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Strengthening Healthcare Access Through Community Engagement using Community Score Card

In rural Malawi, the Nainunje Health Center stands as a lifeline for thousands of community members, offering essential medical care and support. The health specialists, particularly nurses, at the Nainunje Health Center are a testament to commitment and dedication, consistently arriving early in the morning to serve their patients. This timely availability ensures that patients receive the care they need when they need it. As one resident affirms, "The health specialists here are always there for us in the morning, which is a great relief."

Despite the dedicated staff, the health center faced a critical challenge—a shortage of healthcare workers. In the afternoons, patients often arrived at the center only to find no health personnel available. A community member shared, "Due to the shortage of nurses and the influx of patients, our dedicated health specialists extend their working hours, sometimes even skipping lunch. They understand our needs, but it's tough on them." This situation sometimes resulted in prolonged lunch breaks or sporadic attendance during the afternoon hours, affecting the quality of healthcare services.


The Nainunje Health Center, constructed in 1999 to serve a population of 10,000 in Traditional Authority Chiwalo, Machinga district, now faces the challenge of an increased population. As more children are born every day, the center is struggling with a limited number of health workers who face a busy schedule daily to attend to the growing number of patients. In response, Clinical Officer Patrick Chavala recognized the need for additional support. "Two Health Surveillance Assistants will be allocated at Nainunje Health Center to ease the workload. Currently, only five out of ten Assistants are adequately trained for malaria testing," he explained. Furthermore, some health personnel were trained in additional skills, such as blood testing, to assist their colleagues.


Transportation shortages further intensified the situation, making it difficult to provide services to patients in need. An ambulance and a driver were designated to support the health center, but due to fuel challenges, the driver was yet to resume work, leaving the center without vital transportation for medical emergencies.


Creative Center for Community Mobilization (CRECCOM) stepped in with a solution under its COVID-19 Response Mechanism project. They introduced the Community Score Card (CSC), a versatile, participatory tool for service assessment and improvement.


Amid these challenges, the CSC emerged as a powerful tool for community engagement, allowing service users and providers to collaboratively address healthcare issues. The CSC is a versatile, participatory tool designed for continuous assessment, planning, monitoring, and evaluation of services. This approach fosters increased participation, accountability, and transparency, bringing about positive changes in service delivery.


Furthermore, women in the community benefited from the CSC. Previously, some women used to lie to their husbands about the requirements for antenatal care and childbirth at the health center. Senior Nursing Officer Alice Khonje noted that some women were asking their husbands to buy them ten pieces of chitenje, a traditional cloth, during delivery. This led to challenges as some women did not have sufficient chitenje. Through the CSC, it was clarified that only four pieces of chitenje were required, reducing the burden on expectant mothers.

Senior Chief Chiwalo praised the CSC, highlighting how it allowed villagers and health specialists to share their challenges and collaboratively find solutions. The Community Score Card became a powerful means of improving healthcare access and quality in the Nainunje community.


The success of the Community Score Card in Nainunje demonstrates its potential to positively impact service delivery across various sectors. By fostering open dialogue and collaboration between service users and providers, this approach has the power to transform healthcare access, ensuring that even in the face of challenges, communities can find shared solutions and build a brighter, healthier future.

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