The balanced scorecard as a practical tool for global health delivery

by Anjali Sastry on November 14, 2009

Student teams are hard at work on collaborative projects designed to address bottlenecks that limit the delivery of health care in the five countries in sub-Saharan Africa where our dozen teams are working with host organizations this year. What tools from the MBA toolkit will they draw on?

Many of our efforts address management, improvement, and expansion challenges and opportunities. One tool that may find use in several projects is the balanced scorecard (here’s an introduction of sorts, presented as an overview of a new book by leading proponents of the approach). A well-designed scorecard serves as a dashboard for monitoring operational performance, guiding change, interacting with stakeholders, and aligning the organization. We found one example of it used in a report on Service Delivery from the WHO’s Toolkit on Monitoring Health Systems Strengthening.

balanced scorecard

By the way, for more on this particular work on balanced scorecards in Afghanistan, further resources include: Peters, D.H., Noor, A.A., Singh, L.P., Kakar, F.K., Hansen, P.M., Burnham G. “A Balanced Scorecard for Health Services in Afghanistan.” Bulletin of the World Health Organization 2007, 85: 146-151. ( )

Hansen, P.M., Peters, D.H., Niayesh, H., Singh, L.P., Dwivedi, V., Burnham, G. “Measuring and Managing Progress in the Establishment of Basic Health Services: The Afghanistan Health Sector Balanced Scorecard.” International Journal of Health Planning and Management 2008, 23 (2): 107-117.

The Ethiopian health sector is taking 0n a national balanced-scorecard project to improve performance. And US examples of healthcare applications of the approach abound (some examples).

Now, the notion of non-profit dashboards has been around for a while. How are balanced scorecards different from these? Some of the issues are laid out in this blog post. What are the implications for global health delivery? Which aspects of which approach are most useful? Do the same ideas apply to small, resource-constrained organizations?

{ 2 comments… read them below or add one }

venkat February 2, 2010 at 2:21 pm


Nice article. I am trying to understand the BSC and i was looking through bscol (now known as Palladium). They have some good cases on use of BSC in health. I am a novice blogger on some healthcare realted topics.

Exploring the intersection of healthcare and management is great.

Best Regards

Zanyar Golabi December 8, 2010 at 4:46 am

Balanced scorecard is not just a performance measurement system, it also is a strategic management system and a communication tool. Since employees can’t understand strategies clearly, BSC can translate those strategies into performance and help employee align themselves with strategies. Following resources are some other useful researches and case studies have been done in this field or related fields such as health system performance assessment:
Balancing the Healthcare scorecard(
Georgia health system performance assessment (

Another interesting tool is “Dynamic balanced scorecard”. Because BSC can’t consider feedback loops and cause-and-effect relations, it can not realistically model the interactions among strategic initiatives. The effect of delays is overlooked in Static balanced scorecard which encourage us to adopt dynamic balanced scorecard for translating strategy to performance and mapping strategies. Furthermore, BSC is a static model, which unable to help us finding future outcomes. We can not answer questions like :”what is the outcome of this action?”. A dynamic balanced scorecard is an alternative which can address this problems effectively. The following link is a useful document:
Teaching the dynamic balanced scorecard (

Leave a Comment

Previous post:

Next post: