Introduction:
St. Marks Lela dispensary, located in Kisumu County, began as a Level 2 health facility and has since been upgraded to a Level 3 health facility (health centre). It serves a catchment population of approximately 12,000 people. The health facility has three Community Health Units (CHUs) linked to it i.e. Lower Korando, Upper Korando, and Otonglo. The facility offers a range of health services, including Outpatient Services (OPD), special clinics, laboratory services, maternal, newborn and child healthcare services and a pharmacy services.
The facility is overseen by a Health Facility Management Committee, which represents the broader community. This committee is involved in the budgeting process, approves expenditures, and acts as a bridge between the facility and the community.
Previously, the lack of structured feedback channels posed a significant challenge and communities had no formal mechanism to voice their concerns, while health providers received little meaningful data on patient experiences. This created a cycle that frustrated residents who avoided clinics, leading to worsening health outcomes and further strain on the health system.
To address this, the County Government of Kisumu, through the Health Facility Management Committee led efforts to conduct community dialogue sessions to provide a platform for community, service providers and local stakeholders to express their health concerns, and collaboratively develop solutions geared to improve health services within the facility. During these discussions, the health facility identified widespread dissatisfaction with some of the services provided. Key challenges included understaffing which left health workers overburdened and demotivated, persistent medicine stock-outs due to weak supply chain management, and limited infrastructure budgets that left the health facility without basic security measures such as perimeter fencing.
These findings highlighted the need to conduct a Community Scorecard (CSC) assessment to enhance service delivery. The CSC is a structured tool that enables community members to evaluate health services, similar to a "report card", and facilitates joint planning for improvements. Similar approaches have yielded positive results in other counties, such as improved clinic cleanliness in Makueni and reduced maternal mortality in Nakuru. However, common challenges remain, including resistance to feedback from health workers, fear of victimization and sustaining community engagement over time.
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