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Application of Balanced Scorecard in the Evaluation of a Complex Health System Intervention: 12 Months Post Intervention Findings from the BHOMA Intervention: A Cluster Randomised Trial in Zambia

Author

Listed:
  • Wilbroad Mutale
  • Jeffrey Stringer
  • Namwinga Chintu
  • Roma Chilengi
  • Margaret Tembo Mwanamwenge
  • Nkatya Kasese
  • Dina Balabanova
  • Neil Spicer
  • James Lewis
  • Helen Ayles

Abstract

Introduction: In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool that allows for wider analysis of domains that are deemed important in achieving the overall vision of the health system. We present the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluating multiple building blocks in a trial setting. Methods: The BHOMA is a cluster randomised trial that aims to strengthen the health system in three rural districts in Zambia. The intervention aims to improve clinical care quality by implementing practical tools that establish clear clinical care standards through intensive clinic implementations. This paper reports the findings of the follow-up health facility survey that was conducted after 12 months of intervention implementation. Comparisons were made between those facilities in the intervention and control sites. STATA version 12 was used for analysis. Results: The study found significant mean differences between intervention(I) and control (C) sites in the following domains: Training domain (Mean I:C; 87.5.vs 61.1, mean difference 23.3, p = 0.031), adult clinical observation domain (mean I:C; 73.3 vs.58.0, mean difference 10.9, p = 0.02 ) and health information domain (mean I:C; 63.6 vs.56.1, mean difference 6.8, p = 0.01. There was no gender differences in adult service satisfaction. Governance and motivation scores did not differ between control and intervention sites. Conclusion: This study demonstrates the utility of the balanced scorecard in assessing multiple elements of the health system. Using system wide approaches and triangulating data collection methods seems to be key to successful evaluation of such complex health intervention. Trial number: ClinicalTrials.gov NCT01942278

Suggested Citation

  • Wilbroad Mutale & Jeffrey Stringer & Namwinga Chintu & Roma Chilengi & Margaret Tembo Mwanamwenge & Nkatya Kasese & Dina Balabanova & Neil Spicer & James Lewis & Helen Ayles, 2014. "Application of Balanced Scorecard in the Evaluation of a Complex Health System Intervention: 12 Months Post Intervention Findings from the BHOMA Intervention: A Cluster Randomised Trial in Zambia," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-10, April.
    • Handle: RePEc:plo:pone00:0093977
    DOI: 10.1371/journal.pone.0093977
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    References listed on IDEAS

    as
    1. Wilbroad Mutale & Peter Godfrey-Fausset & Margaret Tembo Mwanamwenge & Nkatya Kasese & Namwinga Chintu & Dina Balabanova & Neil Spicer & Helen Ayles, 2013. "Measuring Health System Strengthening: Application of the Balanced Scorecard Approach to Rank the Baseline Performance of Three Rural Districts in Zambia," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-11, March.
    2. Edward Anbrasi & Binay Kumar & Faizullah Kakar & Ahmed Shah Salehi & Gilbert Burnham & David H Peters, 2011. "Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years’ Evaluation in Afghanistan," Working Papers id:4362, eSocialSciences.
    3. Anbrasi Edward & Binay Kumar & Faizullah Kakar & Ahmad Shah Salehi & Gilbert Burnham & David H Peters, 2011. "Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan," PLOS Medicine, Public Library of Science, vol. 8(7), pages 1-9, July.
    4. Gauld, Robin & Al-wahaibi, Suhaila & Chisholm, Johanna & Crabbe, Rebecca & Kwon, Boomi & Oh, Timothy & Palepu, Raja & Rawcliffe, Nic & Sohn, Stephen, 2011. "Scorecards for health system performance assessment: The New Zealand example," Health Policy, Elsevier, vol. 103(2), pages 200-208.
    5. Julio Frenk, 2010. "The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress," PLOS Medicine, Public Library of Science, vol. 7(1), pages 1-3, January.
    6. El-Jardali, Fadi & Saleh, Shadi & Ataya, Nour & Jamal, Diana, 2011. "Design, implementation and scaling up of the balanced scorecard for hospitals in Lebanon: Policy coherence and application lessons for low and middle income countries," Health Policy, Elsevier, vol. 103(2), pages 305-314.
    7. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
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