# Developing a framework for monitoring the stages towards achieving effective coverage and equity for maternal, newborn, child health and nutrition interventions

## TL;DR

This paper introduces a new framework to track progress in scaling up maternal, newborn, and child health interventions to ensure effective coverage and equity.

## Contribution

The novel contribution is a six-domain framework with 26 milestones and indicators for monitoring health intervention scale-up.

## Key findings

- The framework was validated using over 83,000 data points from documents, interviews, and surveys.
- The framework provides a common set of indicators for monitoring progress using existing data sources.
- Applied examples demonstrate how the framework can guide action-oriented monitoring in key geographies.

## Abstract

Reaching the Sustainable Development Goal 2030 global mortality and morbidity targets will require increased access to essential health services. Scaling high-impact health interventions within the public sector is complex; delineation of the pathway to scale for each intervention within each distinct geography is important for prioritising actions to advance interventions towards effective coverage. Following a review of 38 theoretical frameworks describing pathways for scaling health system interventions, we developed, tested and refined a new schema—the Stages of Achieving Effective Coverage and Equity Framework—for use to describe the status of policy adoption, implementation and coverage of key maternal, newborn, child health and nutrition (MNCHN) interventions. We propose a framework with six domains (global, national, systems, implementation, availability and coverage) covering 26 critical milestones with identified corresponding, intervention-specific indicators. Our framework was validated by the alignment of over 83 000 data points sourced from document review, interviews and global or country surveys. Visualisations are presented to highlight how the framework is operationalised to assess scale-up progress. We outline our process of conceptualising and developing a new framework and articulate its use case for action-oriented monitoring of progress towards effective coverage through applied examples in key geographies. Our framework offers an easy-to-follow implementation pathway and a set of common policy and implementation indicators to monitor scale-up towards effective coverage that uses existing secondary data sources where available. Achieving prioritised maternal, newborn and child health targets requires scalable implementation strategies for lifesaving interventions, alongside monitoring progress towards achieving scale.