Programs to reduce mortality among women and children are the target of new resources and redoubled commitment as the 2015 date for achieving the Millennium Development Goals approaches. The need for a common evaluation framework to guide the collection, analysis and synthesis of evidence is increasingly evident. This paper presents such a framework in four parts: (1) a conceptual model for the scale-up to MDGs 4 and 5 for maternal and child survival; (2) recommended indicators for each part of the model that bring together the work of various existing technical groups and prioritize a limited number of indicators for standardization and common use; (3) guidelines for documenting program implementation and contextual factors that may affect program implementation and its effectiveness in reducing maternal and child mortality; and (4) design considerations in evaluating the scale-up. We first present an overview of what is known and/or agreed upon within each of these areas, and in the discussion highlight areas of uncertainty or where there are gaps to be addressed.