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Community Score Card for PMTCT

This project adapts CARE’s Community Score Card© (CSC) to enable women living with HIV and their health service providers to improve the delivery and quality of services in the prevention of mother-to-child transmission (PMTCT) of HIV.

The adapted CSC will serve as a platform where the voices of HIV-positive women will be heard in the planning, monitoring, and quality improvement of PMTCT programs. Ultimately, this intervention aims to improve key PMTCT outcomes, including adherence and retention in treatment and early infant diagnosis of HIV, while increasing dialogue between consumers of PMTCT services, providers delivering services, and government officials providing oversight of health services.


Malawi is among the countries most affected by the HIV epidemic globally – nearly 1 million people there are currently living with HIV. Adolescent girls and women are particularly hard-hit by the epidemic; women aged 15-24 are eight times more likely to be infected with the virus than their male counterparts. This is a challenge because, in addition to transmission through sexual contact, HIV can be transmitted vertically from mother to child. In fact, more than 50,000 pregnant women are in need of HIV treatment – almost 10% of Malawi’s population. With such a high incidence of HIV among women of reproductive age, Malawi has taken a radical and lifesaving step of providing antiretroviral therapy to

HIV-positive pregnant women from the time of diagnosis through the remainder of their lives, testing infants born to HIV-exposed mothers, and starting them on treatment if infected to dramatically increase their chances of survival. Despite this commitment, ensuring that women are retained in care from the point of diagnosis has been a challenge. In 2015, just 39% of all HIV-positive pregnant women remained on treatment after the first 12 months, and only 33% were virally suppressed. This lack of effective adherence to treatment puts the mother’s health, the health of her infant, and the health of her partner at risk.



pregnant women in Malawi are in need of HIV treatment


The reasons behind these poor outcomes are varied and range from poor quality of PMTCT service delivery to a lack of motivation and support from family members and community. CARE, in partnership with The Elizabeth Glaser Pediatric AIDS Foundation, set out to explore how the power of the CSC approach could be harnessed to effect meaningful change. The CSC brings together community members, health service providers, and government officials to identify barriers to PMTCT service accessibility, acceptability, initiation, retention, adherence, and quality (including satisfaction); to generate solutions; and to work in partnership to implement and track the effectiveness of these solutions in an ongoing process of improvement. Adapting the CSC to this context required creative thinking about how to engage this often-stigmatized population in a way that is respectful and preserves their right to privacy and confidentially.


Our mixed-methods evaluation found that health care workers and women living with HIV valued the CSC approach, viewing it as a productive way to make meaningful improvements to services. Health workers and clients felt that the process led to improved trust, respect, and relationships. These improved relationships led to important changes in service delivery. Of the 15 indicators identified as important to PMTCT at the start of the project, 14 improved during the 12-month implementation period, with eight showing statistically significant change. By creating an opportunity for mothers living with HIV to form relationships with their health service providers, communities, and local government officials and jointly identify issues and implement solutions, the CSC process contributed to improvements in the perceived quality of PMTCT services. Stay tuned for official results, currently being prepared for publication.

Program achievements

  • Health workers and their pregnant and breastfeeding clients found the project approach as a productive way to make meaningful improvements to services.
  • Health workers and clients felt the project improved mutual trust and respect, and strengthened client-health worker relationships.
  • The intervention led to significant structural changes and mobilized additional resources for health service delivery.


Community Score Card Technical Brief

From July 2017 - December 2018 CARE implemented the CSC approach in 11 health facilities and compared client health outcomes.

Read the report on the EGPAF website