An RMNCH Scorecard and political accountability for health service improvement in Tanzania
In May 2014, the Tanzanian Ministry of Health and Social Welfare created a “Reproductive, Maternal, Newborn and Child Health” (RMNCH) Scorecard to promote accountability for improved health services. The national scorecard provides information on 18 different indicators for each of Tanzania’s 25 regions. Regional scorecards display the same indicators by district. Nearly all data included come from the routine health information system, enabling quarterly updates. Scorecards are color coded, representing indicators that are on track (green), somewhat below targets (yellow) or poorly performing (red). This colour-coding makes interpretation easy for those not familiar with specific health programmes or indicators.
As such, use of the Tanzanian scorecard is not limited to use by health officials, but is shared regularly with political leaders: the Prime Minister, President, regional commissioners and health teams. At the launch of the first scorecard by the President to an audience including regional commissioners, members of parliament, multisectoral government officials, civil society and others, he stated: “These are your working tools. We will use them to track your commitment, leadership and accountability for the lives of mothers and children at national and regional levels.”
A January 2015 review found that most commissioners hold meetings as least quarterly with their regional and district health staff to review the scorecards and encourage them to find ways to improve their health programmes and scores. The regions, in turn, meet with district health teams who create specific action plans for targeted programmes and indicators. Following the first year of implementation, information system reporting rates (and the timeliness of reporting) increased substantially. The scorecard has been incorporated in Tanzania’s new One Plan II for RMNCH and in the Health Sector Strategic Plan IV (2016-2020) (HSSP IV). The HSSP IV also calls for the creation of “community scorecards” to encourage accountability at the health facility level.