Pathway to High Effective Coverage at Scale: A framework for strategy, monitoring, and evaluation

PURPOSE: Linking health systems changes to sustained coverage improvements can be a challenge. The Pathway to High Effective Coverage at Scale is a framework to guide and assess country-level progress, identify key ingredients for success, determine system capacity to implement and scale-up. It serves as a structure to unpack health systems factors, how they link to one another, and identify critical bottlenecks to achieving desired health outcomes.

BACKGROUND: The Saving Newborn Lives Program in its third phase (SNL3, 2013-2018) supported Ministries of Health in selected countries in efforts to achieve equitable and high effective coverage of high impact newborn services and practices at the national scale. SNL3 and its evaluation partner, EnCompass LLC, developed the Pathway through an iterative, consultative process, building on work of WHO, Unicef, IDEAS/LSTHM and JHU (See Handout A). The framework was used in three different ways: for strategic planning, for monitoring strength of implementation and effective coverage of key newborn-related interventions, and for evaluation.

PATHWAY FOCUS/CONTENT: National and subnational readiness, including policies and management capacity, are examined alongside health systems infrastructure that provides the context for the strength of implementation, ultimately determined by whether delivery elements are in place and functioning. These elements are necessary to achieve effective coverage (defined as services being provided to those needing them with sufficient quality) and impact at scale. See Handout B for sub-elements. Progress within the Pathway is not expected to be linear, although some elements are dependent on the achievement of others. The framework instead defines the various important elements that must come together to reach high effective coverage; selecting elements of focus can be part of the use of the framework.