least two very actionable ideas we hope will strengthen community-led accountability for health and education worldwide:

We spent a lot of time early in this project trying to figure out why scorecards seem to work in some places and some studies — and not in others. And we came up with a few possible explanations.

Maybe scorecards don’t give communities the freedom to work on health problems they think are the most critical. Maybe scorecards force people to tackle problems one way (say, with an in-person meeting) when the right action for their context is something totally different. Maybe the expectation that civil society organizations (CSOs) or donors will come in and solve problems for them with outside resources actually disincentivizes community-led action.

If any of these possibilities are true, they’re also fixable. So, we set out to develop a set of design principles to avoid common pitfalls. We will be tackling the details of these principles in a subsequent blog post, but they can be summarized in the following checklist of questions, which CSOs and others can ask themselves as they design their new scorecard. We don’t know if the “right” answer to all of these questions is no; but thinking through these important design questions can provide some practical food for thought for CSOs and other practitioners who want to consider whether to revisit their design process — and the resulting scorecard.

When it comes to designing and implementing scorecards, there are a lot of decisions that need to be made. And things that may seem small — like the design of the scorecard or the timing of community meetings — can make the difference between the success or failure of an intervention.

You may have a guess — or anecdotal evidence — that one option may be better than another. But these are the types of questions that can be answered quickly, in small pilots or even “pre-pilots,” using rapid data collection on proximal outcomes or outputs.

For example, we learned a lot about what type of environments might lead to more participation by women from doing mock meetings in a few different settings. Within a couple of hours, we had valuable insights into the different ways that women tended to act or speak (or not) when different types of people were in the room with them.

These iterative piloting processes have actionable steps that we discuss in more detail in our next blog post — and in the paper.

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So, what is the right design for a scorecard? And what about the answers to questions on participation and presenting and gathering information? These questions, and more, are addressed in the paper. None of the answers come from a large-scale randomized controlled trial (we are using that for the big impact questions), but we do have insights into what happened when we tested different types of designs in our pilot and pre-pilots.

Check out the new paper, Citizen Voices, Community Solutions, and let us know (comment below) what lessons you have about designing a better scorecard!

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