The CSC implementation design

The implementation was led by stakeholders from Kibuku district, notably sub-county chiefs, local council (LC) chairpersons, health unit management committee (HUMC) chair persons, village health team (VHT) members, community development officers (CDOs), sub-county councilors and volunteers. Technical support was provided by the team from MakSPH.

Five rounds of scoring were implemented on quarterly basis between November 2017 and November 2018. Similar to the CARE CSC design [2], our implementation process included five major steps 1) preparatory ground work (planning, community sensitization and mobilization and input tracking (identification of key inputs for maternal health service delivery) 2) health facility identification and scoring of indicators, 3) community identification, prioritization and scoring of indicators, 4) Interface meeting and 5) dissemination, advocacy and monitoring, as summarized in Fig. 1 .

Community score card Implementation design

During the implementation, a few changes were made to the above design in response to feedback from the local stakeholders. During the first round of scoring, one interface meeting was held at the sub-county level, later the interface meetings were held at parish level to allow more people to attend the meetings. After the third round of scoring, we combined the community scoring and interface meetings into one community meeting. This reduced the overall length of the community score card meeting. These meetings were attended by community members, local leaders as well as health care providers. Details about the changes in the design of the CSC can be found in Sebagereka et al. (Additional file 1).