Digital Community Scorecards

A Citizen Data Hub closing the data-gap on needs of marginalised communities during pandemics to facilitate effective response

Lindsay Alexander, head of Inclusive Governance with 15+ years experience of working with civil society, governments and international institutions in support of inclusive governance, peace and prosperity in fragile states. 

Health professionals and policymakers do not have access to reliable and real time information about the preparedness of local health systems or the needs and impact on vulnerable groups in low-income countries during pandemics.  

Current health systems in Low and Middle Income Countries (LMIC) lack data on vulnerable populations and do not adequately consult communities affected to identify and solve problems. Where available, this data is patchy and does not provide a national scale picture. Marginalised groups (in particular women and minorities), are already disproportionately impacted by health emergencies because they rely on informal economies, have less access to quality social and health services and low or no political representation, and risk increased vulnerabilities. In Nepal, COVID-19 has disrupted essential public health services including a reduction of obstetric and genecology services by 85-90%, which significantly increased risks of infections due to unsafe delivery methods. 

Community Scorecards are a tested data collection tool, however, the process is typically intensive and time-consuming and facilitated in-person which is challenging or impossible during pandemics. Furthermore, in-person data collection is costly over time, labour-intensive and is not as frequent as needed to truly understand and respond to the rapidly changing impacts of a pandemic.  

CARE’s primary target audience are marginalised populations including women, elderly, children, people with disability, refugees, migrants and minorities because COVID-19 has amplified existing inequalities and has had a disproportionate impact on these groups (1).

Our solution will benefit marginalised communities in Nepal – namely Dalits (12% population subjected to caste-based discrimination) and ultra-poor communities of Kailali and Bardia districts with a focus on women who are most impacted by gaps in health systems’ ability to deal with mass health emergencies, and provision of quality equitable services.

Our solution will amplify the voices of people at risk of being left behind in the Covid-19 response and vaccine roll-out.  It will build agency and trust between communities and health facilities to co-design solutions, promoting inclusive governance and equitable participation in public decisions that affect their lives. Communities will be empowered to hold decision-makers to account and provide feedback on public services.

CARE has used qualitative and quantitative data collection approaches (Kobo Toolbox) to understand needs and identify solutions so-far. CARE Nepal has engaged with government to identify gaps in frontline health. The DCSC will continue to engage marginalised groups and understand their needs as the solution is developed. 

Two public goods will be created as a result of this solution. First, the DCSC platform will be released under an open access license. There are many other agencies – both governmental and civil society that use community scorecards in their work.  This will enable them both to use our platform to analyse their own data, as well as contribute to the shared dataset.

Any new components created with Trinity Challenge funding (for example the AI driven chatbot) will be released under the same license.

Second, the dataset generated by the platform will also be released under a creative commons license.  The data will also be analysed and presented through a free-to -use dashboard to amplify key messages. This will enable researchers, evaluators and the media to access the raw data and carry out their own analysis. CARE and partners believe sharing datasets with the local authorities will increase their ability to address the needs of the excluded groups and will increase their responsive when citizens demand for accountability. 

Marginalised and ultra-poor communities will directly benefit as future crises' responses will be adapted to their needs due to increased transparency, accountability, predictability, responsiveness and participation. Policy makers will have access to the latest information, leading to the allocation of appropriate funding, management of staff and increased safety of frontline workers. Local health officials will also enjoy improved relationships with key stakeholders and trust of marginalised groups on the services they provide.    

By facilitating the relationship between community members, health service providers, and local government, the DCSC contributes to important improvements in health-related outcomes.

The impact of future pandemics could be reduced significantly if: 1) we understand the impact of pandemics on the most marginalised groups through innovative technology solutions; 2) we have functional and inclusive local governance structures that monitor service delivery during pandemics; 3) citizens demand equitable health services and distribution of vaccines for marginalised groups.

In Nepal, marginalised and poor communities will benefit from greater visibility to decision-makers leading to improved services. CARE’s work in Malawi in a similar way recorded a significant increase in the number of village clinics (from 204 to 1820) providing treatment for malaria, pneumonia, diarrhoea and malnourishment of children.

The DCSC platform has been implemented in Kenya, Malawi, Uganda, Afghanistan and Nepal, but not yet reached national scale.  This project will incorporate the use of AI driven chatbots to enable generation of a national scale dataset.

We will focus on implementing and testing in Nepal (2 districts), where we will work with 60 health facilities serving 5,000 community members each (total 300,000).  Our solution includes additional pilots of the chatbot in Uganda and Malawi which has potential to reach an additional 30,000 community members.  This will enable us to test the new component in other contexts and identify issues (eg digital literacy, cost of internet) that may limit our ability to replicate and scale in other countries.

We will produce programming guidance and training materials needed to operationalise the platform in other countries.  We will also develop proposal development guidance to help teams incorporate the platform in proposals to other donors, such that they can mobilise resources needed to implement and scale to millions.

Scaling up DCSCs is a preferred innovative model CARE intends to scale as part of our 2030 Strategy and will be implemented across the Federation in 5 countries within this period. 

Our plan is to collect indicators of change at:

Local level: the baseline will provide data for the Monitoring, Evaluation, Accountability and Learning (MEAL) framework, based on indicators (disagreggated by PWD, gender, ethnicity) including:

% increase in health budget allocation for health centres serving the most marginalised and ultra-poor

% population satisfied with last experience of public services  

% citizens better informed about government standards, budgets and performance.

% citizens report that local service providers are more responsive to their needs.

Policy-level: impact related to service availability; implementation of existing policies/regulations; transparency of health officials access to information; relationship between various stakeholders; participation of most marginalised groups in governance of local services, specifically including:

% local health centres with contingency plans to support to the most marginalized groups during pandemics

% service providers using real-time data for planning and improving health services at the local level

Monthly team meetings and periodic reporting will monitor project performance.  A final external evaluation  will analyse the project’s outcomes based on the criteria (relevance, effectiveness, efficiency, impact, scalibilty and sustainability).

- Shrinking Civic space: Space for civic action has continued to be heavily constrained in South Asia. New provisions/legislation restricting the space for free expression have been rolled out in several countries, adding to restrictive measures already in place. In Nepal, since 2010, there have been sustained efforts to curtail civic space. However, there is also growing recognition that pandemic response requires a whole society approach. Using existing policy framework and mechanisms to engage with government and civil society would promote a solution.  

- Poor awareness about right to information: The effectiveness of the “Right to Information” laws in Nepal has been diminished by poor implementation and limited awareness/use of the laws by citizens - especially the most marginalised. Our solution uses a multi-pronged approach to promote awareness about the right to information through engaging community leaders, utilising new technology (mobile phone, SMS messages etc).     

- Norms and behaviours of service providers: Attitudes of service providers toward accountability to citizens remain a challenge. Through supporting existing government initiatives such as Right to Information it is possible to create opportunities to shift expectations and behaviour. This is possible through developing relationships with change agents - emerging leaders, private sector and community engagement. 

CARE works with international and local NGOs/CBOs and service providers, academic institutions, aid agencies and corporates, trusts and foundations, local health authorities. 

Kwantu is a technology-focused social enterprise and DCSC solution lead.

CARE Nepal, Uganda, Malawi have strong community and government and a presence on national COVID-19 taskforce.

The COVID-19 outbreak, offers the opportune time to enhance, test and broaden the usage of DCSCs across the development and humanitarian sectors so that CARE, local governments and other organisations are better prepared for future pandemics - fostering a community of practitioners sharing data for public good, and creating a data-culture from the ground up.

Our solution is based on a clear trajectory which moves the development of Citizens Data Hubs rapidly from innovation to scale. TTC funding will scale these activities, enabling us to move quickly, but will also crucially build on new functionality to facilitate continued remote engagement and data collection at community-level - without this, vulnerable populations risk remaining invisible to decision-makers.

Finally, technology innovations at this stage of growth are often not as attractive to donors as ideas at incubation or already at scale.  Acceleration needs as much time and resource (if not more) than research, development and incubation. TTC and members bring together innovation thought-leaders who understand this landscape well and with whom we would love to collaborate on this journey. We also believe that CARE’s global expertise as a strategic partner for TTC going forward is an area to explore.

Partnership with Google and/or others with expertise in TensorFlow would provide highly effective and widely understood benefits for CARE, local communities, health professionals and Governments. We seek help in training the Google TensorFlow framework to analyse both quantitative and qualitative data generated by the platform.  Our goal is to help identify interesting patterns or trends – for example where scores from specific vulnerable groups are outside the norm – which are relevant to flag for human interpretation.  A secondary goal is to help streamline the analysis of qualitative data sets (for example the reasons that groups give for the scores provided on problems) to identify common pattens and link them to broader categories of problems.