Developing citizen report cards for primary care: evidence from qualitative research in rural Tajikistan

Transparency interventions, such as public reporting, have emerged as a potential policy approach to improving the performance of health care providers in resource-constrained settings. We report on results from focus groups and key informant interviews in rural areas of two Tajik provinces, Soghd and Khatlon, with regards to three important initial considerations for developing a report card initiative for primary health care in this setting: selecting indicators for the report card, collecting data, and working with existing institutions and stakeholders. The findings suggest that citizens are able to articulate and prioritize concerns with respect to local health care services. Participants indicated a preference for arms-length collection of sensitive feedback on local providers. Because citizens and local institutions have close and important relations with their local health care providers, there may be scope for a trusted external actor, such as a non-governmental organization, to facilitate the report card process.