The READY continuum and an event-linked National Readiness Ledger for low-resource settings

Health emergency readiness depends on whether capabilities work when they are needed and whether lessons from events lead to sustained improvement. Capacity assessments, timeliness measures and action reviews each capture part of this picture, but they are kept in separate records. This review examines how the three can be combined into a single, event-linked account of operational readiness for national public health institutes in low-resource settings. We conducted a scoping review with best-fit framework synthesis, framed by population, concept and context and reported with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Searches covered bibliographic, journal and organizational sources to 11 September 2026. Eligible sources addressed preparedness, detection, response or learning in low-resource settings, or methods transferable to them. Two reviewers independently screened every record. A five-source pilot informed the charting form; independent charting of 12 further sources gave 91.7% field-level agreement. Synthesis used 14 analytical domains and 11 interpretive themes. Of 800 identified records, 640 remained after deduplication; 160 full texts were assessed, 112 were excluded, 48 sources were charted and 45 were retained after identity verification. Capacity instruments document standing structures, and their association with early COVID-19 performance was limited and context-dependent. Event timeliness and its association with outbreak outcomes differed by milestone. Uganda translated event bottlenecks into national planning. Frontline studies, all with uncontrolled designs, described improved facility readiness alongside timely detection and notification. Action-review research identified the conditions that support follow-through. The synthesis informed our proposed Risk anticipation, Equip, Alert, Deploy and Yield (READY) continuum and National Readiness Ledger. Event records link results to deficits, actions, owners, financing and verification, and a linked capability register records dated functional status and reassessment requirements. READY is an author-proposed framework with linked records, accountable roles and seven indicators. The indicators draw largely on existing records, supplemented by a capability register, attribution records and verification decisions. Capability status derives from dated functional checks, not from action closure alone. Prospective evaluation should establish feasibility, reliability and effects on sustained capability and later event performance.