A scorecard for assessing functionality of community health unit in Kenya

INTRODUCTION In 2005, Kenya's Ministry of Health (MOH) in its quest to improve health outcomes developed the Community Health Strategy (CHS) as a key approach. The MOH and partners grappled with the challenge of managing the functionality of the Community Health Units (CHUs). Amref Health Africa in Kenya developed a replicable CHUs Functionality Scorecard for measuring and managing the functionality of CHUs. METHODS We designed and piloted the CHU Functionality Scorecard at 114 CHUs in Rift valley province in Kenya. The scorecard categorized CHUs as Functional, Semi-functional, or Non-Functional. We used before and after design to assess the functionality of the CUs. RESULTS Over seven quarters (January 2012 to September 2013). The proportion of functional CHU increased from 3.5% to 82.9%, Semi-Functional reduced from 39% to 13% while Non-Functional reduced from 58% to 4%. The greatest improvements were noted in Community Health Volunteers (CHVs) receiving stipends, CHVs with referral booklets, monthly dialogue days, actions planning, chalk boards, and CHVs reporting rates. CONCLUSION The CHU functionality scorecard is a valuable tool for the management of performance, resource allocation, and decision making. We recommend the adoption of the Functionality Scorecard by the Kenya Government for country-wide application. We recommend: further work in defining Advanced Functionality and incorporating the same into the scorecard; and implementation research on long term sustainability of CHUs.