Scale & sustain

Scale to the whole city

Testing can then be expanded in waves to target additional populations or health facilities, and ultimately extend across the city. Begin with expanding the interventions to all (primary) health facilities or the selected population groups within a given district. Gradually extend the rollout, ensuring that each phase builds on the success and learnings of the previous one. This methodical approach ensures that interventions are effectively scaled up while maintaining or even improving their impact and feasibility.

Commit to continuous refinement and improvement of the interventions based on ongoing data review, assessments and feedback. Regularly host “pause and reflect” sessions to evaluate the impact of the overall roadmap and its individual interventions, and to make necessary adjustments. Loop back with stakeholders previously engaged in the process to gather diverse perspectives and insights. Use the collected data to update the solution packages, ensuring they remain effective and relevant. This commitment to continuous improvement will help sustain the positive outcomes of the interventions over time.

Track KPIs

Throughout the process, tracking a minimum core set of KPIs is essential. The CARDIO4Cities Logical Framework guides a KPI Framework that has proven useful across CARDIO4Cities, with measures falling into three categories:

• Tracking impact: incidence of AMI, stroke, and – if possible – incidence of heart failure and CV death
• Tracking outcomes: prevalence (estimated), patients diagnosed, patients treated pharmacologically, patients controlled (track separately for each risk factor)
• Tracking outputs: % of facilities using simplified guidelines, implementation status for different interventions (e.g., task-shifting of hypertension diagnosis to nurses and/or pharmacists), roll-out of workplace health interventions, etc.)

Depending on the local population health roadmap, additional indicators may be required to document and reflect the specific local CARDIO intervention mix (see CARDIO4Cities Logical Framework). Note that well-formulated and consistently measured indicators are more valuable than a broad range of only partially available data. Ideally, data are displayed in a central population health management dashboard to facilitate regular review by the steering committee, accountability to donors/funders and evidence-based decision making. Measure improvements across the input, output and impact metrics, review progress regularly, and adjust the population health roadmap (step 4) as needed to further accelerate impact.

Consider implementing impact evaluations

Consider conducting a full impact evaluation of the population health roadmap to comprehensively assess the overall effectiveness and long-term outcomes of the interventions. Unlike tracking KPIs, which provides ongoing, specific metrics, a full impact evaluation offers a holistic view of the initiative’s success, including unintended consequences and broader societal impacts.

Such a thorough analysis can inform future policy decisions, optimize resource allocation, and enhance the credibility of the program. However, it requires significant time, resources, and expertise to conduct a rigorous evaluation, and also presents potential difficulties in isolating the effects of the interventions from other external factors.