Can social accountability mechanisms using community scorecards improve quality of pediatric care in rural Cambodia?

Abstract

To determine the effect of social accountability strategies on pediatric quality of care. A non-randomized quasi experimental study was conducted in four districts in Cambodia and all operational public health facilities were included. Five patients under 5years and their caretakers were randomly selected in each facility. To determine the effect of maternal and child health interventions integrating citizen voice and action using community scorecards on quality of pediatric care. Patient observations were conducted to determine quality of screening and counseling, followed by exit interviews with caretakers. Results indicated significant differences between intervention and comparison facilities; screening by Integrated Management of Childhood Illness (IMCI) trained providers (100% vs 67%, P<0.019), screening for danger signs; ability to drink/breastfeed (100% vs 86.7%, P<0.041), lethargy (86.7% vs 40%, P<0.004) and convulsions (83.3 vs 46.7%, P<0.023). Screening was significantly higher for patients in the intervention facilities for edema (56.7% vs 6.7%, P<0.000), immunization card (90% vs 40%, P<0.002), child weight (100 vs 86.7, P<0.041) and checking growth chart (96.7% vs 66.7%, P<0.035). The IMCI index, constructed from key performance indicators, was significantly higher for patients in the intervention facilities than comparison facilities (screening index 8.8 vs 7.0, P<0.018, counseling index 2.7 vs 1.5, P<0.001). Predictors of screening quality were child age, screening by IMCI trained provider, wealthier quintiles and intervention facilities. The institution of social accountability mechanisms to engage communities and facility providers showed some improvements in quality of care for common pediatric conditions, but socioeconomic disparities were evident.