BUILD’s five principles—Bold, Upstream, Integrated, Local, Data-Driven—guide communities as they address upstream health and health equity in ways that honor their needs, history, and goals. Working with BUILD’s 55 communities over seven years, we have observed how they have implemented the principles in their own unique ways. Over time, we have also seen trends, opportunities, and challenges in how communities are applying BUILD strategies to advance health equity. In order to make sense of what we’ve seen and to share what we’ve learned alongside communities, we’ve created the Outcomes Framework and Progress Continua. When used together, with the BUILD principles, they offer communities a coherent way to articulate their work and to track their progress.

These two frameworks were designed for BUILD communities specifically, so we encourage adaptation of the information as needed to align with your own program(s). Be sure to also check out the “Getting BUILD Ready Guide” for more information about both frameworks, as well as access to a variety of tools, tips, and ideas for implementing BUILD principles in your own community health efforts.



Achieving systems change that results in sustainable improvements in community health is a daunting challenge, but as we have seen within BUILD communities and others working on similar upstream issues, it is not impossible. The BUILD Outcomes Framework depicts what “success” looks like in BUILD sites as they fully implement the five BUILD principles and prioritize system-level shifts.

Working with communities, we have gathered evidence on a set of “precursors” or early signs of systems change. These precursors referenced in the Framework are our best understanding of what elements need to be in place in order to achieve outcomes that not only lead to systems change, but also eventually yield long-term improvements in population health and health equity.

The Outcomes Framework describes three “sequences” of outcomes:

  1. Precursors to Systems Change that represent the steps toward systems change, generally realized as sites implement the BUILD principles. While sites implement BUILD principles in varied sequences, emerging evidence suggests that it is critical that all five principles are implemented in order to achieve the precursors.
  2. Systems Changes are sustainable, formal, and at-scale changes that contribute to improvements in community health. They entail shifts in norms, policies, and processes to support community health.
  3. End Goals are meaningful improvements in population health and health equity. These act as the “North Star” for BUILD sites.

The framework is depicted as linear for ease of reading; however, we recognize that this work unfolds in more complex ways.



To better understand what implementation looks like for each principle, we created the Progress Continua. This framework helps communities articulate a set of factors that are core to each BUILD principle. The Continua features four stages of implementation that are emerging for each factor – from ground, early, and middle, to advanced stages. Communities progress over time through these stages as they work together and grow their capacity for addressing upstream issues—such as the ones BUILD communities are working on.

Access the Full BUILD Progress Continua


This framework can be used to identify a community’s current stage of implementation and help them to strategize about the progress they hope to see; what may have to happen to get there; and what may happen after they achieve a certain milestone. To that end, we expect each community will reflect its own set of stages for the various BUILD principles. For example, one community may be at a middle stage for “Bold,” and “early stage for “Integrated,” but advanced when it comes to “Local” factors of progress. Whereas another community with similar characteristics and working in a similar issue area may find themselves at a very different set of stages.

For BUILD sites, this serves in part as an evaluation tool and helps to not only track progress, but also encourage partners to take the steps necessary to meet their goals to advance along the continua. This is by no means meant to be a one-size fits all model, rather it is intended to provide context that can be applied to each BUILD site’s efforts—both individually and as a cohort—to help identify what progress is being made and the process by which it is occurring.


Looking for more information regarding BUILD’s evaluation and learning efforts? Check out BUILD’s Systems Change Compendium to see how these frameworks are being used.