Presentation (CTI)

OBJECTIVES: Population-based screening for noncommunicable diseases (NCDs) is increasingly promoted to advance universal health coverage (UHC). However, evaluation frequently relies on activity-based indicators such as screening uptake and diagnostic yield, which may inadequately reflect whether individuals ultimately receive sustained health benefit. This study examined whether pathway-based metrics and adaptive feedback mechanisms may better characterize meaningful outcomes than conventional screening measures.
METHODS: A comparative framework analysis was conducted using health economics and outcomes research (HEOR), cascade-of-care, implementation science, and adaptive systems perspectives. Published literature, international screening guidance, and eight health system comparators were synthesized using thematic analysis. Comparators were selected through maximum variation purposive sampling to capture diversity in financing structures, implementation maturity, pathway integration, and screening delivery models and included the Philippines, Thailand, South Korea, Singapore, the United Kingdom, Germany, Canada, and Rwanda. Screening indicators and downstream pathway measures were examined across service delivery, patient-centered, implementation, financing, and information-system dimensions.
RESULTS: Activity-based screening measures alone frequently overestimated performance where downstream pathways remained incomplete. Measures more closely aligned with sustained outcomes included referral completion, treatment initiation, continuity of follow-up, financial risk protection, patient-reported outcomes, and equity indicators. Proposed feedback mechanisms included pathway monitoring dashboards, interoperable registries, and integration of patient feedback into monitoring, evaluation, accountability, and learning processes to support iterative redesign. Suggested mitigation strategies included strengthened patient navigation systems, integrated information systems, and adaptive financing mechanisms.
CONCLUSIONS: Screening value may be better assessed through pathway performance and sustained patient benefit rather than screening activity alone. Integrating adaptive feedback mechanisms into screening systems may improve continuity and support more equitable and sustainable health system performance under UHC.