Operationalising health systems thinking: a pathway to high effective coverage

Abstract

Background The global health community has recognised the importance of defining and measuring the effective coverage of health interventions and their implementation strength to monitor progress towards global mortality and morbidity targets. Existing health system models and frameworks guide thinking around these measurement areas; however, they fall short of adequately capturing the dynamic and multi-level relationships between different components of the health system. These relationships must be articulated for measurement and managed to effectively deliver health interventions of sufficient quality to achieve health impacts. Save the Children’s Saving Newborn Lives programme and EnCompass LLC, its evaluation partner, developed and applied the Pathway to High Effective Coverage as a health systems thinking framework (hereafter referred to as the Pathway) in its strategic planning, monitoring and evaluation. Methods We used an iterative approach to develop, test and refine thinking around the Pathway. The initial framework was developed based on existing literature, then shared and vetted during consultations with global health thought leaders in maternal and newborn health. Results The Pathway is a robust health systems thinking framework that unpacks system, policy and point of intervention delivery factors, thus encouraging specific actions to address gaps in implementation and facilitate the achievement of high effective coverage. The Pathway includes six main components – (1) national readiness; (2) system structures; (3) management capacity; (4) implementation strength; (5) effective coverage; and (6) impact. Each component is comprised of specific elements reflecting the range of facility-, community- and home-based interventions. We describe applications of the Pathway and results for in-country strategic planning, monitoring of progress and implementation strength, and evaluation. Conclusions The Pathway provides a cohesive health systems thinking framework that facilitates assessment and coordinated action to achieve high coverage and impact. Experiences of its application show its utility in guiding strategic planning and in more comprehensive and effective monitoring and evaluation as well as its potential adaptability for use in other health areas and sectors.

Household Survey Measurement of Newborn Postnatal Care: Coverage, Quality Gaps, and Internal Inconsistencies in Responses

“…However, calculation of this measure often depends on the availability of both population-based survey data linked to health facility data or other quality of care data. 11 – 13 As health facility surveys with publicly available data are not widely collected, proxies from survey data are often used. Measurement of quality of care in population-based surveys has typically used proxies of contact coverage, timeliness, and skill level of the health care provider.…”

High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

“…Universal coverage of quality MNH services is essential for reducing the NMR and MMR and achieving SDG3 targets [ 15 , 78 ]. A body of literature in Nepal and elsewhere focus on access to health services [ 31 , 41 , 79 , 80 ]; however, quality-adjusted coverage, adherence to quality of care standards, and outcome-adjusted coverage are important stages for the effective coverage and intended MNH outcomes [ 16 , 75 , 81 , 82 ]. As this study demonstrates, programmatic and policy focus must shift beyond service contact to intervention-specific coverage and quality-adjusted coverage for optimal health outcomes and to achieve the SDG3 targets.…”

Evaluations of effective coverage of maternal and child health services: A systematic review

“…The first two components are applicable at a national level, whereas the third and the fourth pertain to the subnational level and the intervention delivery point, respectively. Various countries have used the pathway approach to guide strategic planning, monitoring and evaluation ( Vaz et al. , 2020 ).…”