The service assessment diamond is a simple framework to assess and monitor public services and schemes such as health services, education, safety nets, or utilities such as electricity or water. The tool can be used to guide an assessment, or it can be directly used for scoring services in a workshop or community setting to identify the main issues and start a dialogue.
Commonly public services are assessed under the criteria of awareness, availability, and access (AAA) as well as the quality of services. However, this traditional perspective falls short in terms of
assessing the accountability of the state toward the citizen and specifically to the “powerless”
assessing the adequacy of the entitlements (i.e., are they sufficient to ensure certain rights?)
The service assessment diamond includes these dimensions and can provide a comprehensive analysis of the scheme or services in question.
The example of the malnourished baby girl, Maria
To illustrate the service assessment diamond, let us assume that in country X a baby girl of 12 months called Maria has been sick with diarrhea for many weeks. She has lost a lot of weight. After trying traditional methods of feeding sick children, her mother, Anna, seeks better options. She is afraid the girl could die.
Awareness, Availability, and Access of Services:
Anna asks herself which better options could save the life of her daughter. She knows that people who go to professional health facilities often become sicker or even die. Anna is not aware that this correlation is often because people consult professional services too late when the sickness has already progressed to a serious level. Her awareness of the usefulness of health services and her belief that professional treatment could change Maria’s condition is not high.
Despite these doubts, Anna sees Maria getting worse by the day and considers visiting the health center. The nearest center closed recently due to a lack of nurses, and professional treatment is available only in a village that is around 6 kilometres away. She does not really know what services the health centre provides and if it can help her child.
Accessing the health center is not so easy for Anna and Maria. Anna carries Maria two times to the center before she finds it open. At that time, she meets the only nurse in the center. The nurse asks her for a registration fee, even before any consultation takes place.
Quality of Services:
The nurse finally sees the severely malnourished child and prescribes an oral rehydration salt and some antibiotics. The nurse does not weigh the child. She also fails to refer Maria to the district malnutrition center that handles cases like Maria’s. Clearly, the quality of services was not up to the mark. But how would Anna know?
Making sense of a medical diagnosis is difficult for most, and for Anna as well. She leaves the health center with her child both happy and worried. At last, she has some medicine, but will it help?
The dimensions of the AAA and the quality are straightforward and have traditionally been used to assess services. In the service assessment diamond, we have added two important dimensions for assessing the services:
Let us assume the tragic case in which the child dies, despite having received the medicines at the health service. Shortly after the death, Anna finds out that the worker at the health center that treated her child was not a qualified nurse, but just a helper without any formal training. This is not in accordance with the standards and laws of the country. The mother suspects that the helper was giving the wrong medicines and did not refer the severely malnourished child to a treatment center— which would have been the standard treatment protocol.
Anna feels angry and helpless. But what to do? She consults with some of the older women in the village, and they all advise her to let it go. “There is no way for you to find out the truth or even hold the assistant of the health center accountable!” the elders tell her. Anna gives up.
Apart from failing to provide justice, this lack of clear and easily available accountability mechanisms has many negative effects. The case of Maria might be one of many. Also, if issues of quality or access are not reported, it will be hard to improve the services. Such issues are related to the accountability of the state towards its citizens.
Adequacy of entitlements:
In the three dimensions above, we looked at what should be there (in theory) if compared with what is there (in practice), or in other words, which services is the child entitled to, compared to the services that were delivered to help the child? The story uncovered many areas that need improvement.
We now add a last dimension, the adequacy of the services. Here we assess
if the services and entitlements that should be there—usually defined in laws or provisions—are adequate?
Is the policy and legal framework enough and does it meet the needs of the mother and her child, at least in theory?
Let us go back to the case of Anna and Maria: Apart from all the issues regarding the access, quality, and accountability of the services, an essential question relates to adequacy. In the case of Anna and Maria, the national policies in their country do not emphasize growth monitoring and regular check-ups for children, and no state service looks at this issue.
We could argue that there is a gap in the adequacy of entitlements. If there were a preventive entitlement for a front-line worker to regularly monitor the growth of children, then the mother could have become aware of her child’s problem earlier, and the child might have been saved. Growth monitoring and regular check-ups for infants could then be considered a topic worthy of civil society organizations’ advocacy to improve the adequacy of entitlements.
Application of the Service Assessment Diamond
In Context Analysis: We have used the service assessment diamond since 2019 in the context analysis for initiatives related to social accountability and advocacy in many countries, such as India, Malawi, and Kenya. In those context analyses, services such as primary health services, nutrition programs, agriculture extension services, or employment programs were assessed. The tool proved very useful, delivering quick and structured insights on the strength and issues of service. Those insights helped people prioritize issues and plan social accountability actions and advocacy initiatives.
In Field Level Assessments and Service Design: The use of the diamond at the field level and with communities has been conceptualized but was not yet implemented (status 2022). It would be interesting to combine the diamond with a customer journey to expose and visualize gain and pain points along the journey. For further inspiration, please look at our references.
Nielsen Norman Group. 2018. “Journey Mapping 101.”
About the Author:
Joachim Schwarz is passionate about social justice and on a mission to support like-minded civil society actors and social entrepreneurs to become more powerful and innovative. Hence, in 2014 he left his NGO career to build the Civil Society Academy. He is an outstanding facilitator and coach with expertise in social innovation, leadership, organisational change, and advocacy. After more than 20 years in Africa and Asia, he is now based in Berlin.