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Designing for Scale and taking scale to account: lessons from a community score card project in Uganda

BACKGROUND: Planning for the implementation of community scorecards (CSC) is an important, though seldom documented process. Makerere University School of Public Health (MakSPH) and Future Health Systems Consortium set out to develop and test a sustainable and scalable CSC model. This paper document...

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Autores principales: Kiracho, Elizabeth Ekirapa, Aanyu, Christine, Apolot, Rebecca Racheal, Kiwanuka, Suzanne Namusoke, Paina, Ligia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802338/
https://www.ncbi.nlm.nih.gov/pubmed/33430877
http://dx.doi.org/10.1186/s12939-020-01367-1
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author Kiracho, Elizabeth Ekirapa
Aanyu, Christine
Apolot, Rebecca Racheal
Kiwanuka, Suzanne Namusoke
Paina, Ligia
author_facet Kiracho, Elizabeth Ekirapa
Aanyu, Christine
Apolot, Rebecca Racheal
Kiwanuka, Suzanne Namusoke
Paina, Ligia
author_sort Kiracho, Elizabeth Ekirapa
collection PubMed
description BACKGROUND: Planning for the implementation of community scorecards (CSC) is an important, though seldom documented process. Makerere University School of Public Health (MakSPH) and Future Health Systems Consortium set out to develop and test a sustainable and scalable CSC model. This paper documents the process of planning and adapting the design of the CSC, incorporating key domains of the scalable model such as embeddedness, legitimacy, feasibility and ownership, challenges encountered in this process and how they were mitigated. METHODS: The CSC intervention comprised of five rounds of scoring in five sub counties and one town council of Kibuku district. Data was drawn from ten focus group discussions, seven key informant interviews with local and sub national leaders, and one reflection meeting with the project team from MakSPH. More data was abstracted from notes of six quarterly stakeholder meetings and six quarterly project meetings. Data was analyzed using a thematic approach, drawing constructs outlined in the project’s theory of change. RESULTS: Embeddedness, legitimacy and ownership were promoted through aligning the model with existing processes and systems as well as the meaningful and strategic involvement of stakeholders and leaders at local and sub national level. The challenges encountered included limited technical capacity of stakeholders facilitating the CSC, poor functionality of existing community engagement platforms, and difficulty in promoting community participation without financial incentives. However, these challenges were mitigated through adjustments to the intervention design based on the feedback received. CONCLUSION: Governments seeking to scale up CSCs and to take scale to account should keenly adapt existing models to the local implementation context with strategic and meaningful involvement of key legitimate local and sub national leaders in decision making during the design and implementation process. However, they should watch out for elite capture and develop mitigating strategies. Social accountability practitioners should document their planning and adaptive design efforts to share good practices and lessons learned. Enhancing local capacity to implement CSCs should be ensured through use of existing local structures and provision of technical support by external or local partners familiar with the skill until the local partners are competent.
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spelling pubmed-78023382021-01-13 Designing for Scale and taking scale to account: lessons from a community score card project in Uganda Kiracho, Elizabeth Ekirapa Aanyu, Christine Apolot, Rebecca Racheal Kiwanuka, Suzanne Namusoke Paina, Ligia Int J Equity Health Research BACKGROUND: Planning for the implementation of community scorecards (CSC) is an important, though seldom documented process. Makerere University School of Public Health (MakSPH) and Future Health Systems Consortium set out to develop and test a sustainable and scalable CSC model. This paper documents the process of planning and adapting the design of the CSC, incorporating key domains of the scalable model such as embeddedness, legitimacy, feasibility and ownership, challenges encountered in this process and how they were mitigated. METHODS: The CSC intervention comprised of five rounds of scoring in five sub counties and one town council of Kibuku district. Data was drawn from ten focus group discussions, seven key informant interviews with local and sub national leaders, and one reflection meeting with the project team from MakSPH. More data was abstracted from notes of six quarterly stakeholder meetings and six quarterly project meetings. Data was analyzed using a thematic approach, drawing constructs outlined in the project’s theory of change. RESULTS: Embeddedness, legitimacy and ownership were promoted through aligning the model with existing processes and systems as well as the meaningful and strategic involvement of stakeholders and leaders at local and sub national level. The challenges encountered included limited technical capacity of stakeholders facilitating the CSC, poor functionality of existing community engagement platforms, and difficulty in promoting community participation without financial incentives. However, these challenges were mitigated through adjustments to the intervention design based on the feedback received. CONCLUSION: Governments seeking to scale up CSCs and to take scale to account should keenly adapt existing models to the local implementation context with strategic and meaningful involvement of key legitimate local and sub national leaders in decision making during the design and implementation process. However, they should watch out for elite capture and develop mitigating strategies. Social accountability practitioners should document their planning and adaptive design efforts to share good practices and lessons learned. Enhancing local capacity to implement CSCs should be ensured through use of existing local structures and provision of technical support by external or local partners familiar with the skill until the local partners are competent. BioMed Central 2021-01-11 /pmc/articles/PMC7802338/ /pubmed/33430877 http://dx.doi.org/10.1186/s12939-020-01367-1 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Kiracho, Elizabeth Ekirapa
Aanyu, Christine
Apolot, Rebecca Racheal
Kiwanuka, Suzanne Namusoke
Paina, Ligia
Designing for Scale and taking scale to account: lessons from a community score card project in Uganda
title Designing for Scale and taking scale to account: lessons from a community score card project in Uganda
title_full Designing for Scale and taking scale to account: lessons from a community score card project in Uganda
title_fullStr Designing for Scale and taking scale to account: lessons from a community score card project in Uganda
title_full_unstemmed Designing for Scale and taking scale to account: lessons from a community score card project in Uganda
title_short Designing for Scale and taking scale to account: lessons from a community score card project in Uganda
title_sort designing for scale and taking scale to account: lessons from a community score card project in uganda
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802338/
https://www.ncbi.nlm.nih.gov/pubmed/33430877
http://dx.doi.org/10.1186/s12939-020-01367-1
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