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What Makes for a Good Health Scorecard?

Increasingly in the health sector, scorecards are being used to visually represent statistical data. They are used at varying levels: to compare countries within a region, to compare sub-national districts within a country, and at a more local facility level. Essentially, scorecards are a way of depicting data attractively and accessibly, but many players have taken them a step further as a tool to (a) support policy making, and/or (b) improve accountability. By communicating data more effectively and transparently, the scorecards themselves and the process undertaken to produce them provide a platform for dialogue and participation around the data. Decisions can be thus taken based on this data, scores monitored, and decision-makers held to account.

MannionDaniels has completed an assessment for FP2020 on scorecards, assessing existing health scorecards and interviewing designers and end-users to gain from their experiences.  The MD team consisted of Rolla Khadduri (Technical Team Lead), Clea Knight (Public Health Specialist) and Dr. Poonam Thapa (Associate, Rights Specialist).

Some general positive conclusions regarding scorecards emerged from this assessment:

(+) Scorecards can be an excellent way of presenting a limited amount of data succinctly and convincingly for policy-makers to make resourcing and policy decisions

(+) Having scorecards can, over time, improve the quality of data collected

(+) Scorecards can be a platform for improved data utilisation, if used within an existing platform of data review and decision-making. These could be District Health Management Meetings, or Joint Annual Review processes for example.

(+) The use of scorecards can improve service delivery at facility level if presented at sub-national level with specific facility information such as enablers / gap-analysis

However, there were commonly-held cautions amongst about the following issues:

(*) For scorecards to be used, country-ownership is paramount.  Technical support from outside organisations are encouraged, but only when scorecards are asked for and needed by national governments first.

(*) Similarly, indicators should be chosen based on specific country contexts of what are priorities in the country and what data is available

(*) Countries are being asked to collect a multitude of indicators, and use a multiplicity of tools already.  This can be counter-productive, so the decision to proceed with developing a scorecard needs to be taken in consideration of other data collection/representation national contexts. Principles of harmonisation and aid effectiveness call for increased integration with existing initiatives so as to reduce the burden on national governments.

(*) Developing, designing and maintaining scorecards takes a great deal of time and effort (up to one year).

For presentation, the key message is: The simpler, the better

(+) Do keep the data simple

(+) Do use a traffic light colour system (red, amber, green) for easy visual representation

(+) Do use info-graphics and icons, instead of text

(-) Don’t use indicators where there are lots of blank values

(-) Don’t try to include too much data on one scorecard

(-) Don’t use complicated graphs that need lengthy explanation

Other summary findings from the assessment include:

High-quality scorecards depict both values and also change in values over time. Having a change in value allows deeper analysis of gaps and bottle-necks, which can instigate action.  The process of data collection, and the process of acting upon the data, is more important to data use than the data itself.

Starting with the right approach to scorecards is important from the beginning of the process, emphasising supportive tracking and transparent monitoring as the aims of using scorecards.

Integrating a rights-based approach is key from the start of the process. At a macro-level, disaggregating data by age, marital status, wealth quintile, education, region, ethnicity and urban/rural is useful to visualise needy populations and determine priority setting.  At facility-level, including indicators on quality and data from private facilities would increase representation of services that more of the population use.

MannionDaniels has provided key technical inputs to the inception phase of the recently launched Girl Generation initiative. This is a social change campaign aimed at increasing momentum within Africa to end FGM/C in one generation through catalysing a global movement. The Girl Generation will bring stories of change to a global audience, stimulate media campaigns, recruit ambassadors, and mobilise resources to help end FGM in one generation.

During the 6-month inception phase, MannionDaniels was contracted to provide technical inputs to the design of the campaign focussing on Somalia and Sudan. Country Technical Appraisals for Sudan and Somalia were led by Clea Knight with support from MD consultant Una MacAskill on the Somalia appraisal. Findings from these technical appraisals were integrated into the design, branding and messaging of the campaign.

The Girl Generation was launched on 10th October, the eve of the International Day of the Girl Child.

@TheGirlGen #TheGirlGeneration #DayoftheGirl #IDG2014

By David Daniels

Her Royal Highness Crown Princess Mary of Denmark introduced AmplifyChange – a new fund for civil society advocacy on sexual and reproductive health and rights (SRHR) – at an event in New York on the 22nd September 2014.

The launch coincides with the 20th anniversary of the ground-breaking International Conference on Population and Development (ICPD) held in Cairo; the fund aspires to uphold the ICPD vision of SRHR for all, regardless of age, sex, race, ethnicity, religious affiliation, marital status, sexual orientation or gender identification.

Mr Mogens Jensen, Denmark’s Minister for Trade and Development Cooperation and Ms Lilianne Ploumen, the Netherlands’ Minister for Foreign Trade and Development Cooperation, went on to underline the commitment of their governments and that of the William and Flora Hewlett Foundation and the David and Lucile Packard Foundation, co-sponsors of the new Fund, to supporting marginalised and underfunded areas of SRHR with an initial focus in sub-Saharan Africa and South Asia.

The Fund Director, Mr John Worley, described how AmplifyChange is a new and unique initiative that reaches out to civil society organisations including the many unfunded groups working in fragile and conflict-affected environments.

“AmplifyChange will support the efforts of civil society working to secure universal access to sexual and reproductive health and rights,” said Worley. “When we recognise SRHR as human rights, we enable women, men and young people to realise their full potential in safe and supportive environments.”

AmplifyChange will disburse an initial Fund of €14 million in the next two years.  It will support CSOs working to promote and protect the sexual health of young people, especially girls, improve access to services and efforts to stop child or coercive marriage.  It will also be support organisations seeking ways of challenging and ending gender based violence; discrimination against and criminalisation of people who identify as gay, lesbian, bi-sexual, transgender, and intersex; and ending the practice of female genital cutting.

The fund is a timely intervention, as the shocking statistics speak volumes about the issues AmplifyChange will seek to address.

•          About every 10 minutes, somewhere in the world a woman dies from the consequences of unsafe abortion

•          One hundred and twenty million girls and female adolescents under the age of 20 have been raped or forced to perform other sexual acts. One in 10 girls around the world experiences serious sexual violence

•          Some 25,000 girls are married every day. Young brides face higher risks of sexual violence and curtailment of personal freedom and educational opportunity.

•          Some five million young people aged between 15 and 24, and two million adolescents aged between 10 and 19 are living with HIV

•          Young girls aged 10-19 account for nearly one quarter all deaths and injuries associated with early pregnancy and childbirth

•          More than 70 countries criminalise lesbian, gay, bisexual, transgender and intersex (LGBTI) people

•          Over 200 million women in developing countries who would like to choose if or when to have children have inadequate access to a method of contraception that meets their needs

The AmplifyChange team will be launching a series of calls for proposals starting early in 2015.  For more information and to register interest in the Fund please visit


David Daniels is Chief Executive of MannionDaniels, which leads an international consortium responsible for disbursing the fund.

bangladesh mother

As part of the Mid-Term Review of the Bangladesh Health, Population and Nutrition Sector Development Programme (HPNSDP) 2011-2016, a National Stakeholder Consultation Workshop on SRHR was held in Dhaka on 26th August.  This emphasised the importance of different aspects of Gender, Equity, Voice and Accountability (GEVA) that has been a cornerstone of the sector programme to date.  Speakers from a range of Civil Society organisations and Academic Institutions presented the latest data on topics such as the demographic transition, urban SRHR services, marginalised groups, Menstrual Regulation and Post Abortion Care services, the need for adolescent friendly services, sexuality education, and current concerns in the national response to HIV.  The workshop participants also worked on a set of recommendations to be considered by the Independent MTR team that includes MannionDaniels.  The final report of the MTR team will be presented on 8th October to the Ministry of Health and Family Welfare.  The workshop was supported by the Governments of Sweden and the Netherlands.

A new 5-year Health Sector Programme for Nepal


The Ministry of Health and Population in Nepal has started work on formulating a new 5-year Nepal Health Sector Programme (2015-2020).  This strategic plan will draw on the policy directions outlined in the new National Health Policy (2014) recently approved by the Cabinet.  The NHSP-III is emphasising the need for greater output-based and decentralised planning and budgeting for the sector.  The plan will also indicate the importance of ensuring financial protection for the poor and give more attention to improving quality of services across all areas of the health system.  NHSP-III will aim to build financial sustainability, better coordination and strengthened partnership with non-state partners. The MoHP will be looking at stronger regulation of the sector including measures to ensure quality of care through commercial and not-for-profit health providers. The rise in non-communicable diseases in Nepal poses a big challenge for the Ministry and in response the new plan will include components on promoting healthy lifestyles and working to create healthy environments.  An emphasis will be put on the importance of good information and self-responsibility  for health.  MannionDaniels is supporting the NHSP-III building on its earlier involvement in the Mid-Term Review of the current NHSP-II. The work on the new sector programme is on-going and should be completed by the end of the year.