Measures to monitor the implementation of Essential Health Benefit Packages at a national scale

Abstract Universal health coverage requires identifying who is covered by which services. However, weak health information systems hinder monitoring coverage of Essential Health Benefit Packages (EHBPs). We developed a method for measuring input-adjusted coverage, a potential coverage metric, combining geographic proximity with minimum-input facility readiness, using Malawi as a case study. We mapped the Disease Control Priorities Project interventions to the 2019 Harmonized Health Facility Assessment, constructing transparent input-based readiness indicators. We assessed readiness and generated readiness bottleneck cascades for 129 interventions in 563 publicly financed healthcare facilities. We conducted service area analysis, assessing national and district-level coverage within 5 and 25 km catchment areas based on health service level. Findings revealed high childhood vaccinations, HIV, and malaria management readiness and coverage compared to non-communicable diseases and surgical care. This method repurposes facility surveys and provides actionable insights on supply-side gaps for EHBP planning, resource allocation, and monitoring in low-resource settings.