CSC leads to an estimated 57% increase in the use of modern contraception.

“Effects of a social accountability approach, CARE’s Community Score Card (CSC) on reproductive health-related outcomes in Malawi: A cluster-randomized controlled evaluation.”

The cluster-randomized controlled evaluation assessed the CSC’s effect on reproductive health related outcomes in Ntcheu, Malawi. Results demonstrated a large and significant effect on use of modern contraception, with an estimated 57% greater use in the intervention versus control condition at end line.  The evaluation also showed that the CSC increased community health workers’ home visits during pregnancy by 20% and after pregnancy by 6%, compared to control areas. In addition to this, women’s satisfaction with reproductive health services increased significantly, compared with control areas. Further, it was found that the CSC builds mutual accountability, and ensures that solutions to problems are locally-relevant, locally-supported and feasible to implement.

This is the first study to use a rigorous cluster-randomized controlled design to evaluate the effectiveness of CARE’s CSC on a wide range of reproductive health-related outcomes. Click on the link below to read the full article.

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ODI Research into CSC “CARE’s experience with Community Score Cards”

CARE’s experience with Community Score Cards.

What works and Why?

by Joseph Wales and Leni Wild

This policy brief explores the experience of CARE International in implementing community score card programmes in four countries – Ethiopia, Malawi, Tanzania and Rwanda – and aims to address the significant research gap around cross-country comparative analysis of social accountability programmes.

The key findings of the research are that:
•• CARE’s Community Score Card programmes have contributed to strengthening service provision and community-state relations in each of these countries
•• Often this requires high levels of engagement with, and working through, different levels of the state apparatus. For support based on the idea of civic engagement, this is a counter-intuitive finding.
•• Reinforcing this, impacts are often ‘stuck’ at the local level and have only translated into national level impacts where they have plugged into existing government reforms.

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Review of 8 CSC Projects in 5 countries

A review of CARE’s Community Score Card experience and evidence” Sara Gullo, Christine Galavotti and Lara Altman, Health and Policy Planning, 2016

While the evaluations had many limitations, consistency of the results, as well as the range of outcomes, suggests that the CSC is contributing to significant changes. All projects reported CSC-related governance outcomes and service outcomes. There is promising evidence that the CSC can contribute to citizen empowerment, service provider and power-holder effectiveness, accountability and responsiveness and spaces for negotiation between the two that are expanded, effective and inclusive. There is also evidence that the CSC may contribute to improvements in service availability, access, utilization and quality. The CSC seems particularly suited to building trust and strengthening relationships between the community and service providers and to improving the user-centred dimension of quality. All of the projects reported challenges, with ensuring national responsiveness and inclusion of marginalized groups in the CSC process proving to be the most intractable. To improve health system performance and accelerate health progress we recommend further CSC use, enhancements and research.”

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Post-disaster shelter in India (Summary): Conclusions and recommendations

The introduction, conclusions and recommendations from the full report.

The study evaluates the medium- to long-term effectiveness of post-disaster shelter responses and recommends measures to strengthen future shelter programmes, whether undertaken by CARE or other agencies, to most effectively address the complex and interconnected needs of disaster-affected women, girls, men and boys. Recommendations cover impact (scale and coverage); shelter and settlements; accountability; specific needs and capacities of women, girls, men and boys; relocation projects; and the shelter sector in India.

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