1. STEP 5 & 6

2. 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

3. 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.

4. Activity: Prioritizing Health Equity Issues

5. 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?

6. Mock matrix (data for 2009) Policy DomainIndicatorDistrict ADistrict BDistrict CDistrict DDistrict EDistrict FBenchmarkTarget Health outcomes: Summary indicatorInfant mortality253560704575 5030 Health outcomes: disease-specific indicators Diabetes Prevalence (per 100,000) 2259015080190250 200100 Tuberculosis prevalence (per 100,000) 350280260180320400 300150 Physical infrastructure & environment Access to safe water806560696089 7090 Access to improved sanitation 806550856092 7090 Social and human development Skilled birth attendance987470699565 7095 Fully immunized children956575809071 7090 Prevalence of tobacco smoking 351510 814 1510 Economics Unemployment111812151316 1510 Poverty rate30201081215 2010

7. 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.

8. Prioritize policy domain or district? IndicatorDistrict? City-wide implementation? Reason for this being a priority health inequity issue

9. Identifying the Best Response

10. 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

11. 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) 221921412615 Physical infrastructure & environment Access to safe water (%) 8858895883100 Social & human development Completion of primary education (%) 857889n.a.8485 Fully immunized children (%) 757071626570

12. 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

13. 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.

14. Revisiting the Matrix Policy DomainIndicatorDistrict ADistrict BDistrict CDistrict DDistrict EDistrict FBenchmarkTarget Health outcomes: Summary indicatorInfant mortality253560704575 5030 Health outcomes: disease-specific indicators Diabetes Prevalence (per 100,000) 2259015080190250 200100 Tuberculosis prevalence (per 100,000) 350280260180320400 300150 Physical infrastructure & environment Access to safe water806560696089 7090 Access to improved sanitation 806550856092 7090 Social and human development Skilled birth attendance987470699565 7095 Fully immunized children956575809071 7090 Prevalence of tobacco smoking 351510 814 1510 Economics Unemployment111812151316 1510 Poverty rate30201081215 2010

15. Intervention Proposal Stakeholder: Priority issue(s): Focus on a specific district or indicator?

16. Intervention Proposal Proposed interventions: Reasons?

17. Intervention Proposal Discuss how the interventions will meet the criteria of evaluation (in slide 10)?

18. 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.