Scorecards and social accountability for improved maternal and newborn health services: A pilot in the Ashanti and Volta regions of Ghana

Int J Gynaecol Obstet. 2016 Dec;135(3):372-379. doi: 10.1016/j.ijgo.2016.10.004. Epub 2016 Oct 14.


Background: With the limited availability of quality emergency obstetric and newborn care (EmONC) in Ghana, and a lack of dialogue on the issue at district level, the Evidence for Action (E4A) program (2011-2015) initiated a pilot intervention using a social accountability approach in two regions of Ghana.

Objective: Using scorecards to assess and improve maternal and newborn health services, the intervention study evaluated the effectiveness of engaging multiple, health and non-health sector stakeholders at district level to improve the enabling environment for quality EmONC.

Methods: The quantitative study component comprised two rounds of assessments in 37 health facilities. The qualitative component is based on an independent prospective policy study.

Results: Results show a marked growth in a culture of accountability, with heightened levels of community participation, transparency, and improved clarity of lines of accountability among decision-makers. The breadth and type of quality of care improvements were dependent on the strength of community and government engagement in the process, especially in regard to more complex systemic changes.

Conclusion: Engaging a broad network of stakeholders to support MNH services has great potential if implemented in ways that are context-appropriate and that build around full collaboration with government and civil society stakeholders.

Keywords: Emergency obstetric and neonatal care (EmONC); Evidence for Action (E4A); Ghana; Maternal health; Neonatal health; Quality of care; Scorecards; Social accountability.

MeSH terms

  • Emergency Medical Services / standards*
  • Female
  • Ghana
  • Health Facilities / statistics & numerical data*
  • Humans
  • Intensive Care, Neonatal / standards*
  • Logistic Models
  • Maternal Health Services / standards*
  • Pilot Projects
  • Pregnancy
  • Prospective Studies
  • Quality Assurance, Health Care / standards*
  • Social Responsibility*