Wednesday, November 12, 2014

Increasing Accountability of government through Citizen Reporting Card

Increasing Accountability of Government through Citizen Reporting Card:
What is a Citizen Report Card?
The Citizen Report Card (CRC) is a tool to assess the performance of service providers, in this case health service providers, by comparing performance across service providing organizations and generating a database of feedback on services provided to the public. This study found conducted found that the CRC process has built a bridge between health service providers and the communities they serve by gathering and publicly presenting citizens’ opinions of health care services in selected districts of Badakhshan province. The Citizen Report Card (CRC) is a tool to;
  • Collect citizen feedback on public services from actual users of a service (and not opinions from the general public)
  • Assess the performance of individual service providers and/or compare performance across service providers and
  • Generate a database of feedback on services that is placed in the public domain.
Most governments are responsible for providing essential services to the people. Governments spend huge amounts of resources to provide following services:
       drinking water
       health care and

In some instances, governments give contracts to private entities to provide services. Some central and state governments have also decentralized service provision to local units of government.
Citizen Reporting Card is a simple and participatory process whereby citizens are empowering to assess  quality and effective of public services provided by government.
What issues will a Citizen Report Card address?
The CRC addresses critical themes in the delivery of public services such as access to services, quality and reliability of services, problems encountered by users of services and responsiveness of service providers in addressing these problems, transparency in service provisions like disclosure of service quality standards and norms, and costs incurred in using a service including hidden costs such as bribes. The CRC also provides a supportive score that captures the totality of critical service-related parameters.

What kind of institutional capacity would need to conduct a Citizen Report Card?

CRCs work best when there is an explicit recognition within an organization on the need to conduct a user feedback led diagnostic or assessment exercise. Some critical institutional capacities required to make CRCs effective are:
  • Analytical staff well-versed in quantitative methods. Since a large part of the CRC
  • involves sample surveys and analysis of data, a major pre-requisite is that the organization should have either in-house capabilities to understand and interpret numbers or have resources to locate external support.
  • Dedicated resource to anchor and manage the CRC processes.
  • Dedicated resources for communication and outreach.
  • Support from the senior management

The tools of the study were jointly developed with the provincial health department of Badakhshan. During the first stage, district health centers were selected as primary sampling units by considering geographical locations and accessibility. In the second stage, approximately community 560 respondents were selected randomly. Their opinions on quality of service, satisfaction rate and main areas of improvement for health services available to them were recorded. The study was conducted by staff of Aga Khan Foundation and members of District Development Assemblies (DDAs). Selection of respondents have taken placed randomly, the interviewer waited near to the center of Clinic while patients  were examining by doctor and taking prescribed medicines from the clinic then he/she selects  two male and tow female out of 15 up to 20 patients and asking respective questions which were already determined by interviewer. Badakshan colleagues to take an action of this training at least let us start from one District Level Hospital in the region.

Based on a variety of questions that were aimed at finding out the primary reasons for visiting health centers, what kind of services were available to citizens, and the quality of services received, some of the key results were highlighted.  Results demonstrated that 67% of respondents visited their respective health care centre with the primarily to obtain medicine free of charge. A small number of visitors (11%) noted that they were able to access information about health services available at centers on information boards or displays at centers.  A majority of service users (78%) reported that their registration was completed within two hours. Most of the respondents (92%) visited doctors within an hour or less after completing registration process. However, a significant number of respondents (41%) also reported that the center's laboratory equipment were not functional.

 Approximately, 65% respondents said that the health services were had improved in comparison to the previous year. They also reported satisfaction rates on different services. The proportion of the respondents who were very satisfied or satisfied with the registration process and the health centers’ staff’s attitudes are 66% and 53%. A significant percentage of respondents reported being dissatisfied with the laboratory facilities (43%) and treatment facilities (30%) of the centers.


This CRC tool was introduced by AKF Afghanistan for the first time in the country primarily to create transparency, engender citizen sense of engagement in the service delivery process, and enable the health system of the government to be more accountable towards their respective citizens. In doing so, the CRC aims to improve the quality of service delivery by engendering a supply-demand relationship between government and citizens for public services.  The majority of patients reported positive experiences and overall improvement of health facilities in comparison to the previous year but felt the level of services at present did not satisfy them properly providing a crucial baseline assessment of public opinion on health service delivery in Badakhshan province.