A major challenge of this project was getting clinic staff to participate and talk openly about their issues. In some instances, it was also very challenging to access and include key health officials in the various stages of implementation of the project. The commitment, passion and engagement of the RMCH Action Groups in both districts were crucial factors contributing to the success of this project. In OR Tambo 3 facility staff members (including a midwife) were also part of the RMCH Action Group. This made conducting the community scorecard with the health facility in that district a lot easier than it was in uMgungundlovu. This highlights the importance of including health facility staff in the scorecard process.
- A key lesson learnt from this project is that joint monitoring and accountability through Clinic Committees is important. To facilitate partnerships especially between facility staff and the community, exploring communication and joint problem solving between different levels of health care staff and facility management is a key recommendation.
- Using this intervention, monitoring maternal and child health outcomes (as identified in the agreed upon action plan) has to be repeated several times over a long period of time, to observe any changes and impact.
- The RMCH Action Groups in the districts have the capacity to implement the community scorecard process independently, but require adequate support and resources to do so.
- Emphasis should be placed on government providing adequate financial support to CCs so that they need not rely on project cycle funding from CSOs, which is not sustainable in an environment of reduced donor support to South Africa’s civil society sector.
Going forward, existing partnerships with Civil Society Organisations (CSO), who are members of the RMCH Action Group, will assist with sustainability and potentially allow RMCH Action Groups to repeat the scorecard process and follow up on the actions developed and agreed upon.