CHORUS at the International Conference on Urban Health, Atlanta 2023

Conferences

We are very pleased that CHORUS researchers have had numerous abstracts accepted for this year’s International Conference on Urban Health, being held in Atlanta, USA, from 7 – 9 November 2023. The theme for the conference is ‘Turning Evidence into Impact: Urban Equity as a Global Driver of Equity and Social Justice’. We hope to see you there, do get in touch to link up in Atlanta.

Here is a summary of the CHORUS panel, presentations and posters during which we will share findings from our extensive needs assessment works in Nigeria, Bangladesh and Nepal, and we will also share insights on co-creating health interventions with multiple stakeholders with a range of expectations.

 

Panel Session

‘Herding Cats or flying with the flock? Experiences of co-designing health systems interventions to improve health in complex urban environments’

Wednesday 8th November, 10.45 – 11.45, Room: Old 4th Ward

With multiple stakeholders, all with competing agendas and different expectations – how do you effectively develop sustainable, feasible, equitable interventions to strengthen health systems?

We will share videos from each of our CHORUS teams to explain and reflect on the co-design process for the following health systems adaptations:

  1. Linking informal and formal providers for improved primary care service coverage and quality in informal settlements in Enugu, Nigeria: Co-design brought together informal providers (such as patent-medicine vendors, traditional birth attendants and bone-setters), community leaders, government primary care with multiple city and state decision-makers.  
  2. Improving primary care and prevention of diabetes and hypertensions across government and NGOs in Dhaka, Bangladesh: the co-design process worked across two ministries and city corporations as well as technical teams implementing app-based reporting systems. 
  3. Adapting a community health programme designed for rural areas, to meet the needs of urban poor communities in Accra, Ghana.  
  4. Building linkages between private pharmacies and local health system in primary health care for improve treatment of diabetes and hypertension in urban city of Nepal. 

Presenters will form a panel and our moderator will facilitate discussion on various co-design challenges, including addressing power imbalances within health services so key voices can be heard; managing expectations and prioritisation of interventions within resource-constrained environments, and facilitating meaningful community engagement, considering differences by gender, occupation, education and other characteristics within each context. 

Facilitator: Prof. Zahidul Quayyum, BRAC JPGSPH, Bangladesh

Panel members and presenters: Dr. Aloysius Odii and Dr. Uchenna Ezenwaka, Health Policy Research Group, University of Nigeria; Prof. Rumana Huque, ARK Foundation, Bangladesh; Deepak Joshi, Herd International, Nepal

Oral Presentations

Tuesday 7th November, 15.30, Room: Buckhead

‘An analysis of urban health policies in Bangladesh and Identifying gaps between policies and practices’

In Bangladesh, the rapidly increasing urban poor population face various social and financial barriers to accessing healthcare. While urban health has been emphasised over the years in various plans, policies, and strategies, there has been little intensive effort at the national level to provide need-based and quality healthcare to the urban population. The presentation will share findings from our policy analysis, which aimed to explore the past and current health policies and strategies of Bangladesh to understand how urban health with its special needs has been addressed, what the current implementation challenges are, and how to address the gaps between policies and practices. This analysis will help us to understand if past and current health-related policies are translated into tangible solutions to address prevailing poor health outcomes and health system issues and underlying implementation challenges. 

Presenter: Prof. Zahidul Quayyum, BRAC JPGSPH, Bangladesh

Contributors: Baby Naznin & Swaksar Adhikary, BRAC JPGSPH, Bangladesh

Breakout Session 35: CHORUS Oral Presentations

Wednesday 8th November, 15.00 – 16.15, Room: Old 4th Ward

 

‘Assessing the preparedness of people living in slums to accept and support the linking of informal health providers to the formal health system in Nigeria’

Informal Health Providers (IHPs) are an integral part of the health systems in developing countries. Linking them to the formal health system can potentially improve health service delivery and promote health equity and reduce disparities, particularly for underserved populations like slum dwellers. However, for the linkage to be effective, successful and provide short to long-term public health benefits, community acceptance and support are essential. The CHORUS team in Nigeria share findings on the willingness of slum dwellers to accept the linkages, although note the varying interests of slum dwellers, IHPs and formal providers need to be managed.

Presenter: Dr. Aloysius Odii, Health Policy Research Group, University of Nigeria

 

‘Analysing the level of acceptability and perceived benefits of linkage between informal and formal health providers in urban slums in Nigeria’

Informal healthcare providers (IHPs) present opportunities to improve provision and access to essential health services in underserved areas such as urban slums. However, the absence of a coordinated structure for IHPs contributes to weak enforcement of regulations and poor adherence to the limits of practising license, resulting in the provision of substandard quality of care. Institutionalizing and strengthening linkages between IHPs and the formal health systems could lead to improved access to quality essential healthcare services in urban slums. The level of acceptability is high among residents of urban slums in southeast Nigeria, and the perceived benefits include improved capacity, referrals and access to quality treatment, although several intersectional factors affect the willingness to link the informal and formal systems.

Presenter: Dr. Uchenna Ezenwaka, Health Policy Research Group, University of Nigeria

 

‘Social determinants and risk factors associated with non-communicable diseases among urban poor in Nepal: a comparative study with poor, middle and rich groups using a STEP survey’

The burden of non-communicable diseases (NCDs) is disproportionately high among urban populations. A CHORUS study in Nepal compared the social determinants, NCD risk, and NCD among urban poor, middle, and rich groups to determine the factors associated with hypertension, obesity, and diabetes among urban poor.  The findings indicate significant disparities in education, employment, and lifestyle habits based on wealth quintiles, and targeted interventions aimed at improving access to healthcare, education, and lifestyle modifications could help reduce these disparities and improve health outcomes among vulnerable populations.

Presenter: Deepak Joshi, HERD International, Nepal

 

‘Where does Bangladesh’s urban poor go for NCD care, and do they receive adequate advice for NCD prevention and control?’

Despite an increase in NCD risk factors such as poor diet, physical inactivity, and alcohol consumption among urban dwellers, in comparison to rural residents in Bangladesh, NCD services are not widely available across urban primary health care (PHC) centres. A CHORUS study in Bangladesh sought to understand the NCD health-seeking behaviour of urban dwellers, and NCD lifestyle modification advice received by them.  By improving the provision of lifestyle modification advice for NCDs in urban PHCs, the health of the urban poor can be improved, and the urban health system strengthened.

Presenter: Prof. Rumana Huque, ARK Foundation, Bangladesh

Contributors: Deepa Barua, Masroor Salauddin, Salma Anee, Nabila Binth Jahan, Tahzir Faiaz Chowdhury, Fatema Kashfi, ARK Foundation, Bangladesh

 

‘Changes in NCD management within urban primary health care system: Evidence from 2014 and 2017 national surveys’

Despite evidence from nationwide surveys showing an increase in NCD risk factors among Bangladeshi urban dwellers over time, there is an evident gap in the status of NCD management across urban primary health care (PHC) centres. We aimed to understand the changes in NCD management within urban primary health care system between 2014 and 2017 from nationally representative surveys.

Presenter: Prof. Rumana Huque, ARK Foundation, Bangladesh

Contributors: Deepa Barua, Masroor Salauddin, Salma Anee, Nabila Binth Jahan, Tahzir Faiaz Chowdhury, Fatema Kashfi, ARK Foundation, Bangladesh

 

‘The Role of Public-Private Partnership (PPP) models in addressing the challenges of urban health systems: A systematic review of evidence from least developed, low income and lower-middle-income countries’

In low and middle-income countries, the provision of Primary Health Care (PHC) solely through the public sector has limitations and challenges, such as inadequacy of trained human resources and, frequently, poor-quality services with insufficient medicines and equipment. Evidence suggests that public-private partnerships (PPPs) can help to deliver PHC services more effectively and efficiently. A CHORUS systematic review assessed the existing PPP models in urban health systems and explored their contributions to improving urban health services and outcomes. We found that the main role of the public sector (in 70% of studies) was stewardship and support to the private sector, whose main role was service provision (in 85% of studies). We also found 23 PPPs that specifically targeted urban-poor populations, however studies identifying the impacts of PPPs on health outcomes in urban LMICs are limited. In order to meet the health needs of growing urban populations, further research into the implementation and impact of PPPs is needed to inform policy and practice.

 

Presenter: Prof. Zahidul Quayyum, BRAC JPGSPH, Bangladesh
 
Contributors from across the CHORUS Consortium: Dr Aishwarya Vidyasagaran; Dr. Baby Naznin; Jannatun Tajree; Swaksar Adhikary; Deepa Barua; Maisha Ahsan; Deepak Joshi; Sampurna Kakchapati; Grishu Shrestha; Dr. Florence Sibeudu; Dr. Juliana Onuh; Dr Chukwuedozie Ajaero; Dr Chinyere Okeke; Dr Prince Agwu; Dr. Pamela Ogbozor; Dr. Abena Engmann; Prof. Bassey Ebenso; Dr. Su Golder; Dr. Noemia Siqueira, Prof. Helen Elsey

Posters

Wednesday 8th November, 14.00 – 15.00, Room: Midtown

‘Assessing the types, mechanisms, and effects of collaborative partnership in service delivery between formal and informal health providers in urban slums in Nigeria’

Uchenna Ezenwaka, Health Policy Research Group, University of Nigeria

 

‘The complexities of formalizing informal health providers to advance urban health systems that are more inclusive and pro-poor’

Dr. Uchenna Ezenwaka, Health Policy Research Group, University of Nigeria

Contributor: Prof. Chinyere Mbachu, Health Policy Research Group, University of Nigeria

 

‘Patient’s Preference for Outpatient Care Providers in Urban Areas of Bangladesh: Evidence from a National Survey’

Prof. Zahidul Quayyum, BRAC JPGSPH, Bangladesh

Contributor: Zahid Hassan, University of Leeds

 

Thursday 9th November, 14.30 – 15.00, Room: Midtown

‘Examining the perceived advantages and disadvantages of linking the formal health system with informal healthcare providers in Nigeria for improving health delivery in urban slums’

Dr. Aloysius Odii, Health Policy Research Group, University of Nigeria

Contributor: Dr. Charles Orjiakor, Health Policy Research Group, University of Nigeria

 

‘Who provides health services in urban slums in Nigeria, what are their challenges and how can the services be improved?’

Dr. Aloysius Odii, Health Policy Research Group, University of Nigeria

Contributor: Dr. Okechukwu Ozor, Health Policy Research Group, University of Nigeria

 

‘Existence and Motivations for Referral and Data Reporting Practices among Informal Healthcare Providers in Urban Slums in Southeast Nigeria: Implications for Sustainable Development Goal 3’

Dr. Uchenna Ezenwaka, Health Policy Research Group, University of Nigeria

Contributor: Dr. Ifeyinwa Arize, Health Policy Research Group, University of Nigeria

ICUH 2023 (2)