ELLA Policy Brief: Citizen Participation in Evaluating Health Services: The Latin American Experience

ELLA is the Evidence and Lessons from Latin America Programme


Throughout Latin America, civil society groups are using report cards as a tool to gather citizen feedback on the quality and coverage of public services. This Brief focuses on the use of report cards to assess health services, in particular. Through these report card exercises, civil society has been able to highlight problems citizens face in accessing quality health care, such as lack of medical supplies or personnel, or long waiting times to see a physician. By then bringing these findings before public health agencies and the media, citizens have succeeded in achieving concrete improvements in both health care access and quality. This Brief analyses three different report card experiences, from Colombia, Mexico and El Salvador, emphasising the outcomes of these exercises and the contextual factors enabling their success.

Key Lessons:

The relevance of report cards lies in their potential to promote accountability at the local government level, both vertically to other governmental entities, and horizontally to citizens, ultimately enhancing the access and delivery of public health care services. The experiences presented here show how the use of report cards facilitated concrete improvements in health services.

The use of community report cards seems to work best when implemented as a process that includes an interface meeting between community members and service providers that allows for immediate feedback. Considering this, it has the potential to be a strong instrument for empowerment and for modifying the relationship between citizens and local government.

Latin American experiences show that changes in the delivery of public health services are more likely to happen if civil society is able to undertake strategic advocacy actions such as publishing the report card results and proposals through the media and engaging local authorities and health policymakers in the process.


Chacón Fregoso, G. ELLA Policy Brief: Citizen Participation in Evaluating Health Services: The Latin American Experience. ELLA, Practical Action Consulting, Lima, Peru (2012) 6 pp.

Published 1 January 2012