STEP 5 & 6
Objectives -To be able to use the MATRIX and MONITOR to prioritize problems and/or districts requiring action. -To be able to select appropriate interventions that address the priority health inequities selected. Objectives for Session
Interpreting the Urban HEART MATRIX and MONITOR Now that you have produced strong evidence of health inequities in your city/region, the next step is to raise awareness of equity gaps and prioritize the problems requiring action. Schedule priority-setting workshops and meetings with stakeholders. Teach participants how to read the MATRIX and MONITOR. Facilitate discussion around 3 main topics: – Seeing trends or pockets of health inequities – Understanding the causes and effects of the inequities – Prioritizing problems or districts requiring action Rank-order stakeholders’ equity priorities.
Activity: Prioritizing Health Equity Issues
Prioritizing Health Equity Issues In your groups, review the MATRIX on the following slide and answer the following questions: 1.Is there general consensus among the stakeholders (i.e. group members) for the priority areas identified? 2.How would you propose resolving conflicts between stakeholders? 3.Are there any immediate concerns in the city which should be addressed first?
Mock matrix (data for 2009) Policy DomainIndicatorDistrict ADistrict BDistrict CDistrict DDistrict EDistrict FBenchmarkTarget Health outcomes: Summary indicatorInfant mortality Health outcomes: disease-specific indicators Diabetes Prevalence (per 100,000) Tuberculosis prevalence (per 100,000) Physical infrastructure & environment Access to safe water Access to improved sanitation Social and human development Skilled birth attendance Fully immunized children Prevalence of tobacco smoking Economics Unemployment Poverty rate
Documenting Areas of Health Inequity After reaching consensus within your group, identify 2-3 priority areas and/or districts for which intervention plans should be developed. List the priority areas/districts and provide brief explanations for your choices in the following table.
Prioritize policy domain or district? IndicatorDistrict? City-wide implementation? Reason for this being a priority health inequity issue
Identifying the Best Response
Developing an Intervention Plan Criteria for selecting an appropriate intervention plan: Reduces health inequities Available local resources Acceptable by affected communities and other key players Achievable within timeframe Likely to be effective and efficient Complies with national priorities
How to use the Urban HEART response menu Review your MATRIX to confirm the policy domain responsible for your problem indicator District ADistrict BDistrict CDistrict D City average National targets Health outcomes Infant mortality (per 1000 live births) Physical infrastructure & environment Access to safe water (%) Social & human development Completion of primary education (%) n.a.8485 Fully immunized children (%)
How to use the Urban HEART response menu Go to Annex VII of User Manual Choose the strategy package that is most relevant to the problem you want to address Review the list of interventions in the strategy package Select the intervention that is most appropriate for your city
Activity: Selecting Interventions In your stakeholder group analyse the MATRIX and select recommendations for an intervention proposal. Fill in the “Intervention proposal” slides. The proposal will later be presented to the Mayor for his/her consideration. Be prepared to justify your choices and explain why you have focused on certain aspects of the MATRIX.
Revisiting the Matrix Policy DomainIndicatorDistrict ADistrict BDistrict CDistrict DDistrict EDistrict FBenchmarkTarget Health outcomes: Summary indicatorInfant mortality Health outcomes: disease-specific indicators Diabetes Prevalence (per 100,000) Tuberculosis prevalence (per 100,000) Physical infrastructure & environment Access to safe water Access to improved sanitation Social and human development Skilled birth attendance Fully immunized children Prevalence of tobacco smoking Economics Unemployment Poverty rate
Intervention Proposal Stakeholder: Priority issue(s): Focus on a specific district or indicator?
Intervention Proposal Proposed interventions: Reasons?
Intervention Proposal Discuss how the interventions will meet the criteria of evaluation (in slide 10)?
Activity: Pitch your response to a Mayor -Engage the “city Mayor” with your group’s Urban HEART plan of action. -Remember to try to connect interventions as much as possible to the Mayor’s agenda and existing initiatives. -Try to propose a long term strategy, but focus on short term deliverables.