abstract: 'Background Women seeking family planning services from public-sector

  facilities in low- and middle-income countries sometimes face

  provider-imposed barriers to care. Social accountability is an approach

  that could address provider-imposed barriers by empowering communities

  to hold their service providers to account for service quality. Yet

  little is known about the feasibility and potential impact of such

  efforts in the context of contraceptive care. We piloted a social

  accountability intervention-the Community Score Card (CSC)-in three

  public healthcare facilities in western Kenya and use a mix of

  quantitative and qualitative methodologies to describe the feasibility

  and impact on family planning service provision. Methods We implemented

  and evaluated the CSC in a convenience sample of three public-sector

  facility-community dyads in Kisumu County, Kenya. Within each dyad,

  communities met to identify and prioritize needs, develop corresponding

  indicators, and used a score card to rate the quality of family planning

  service provision and monitor improvement. To ensure young, unmarried

  people had a voice in identifying the unique challenges they face, youth

  working groups (YWG) led all CSC activities. The feasibility and impact

  of CSC activities were evaluated using mystery client visits,

  unannounced visits, focus group discussions with YWG members and

  providers, repeated assessment of score card indicators, and service

  delivery statistics. Results The involvement of community health

  volunteers and supportive community members - as well as the willingness

  of some providers to consider changes to their own behaviors-were key

  score card facilitators. Conversely, community bias against family

  planning was a barrier to wider participation in score card activities

  and the intractability of some provider behaviors led to only small

  shifts in quality improvement. Service statistics did not reveal an

  increase in the percent of women receiving family planning services.

  Conclusion Successful and impactful implementation of the CSC in the

  Kenyan context requires intensive community and provider sensitization,

  and pandemic conditions may have muted the impact on contraceptive

  uptake in this small pilot effort. Further investigation is needed to

  understand whether the CSC - or other social accountability efforts -

  can result in improved contraceptive access.'
affiliation: 'Onyango, DO (Corresponding Author), Kisumu Cty Dept Hlth, Kisumu, Kenya.

  Onyango, DO (Corresponding Author), Univ Med Ctr, Julius Ctr Hlth Sci \& Primary
  Care, Julius Global Hlth, Utrecht, Netherlands.

  Onyango, Dickens Otieno, Kisumu Cty Dept Hlth, Kisumu, Kenya.

  Onyango, Dickens Otieno, Univ Med Ctr, Julius Ctr Hlth Sci \& Primary Care, Julius
  Global Hlth, Utrecht, Netherlands.

  Tumlinson, Katherine; Chung, Stephanie, Univ N Carolina, Dept Maternal \& Child
  Hlth, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27515 USA.

  Tumlinson, Katherine; Bullington, Brooke W., Univ N Carolina, Carolina Populat Ctr,
  Chapel Hill, NC 27515 USA.

  Bullington, Brooke W., Univ N Carolina, Gillings Sch Global Publ Hlth, Dept Epidemiol,
  Chapel Hill, NC 27515 USA.

  Gakii, Catherine, Innovat Poverty Act Kenya IPA K, Nairobi, Kenya.

  Senderowicz, Leigh, Univ Wisconsin, Sch Med \& Publ Hlth, Dept Obstet \& Gynecol,
  Madison, WI USA.'
article-number: '1960'
author: Onyango, Dickens Otieno and Tumlinson, Katherine and Chung, Stephanie and
  Bullington, Brooke W. and Gakii, Catherine and Senderowicz, Leigh
author-email: macdickens2002@gmail.com
author_list:
- family: Onyango
  given: Dickens Otieno
- family: Tumlinson
  given: Katherine
- family: Chung
  given: Stephanie
- family: Bullington
  given: Brooke W.
- family: Gakii
  given: Catherine
- family: Senderowicz
  given: Leigh
da: '2023-09-28'
doi: 10.1186/s12889-022-14388-y
eissn: 1471-2458
files: []
journal: BMC PUBLIC HEALTH
keywords: 'Social accountability; Contraception; Quality of care; Kenya; Mystery

  clients; Sub-Saharan Africa; Provider bias'
keywords-plus: HEALTH SECTOR; PROVIDERS; ACCESS
language: English
month: OCT 24
number: '1'
number-of-cited-references: '28'
orcid-numbers: 'Tumlinson, Katherine/0000-0001-8314-8219

  Bullington, Brooke/0000-0002-3341-087X

  Chung, Stephanie/0000-0002-2383-0512

  Senderowicz, Leigh/0000-0002-6713-1473'
papis_id: 7df98755cbc19ad68a95e481d1daaedb
ref: Onyango2022evaluatingfeasibilit
researcherid-numbers: 'Tumlinson, Katherine/E-6975-2013

  '
times-cited: '0'
title: Evaluating the feasibility of the Community Score Card and subsequent contraceptive
  behavior in Kisumu, Kenya
type: article
unique-id: WOS:000871406300003
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '22'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2022'