Patient Voice Program and Citizen Voice and Action: Leaders’
responsiveness to RMNCH gaps raised by citizens through community
scorecard meetings in Rwanda: A cross-sectional study
Abstract
Background: The Patient Voice Program and Citizen Voice and
Action models use scorecard meetings for community-provider-government
dialogue to improve health services. This study evaluates the
responsiveness of leaders and providers to concerns voiced by citizens
through these scorecard meetings at the health center and district
office levels in Rwanda. Methods: We conducted a
cross-sectional study from July to September 2022 in 325 Rwandan health
centers across 20 districts. Responsiveness was measured by comparing
resolved issues to raised issues. Logistic regression identified
predictors of issue resolution, with a p-value less than 0.05 considered
significant. Median responsiveness turnaround time was also analyzed.
Results: In total, 59.4% (1,163) of the identified gaps were
resolved. Facility-level issues experienced a higher resolution rate
(65.9%) than district-level issues (35.4%). Gaps at the facility level
were 3.24 times more likely to be resolved than those at the district
level (OR: 3.24, p<0.001, 95% CI: [2.48,4.25]).
Integrated gaps had 1.46 times higher odds of resolution compared to
issues stemming from reproductive, maternal, newborn, and child health
services (OR: 1.46, p<0.05, 95% CI: [1.13,1.88]). The
median responsiveness turnaround time for resolving a gap was
approximately 15.4 months (IQR: 6.7-25.8). Conclusions: The
study shows that Patient Voice Program and Citizen Voice and Action
models are effective in addressing healthcare service gaps. By promoting
collaboration among communities, healthcare providers, and governments,
these models facilitate targeted, locally-supported solutions that
significantly improve the resolution of health service delivery issues.