STEP 5 & 6
Objectives for Session
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.
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 Domain
Indicator
District A District B District C District D District E District F Benchmark Target
Health outcomes: Summary indicator
Infant mortality
25
35
60
70
45
75
50
30
Diabetes Prevalence (per
100,000)
225
90
150
80
190
250
200
100
Tuberculosis prevalence
(per 100,000)
350
280
260
180
320
400
300
150
Access to safe water
80
65
60
69
60
89
70
90
Access to improved
sanitation
80
65
50
85
60
92
70
90
Skilled birth attendance
98
74
70
69
95
65
70
95
Fully immunized children
95
65
75
80
90
71
70
90
Prevalence of tobacco
smoking
35
15
10
10
8
14
15
10
Unemployment
11
18
12
15
13
16
15
10
Poverty rate
30
20
10
8
12
15
20
10
Health outcomes: disease-specific indicators
Physical infrastructure & environment
Social and human development
Economics
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?
Indicator
District?
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
National
targets
District A
District B
District C
District D
City
average
Health
outcomes
Infant
mortality (per
1000 live
births)
22
19
21
41
26
15
Physical
infrastructure
& environment
Access to safe
water (%)
88
58
89
58
83
100
85
78
89
n.a.
84
85
75
70
71
62
65
70
Completion of
primary
Social & human education (%)
development
Fully
immunized
children (%)
Review
Choose
Select
thethe
list
thestrategy
of
intervention
interventions
package
that
that
inisthe
most
is strategy
most
How toGo
usetothe
Annex
Urban
VII HEART
of Userresponse
Manual menu
relevant toappropriate
the problem
package
foryou
your
want
cityto address
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 Domain
Indicator
District A District B District C District D District E District F Benchmark Target
Health outcomes: Summary indicator
Infant mortality
25
35
60
70
45
75
50
30
Diabetes Prevalence (per
100,000)
225
90
150
80
190
250
200
100
Tuberculosis prevalence
(per 100,000)
350
280
260
180
320
400
300
150
Access to safe water
80
65
60
69
60
89
70
90
Access to improved
sanitation
80
65
50
85
60
92
70
90
Skilled birth attendance
98
74
70
69
95
65
70
95
Fully immunized children
95
65
75
80
90
71
70
90
Prevalence of tobacco
smoking
35
15
10
10
8
14
15
10
Unemployment
11
18
12
15
13
16
15
10
Poverty rate
30
20
10
8
12
15
20
10
Health outcomes: disease-specific indicators
Physical infrastructure & environment
Social and human development
Economics
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.