CHORUS: Community-led Responsive and Effective Urban Health Systems

Context

As rapid and uncontrolled urbanisation continues across low- and middle-income countries, health systems are struggling to keep up, and the needs of poor urban communities are often not met. This is especially true for those experiencing exclusion due to intersections with gender, caste, ethnicity, religion and disability. Many of the challenges to good health among urban residents are created by the wider urban environment such as inadequate water and sanitation provision, air pollution, urban design that favours vehicles and the influential role of commercial organisations and easy access unhealthy diets, tobacco and substance abuse.

To build resilience and respond to these challenges, the urban health system must be conceptualised to include sectors beyond health and enable linkages between multiple government, NGO and private providers whilst ensuring responsiveness and accountability to urban residents, particularly the poor. Our demand-led approach works with poor communities to understand their health needs and design and evaluate interventions that will drive the improvement of the urban health system in cities in Bangladesh, Ghana, Nigeria and Nepal. We work closely with urban policymakers and providers to ensure that the interventions we co-design are consistent with policy objectives and are feasible and sustainable.

We have a number of smaller projects led by early career researchers working with CHORUS partners and these focus on areas such as reducing pollution and improving water and sanitation in informal settlements as well as increasing access to parks and spaces for physical activity and improved mental health.

Key Aims & Objectives

The work of all CHORUS projects falls under 4 pillars:

Pillar 1) linking the plurality of private, NGO and government providers

RQ1.1) What financing mechanisms can be used to ensure access of the poor to the plurality of health services in urban areas?

RQ 1.2) How can the links between private, NGO and public providers be strengthened to ensure delivery of essential and quality health services to the urban poor?

RQ 1.3) What regulatory, governance and supervision mechanisms are effective in managing the plurality of providers in urban areas that provide services to the urban poor?

Pillar 2) building collaboration across sectors to address social determinants of health

RQ 2.1) How do wider determinants of health at an individual (e.g. gender, socio-economic status, disability) and societal level (e.g. social capital, built environment, infrastructure) influence the health and health-seeking behaviour of different categories of urban poor?

RQ 2.2) What data are available from public, private and CSO facilities, different sectors (e.g. police on traffic accidents, pollution and sanitation) and household surveys: what is the quality and the gaps and how can local governments use this data used for health planning and resourcing?

RQ 2.3) How can urban stakeholders coordinate planning, decision-making and monitoring to use evidence data to inform provision of cost-effective public health functions?

Pillar 3) strengthening systems to prevent and respond to the double burden NCDs and CDs

3.1) What interventions are most effective, cost-effective and scalable in improving the software of the HS, e.g. health worker skills to address determinants of health through patient-centred approaches for behaviour change on tobacco-use, diet, antibiotic use? 3.2) How can treatment, secondary and primary prevention of NCDs and CDs be integrated within health care and community health responses?

Pillar 4); Identifying, reaching and engaging the urban poor.

4.1) How can urban poor residents or representatives work with different sectors, levels and types of healthcare to design and deliver cost-effective and scalable interventions to address intermediary determinants of health related to: a) living conditions of poor households (e.g. pollution, pollution, hazardous roads); b) behavioural and psychosocial determinants (e.g. tobacco, poor diets)?

4.2) How can residents of urban poor neighbourhoods be empowered to identify the threats to their health, monitor improvements and work collectively to improve their health?

4.3) How can private and public healthcare providers be supported to identify marginalised individuals and communities and help them access quality, accountable services?