Delegation of the European Union to Eswatini

Structured participatory dialogue between medical staff and patient improves satisfaction at local health clinics in Swaziland

28/06/2018 - 11:03
Public Health and Social Protection

Community Score Cards (CSC) is a model for structured dialogue between service providers and users. It is a way to define needs and execute action plans at a grassroots level.

The objective of the project is to improve accessibility and satisfaction at health clinics. Eight clinics, each covering 3 communities, participated in the three year pilot project.

One CSC cycle took 8 months. During the first 3 months, patients and medical staff had focus group discussions. These resulted in a list of priorities. Patients, staff and local authorities worked together with World Vision to make the improvements. One example is the construction of ramps for wheelchair users. Finishing the 8 month cycle, the measured satisfaction about the improvements was high. This cycle was repeated 4 times in all 8 clinics.

Total Cost (EUR): 1 155 741.08

EU contracted amount (EUR): 1 155 741.08

Duration: January 2015 - January 2018

Implementing organisation: World Vision Austria

Funding Instrument: European Development Fund (EDF)

Benefitting zone: Swaziland


STORY: Structured dialogue with clinic helps wheelchair user to get ramp 

Patients enjoy better service at health clinics in rural Swaziland after the Community Score Cards process, a model for structured dialogue.

"For the first time, we as a community were given a platform to say what we needed. Before, we didn’t even know where to start. Thanks to the dialogue model of Community Score Cards, we were given the opportunity to express our demands, and act upon them."

Agrippa Sukati (29) participated in the focus group discussions.



Focus group discussions in the 8 clinics defined 36 priorities. The most important ones are: shortage of clinic staff, poor hygiene and sanitation, lack of maternity services, insufficient maintenance of infrastructure, shortage of staff and equipment, long waiting times, unfriendly and inadequate attendance by medical staff, and inaccessibility for people living with disabilities. Staff would improvise a ‘treatment area’ with sheets around the disabled patient, outside near the queue, lacking all sense of privacy.



  • The general objective of the Community Score Cards (CSC) project is to provide a framework for defining needs within the community.
  • Focus group discussions empower patients and staff to identify their demands and act upon them.
  • Improve access to local health clinics.



  • Better access. For example, clinics are now also open after business hours and on weekend. Employed people (mostly men) can now go to the clinic after work.
  • New structures. For example: ramps for wheelchair users
  • Improved hygiene and sanitation. For example, new toilets.
  • Better attendance by medical staff: they are more punctual. Also, the waiting time is shorter.
  • New health programmes. For example cervical cancer screening and Tuberculosis screening are now available at some clinics.
  • The relationship between medical staff and patients is better and more respectful.
  • The measured satisfaction of patients and staff at the end of the CSC process was very high.



Agrippa Sukati (29) participated in the focus group discussions.

When Agrippa was five months old, doctors discovered complications. Born a paraplegic, his family had difficulty to accept him at first. Agrippa:"The first years of my life I went from hospital to hospital. I also stayed with traditional healers on and off for about three years. Therefore I only started primary school at the age of nine instead of six." In spite of this delay in his education, Agrippa got a higher degree in Office Management and Technology. "Even with my diploma, and despite countless job applications, I couldn’t find a job. That’s why I opened my own shoe repair shop at the bus station in 2016. Business is not great, but I’m keeping my head above the water".

Agrippa’s life has not been easy, but at least now he has easy access to his health clinic: "I participated in the focus group discussions where I could let my needs be heard. I wanted access for wheelchair users and better availability of medication. For the first time, we as a community were given a platform to say what we needed. Before, we didn’t even know where to start. Thanks to the dialogue model of CSC, we were given the opportunity to express our demands and act upon them."

Before the ramps were built, Agrippa had to wait outside the door to the waiting room: "I had to shout for help until someone would come and lift me and my wheelchair up and into the waiting room. This was not pleasant. I am so grateful I can move freely in and out of the clinic now." The construction of the ramps isn’t the only improvement coming from the CSC programme. "Nobody at the clinic used to pay attention to me. Now, everyone greets me when I arrive. The staff makes everyone feel welcome at any time of day. This is a great improvement in atmosphere at the clinic."





  • The project lasted 3 years: 4 cycles of 8 months.
  • 8 health clinics participated, serving 24 communities in total.
  • A total of 259 medical staff took part in the pilot project.
  • Between 76.000 and 160.000 local community members can now enjoy better service at their local health clinics.




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