Community scorecards: Advancing adolescent health in Bangladesh

By Glynnis McIntyre
September 10, 2019

Advancing Adolescent Health (A2H) was a three-year USAID-funded project with the goal of improving sexual and reproductive health and family planning knowledge, access and use of related services for adolescents in Bangladesh. Understanding that one of the key barriers to improving adolescent sexual and reproductive health (ASRH) in Bangladesh is the lack of access to adequate, youth-friendly health services, the project sought to partner with local communities to improve understanding of, and norms around, ASRH needs and services, , paying special attention to serving girls and young women.

In 2018, the project introduced the community scorecard (CSC), a participatory process for evaluating service delivery, to identify the gaps and challenges around ASRH service delivery in the Rangpur district. Through the CSC process, groups of eight to 10 adolescents were convened to evaluate service delivery in their community. Simultaneously, family welfare center (FWC) health service providers were also asked to provide a neutral assessment of their services.

The results of the adolescent and health service provider evaluations were then presented to the FWC management committees, which serve as the union-level government health services management committees. The FWC management committees developed and implemented joint action plans to address the key priorities and issues identified through the CSC process. For more systemic issues that could not be addressed at the union level, such as lack of electricity, poor road conditions and inadequate medicine and supplies, the FWC management committee used the evaluations to advocate with the relevant state and central government authorities. Implemented over a nine-month period, the A2H project engaged 1,800 adolescents and 112 health services providers in this CSC process.

Through the CSC process, the project was able to identify key barriers to service delivery including inadequate training of health services providers to address adolescents’ health needs, inadequate time and lack of privacy for consultations and a lack of resources to treat adolescent health issues.

In addition to identifying key barriers to service delivery, the CSC empowered adolescents and health service providers to engage in open discussions about service delivery and advocate with local authorities to improve these essential services. Many adolescents commented that this was the first time they had been asked their opinion about services. Similarly, health service providers, who were not used to soliciting feedback from adolescents, commented that this process allowed them to better understand adolescents’ needs and evaluate whether they were being met.

Over the nine-month CSC implementation period, A2H staff observed improvements in both adolescent and health service providers’ perceptions around service delivery. In general, both adolescents and health service providers in the eight “upazilas,” or administrative regions, ranked service provision as “very good” (score of 81 or above on a 100-point scale) or “good” (score of 61-80), with health service providers ranking their services more highly than the adolescents. In the third quarter of implementation, 39 of the 77 Union Health and FWCs were ranked as “very good” by adolescents, an increase from the first quarter, during which only 35 UH and FWCs were ranked as “very good.” Comparatively, in the third quarter, 52 of the 77 UH and FWCs were ranked as “very good” by health service providers, an increase from the first quarter, during which 37 UH and FWCs were ranked as “very good.”

For more information on A2H and the findings from the CSC process, read our technical brief.