Using Scorecard to Improve Reproductive, Maternal, Neonatal, Child and Adolescent Health Performance Indicators in Public Primary Health Facilities, Kenya

The study investigated factors associated with the use of scorecards to improve RMNCAH performance indicators in public primary care health facilities in Kwale and Kilifi counties. It employed a mixed-methods quasi-experimental research design and randomly sampled 119 participants. The investigators collected data through questionnaires, key informant interviews and FGD. Nurses employed scorecards more frequently than RCOs (p = 0.007), and the intervention group contained a higher percentage of healthcare workers between 30 and 39 years old (p = 0.004). Rural facilities had the highest scorecard usage (p = 0.034). Facility type, sex, and staff size were not significantly associated with scorecard use. At baseline, 74% of intervention facilities monitored RMNCAH indicators compared to 99% of control facilities (p = 0.134). However, by the endline, all intervention facilities (100%) monitored RMNCAH performance, while the control facilities decreased to 98%. In addition, at baseline majority of facilities in the intervention group (76%) monitored performance monthly, compared to 56% in the control group (p = 0.006). By the endline, 92% of intervention facilities monitored monthly, while only 53% of control facilities did so (p = 0.001). Regarding the analysis of RMNCAH data, at baseline, 85% of intervention facilities analyzed RMNCAH data compared to 93% in the control group. However, by the endline, 95% of facilities in both groups were analyzing data, hence data analysis is generally well-integrated in both settings (p = 0.000). The study revealed that at baseline, most HCWs in the intervention group (73%) had a low rating for behavioral factors, but this decreased significantly to just 5% at endline (Chi-Square = 21.68, p < 0.001). The study established that behavioral change interventions improved healthcare workers' (HCWs) engagement with performance monitoring tools, and high behavioral ratings rose from 27% to 95% in the intervention group. However, 63% of HCWs in the control group rated behavioral factors as low at endline. The intervention group experienced an increase in staff involvement in performance review meetings from baseline to the endline of the study period (Chi-Square = 16.00, p = 0.220). Involved representatives rose from 47% to 97% at endline. DDIU training coverage within the intervention group grew from 84% to 97% (Chi-Square = 21.01, p = 0.030) while the control group maintained its 84% rate. The adoption of scorecards for RMNCAH monitoring required education, experience, training, a positive assessment of facility performance and strong leadership combined with perceived facility competence.