How to use scorecard data for action What

How to use scorecard data for action

What we’ll cover • How to analyze scorecards and perform bottleneck analysis • How to generate SMART actions and use the action tracker • How Ghana has used the action tracker to improve service delivery • How the scorecard process and existing accountability system can enhance accountability at all levels

Introduction 3 steps to accountability in the scorecard approach Step 1 Review • Review the scorecard during regular management meetings with senior leadership, colleagues from relevant programmes and country partners • Identify underperforming regions or indicators to address Step 2 Act Step 3 Monitor • Using the Action Tracker, capture action items that are practical and specific, that are assigned to specific owners • Ensure timely response to action items and monitor progress regularly

Step 1 - Review Understand why an indicator might be underperforming Topic Example questions Identify if this problem needs a solution • Is this an anomaly? Or is performance likely to remain the same or even worsen? Understand the reason for the problem • What are the root causes of the poor performance? • What causes impact the region’s performance greatest? • Do the root causes impact health facilities / individuals equally across the region? • Which causes can be managed or controlled? Determine what action can solve the problem • What role does community engagement play in identifying solutions? • What interventions are in place or have been tried? • Which interventions have been successful? Which have been unsuccessful?

Step 2 - Act Generate clear, specific action items Good example Bad example Actions are specific Install 3 new computers with LMIS software in each regional medical store Improve quality of LMIS data Person who is responsible for the action must be able to implement the solution Secure funding for 5 million LLINs for national campaign through the Global Fund (owner = Malaria Programme Manager) Ensure LLIN coverage is maintained (owner = DHMT) It is clear who is responsible for the action Director of Maternal & Newborn Increase national total donor Health to establish a regular forum contribution to RMNCAH Sector to engage partners, mobilise funds and improve funding allocation You can clearly monitor progress on the action Engage local NGO to scale up PHAST in the 5 communities with high diarrhea prevalence in district X Improve hand washing in district X

Step 2 - Actions usually fall in these categories Action category Description Advocacy for high level policy and strategy change Changes to national and local policy or strategy to enable more effective implementation and adoption of initiatives Petition support from partners Changes to procurement & supply management of commodities to avoid disruptions, delays, unfulfilled demand, and poor quality Manage procurement and supply chain issues Changes to procurement & supply management of commodities to avoid disruptions, delays, unfulfilled demand, and poor quality Build capacity Training of personnel and upgrading of infrastructure to maximize effectiveness of resource utilisation Address funding Identification, securing, and disbursement of funding for products, initiatives, and infrastructure and technology upgrades Improve quality and utilization of data Improvements in data quality & systems used for monitoring and evaluating that data to track current status and progress Catalyse community engagement Working with the community to identify bottlenecks, and deploy necessary interventions Investigate the root causes Statement of intent to investigate the root cause of the problem to better understand what actions to take

Step 2 - Act Ensure there are clear owners for actions Owners Broad responsibility Political leaders • Performance transparency • Using political power and resources to improve health where it matters most Policy / Programme • Identifying key gaps in programming • Changing policy to foster improvements • Re-allocate resources to solve problems requiring funding Development partners • With Ministry of Health programmes, identifying and providing financial and human (such as technical assistance) resources for programme needs • Engaging the community around specific bottlenecks Subnational stakeholders • Supporting implementation • Benchmarking performance, data validation • Feedback on implementation effectiveness Community • Validating and supplementing data • Joint problem solving to identify bottlenecks and propose community-oriented solutions

Step 3 - Monitor Action tracker enhances accountability… Actions are assigned at all levels, based on bottleneck analysis to ensure targets are met and indicator performance improves Region 2 District A Region 3 M&E Newborn health Hire three M&E staff members on temporary basis to clear backlog of HMIS records Improve timeliness and quality of data by retraining PHU workers in data management Implement excusive breastfeeding for 6 months program at PHUs and conduct community outreach campaign to raise awareness of EBF Missed deadlines are highlighted in red, prompting immediate management attention List of action items displays description, status, due date, and owner 15/12/2016 25/10/2016 30/03/2016 15/12/2016 25/11/2016 30/09/2016 Action achieved No progress Some progress User 1 Training canceled Admin 3 Contacted managers User 4 1 2 0 Visual indicator of status allows manager to quickly identify which action items are at risk (e. g. , yellow = some progress and on track)

Step 3 - Monitor …with its in-built accountability system The action tracker facilitates continuous monitoring and reporting on action items, including real-time dialog between national and subnational individuals. Action items are initiated due to underperformance. • SMS can be set up to be sent automatically to alert senior stakeholders if actions deliverables have not been delivered on time. • This allows a quick response to urgent bottlenecks and ensures full visibility of any programme requirements. • It is available on the mobile app of the scorecard so allows programme managers and staff to easily update and monitor progress on actions. Scorecard

Country examples of scorecard-driven action Federal Republic of Nigeria Long-lasting insecticidal net (LLIN) The Governor of Cross Rivers State noted that LLIN coverage was dropping on the scorecard. The governor identified that LLINs were stored in the warehouse but without resources for distribution. Therefore, he released local resources so that the nets were distributed, immediately increasing net coverage.

Country examples of scorecard-driven action Republic of Madagascar Response to malaria upsurge Review of the malaria scorecard revealed upsurges of malaria in a number of districts. The review led to a rapid investigation followed by vector control, intensified case management and active foci detection, allowing the country to rapidly control the outbreak.

Country examples of scorecard-driven action Republic of Kenya Resource mobilisation When the RMNCAH scorecard was first introduced in Migori County in 2015, family planning commodity coverage was found to be below 40%. Further analysis of this scorecard data led to an equal concern about the gap in adolescent services in the county. As a result, costed implementation plans for family planning and adolescent health were developed.

Country examples of scorecard-driven action Republic of Malawi Antenatal care (ANC) coverage An RMNCAH scorecard analysis showing low ANC coverage led the government to take actions such as: • creating a special cadre of workers to encourage women to seek early antenatal care • male championships with men joining women at ANC • the use of smartphones for support supervisions of health facilities.

Conclusion In this session, you have learnt how: • to review and investigate underperforming indicators • to create actions that are easy to understand easy to monitor • to assign actions to people who have the ability to complete the action • to use our Action Tracker in the scorecard web platform to monitor progress