The Black Sash RMCH Project identified clinic committees as the accountability mechanism on which to focus the overall RMCH intervention. Clinic Committees together with service providers such as community and facility based health care workers and outreach staff - Community Health Workers (CHWs), Community Care Givers (CCGs) and District Clinical Specialist Teams (DCSTs)- play an important role in addressing demand side barriers. Black Sash piloted the Community Scorecard intervention in two health sub-districts Port St John’s in Nyandeni SubDistrict of OR Tambo District in the Eastern Cape (EC), and in Bruntville in Mpofana Sub-District of uMgungundlovu district in KwaZulu-Natal (KZN), to test this intervention. The project thus contributed to the RMCH Demand and Accountability objectives in addressing challenges at community and health facility level, which contribute to high mortality rates of mothers and their babies.
Situational Analysis and Literature Review
The project started out with an extensive situational analysis in 2013, resulting in a Baseline Report on the functionality of existing accountability structures and challenges relating to Maternal and Child Health in OR Tambo and uMgungundlovu. It also conducted a literature review on experience in strengthening clinic committees and on possible interventions to strengthen demand and accountability for MNCH services such as community scorecards, safe motherhood groups and participatory budgeting, as intervention methodologies. These findings were shared with stakeholders in OR Tambo and uMgungundlovu districts during several workshops held in February 2014 and together with stakeholder input, a preferred intervention strategy was chosen.
Community Scorecard Methodology
The community scorecard methodology was chosen as the most appropriate method to be tested under the RMCH project. This methodology aimed to monitor the district’s delivery and the community’s uptake of MNCH services through the joint identification of problems, solutions and action. To implement the community scorecard initiative, Black Sash developed several products including training materials and manuals, as well as information pamphlets on MNCH services.