Chorus
Our research is driven by the health related challenges facing the urban poor, and the systems solutions co-created by stakeholders across multiple sectors, providers and communities.
Our demand-led approach follows 5 intertwined phases, combining quantitative, qualitative, participatory and health economic methods across multile disciplinary perspectives
STAGE 1:
Needs Assessment, community engagement, data visualisation, system & stakeholder mapping
To ensure each project is grounded in the realities facing the urban poor, projects begin with an extensive needs assessment. Methods include:
Participatory and visual methods with urban residents using techniques such as social mapping, transect walks, photovoice work well to engage residents and generate in depth insights, particularly with those that rarely have an opportunity to voice concerns or provide their perspective.
To inform all subsequent stages, projects include a thorough mapping and analysis of the current stakeholders to understand their priorities, and use methods such as ‘rich pictures’ to the gaps and opportunities for system changes.
STAGE 1 RESOURCES
STAGE 2:
Evidence Review, policy mapping and analysis of existing data
To ensure value for money and good research practice, the CHORUS team ensure that we make use of available evidence and secondary data to inform the design of health systems interventions. Our teams have conducted systematic and scoping reviews to understand existing urban health system evidence. These reviews have offered the perfect opportunity for building the capacity of our early career researchers in critically appraising and synthesising academic research. Our teams have also analysed existing large data sets from global household surveys such as WHO’s STEPS, Demographic and Health Surveys as well and Health Management Information Systems and facility surveys.
STAGE 2 RESOURCES
STAGE 3:
Intervention co-creation
Drawing on the evidence from stages 1 and 2, CHORUS teams bring the variety of stakeholders together – including health professionals, city officials, formal and informal health providers and community members – to co-develop and shape interventions to strengthen the urban health system.
We use intervention development frameworks such at the 6SQUID framework, to guide our work with stakeholders to help define the problem and its causes, clarify influencing factors and develop theories of change. Each team facilitates this process through a series of workshops, formal and informal meetings, often using participatory ranking methods to prioritise aspects of the interventions. The engagement of stakeholders in the development and implementation of initiatives helps ensure interventions meet the needs of local populations whilst also fitting within current systems and policy frameworks. However, ensuring engagement is meaningful and inclusive of all perspectives requires deep knowledge of the context and must be done through careful consensus building. Across CHORUS we use action learning groups and reflective workshop to share our experiences of codesign, particularly addressing equity and gender within our research and intervention development.
STAGE 4:
Implementation Research
The large CHORUS projects implement the co-created health system interventions, in selected low-income urban neighbourhoods, working collaboratively with the multiple stakeholders involved. This involves training up health providers – both formal, private and informal providers as well as supporting managers within the health system to supervise effective implementation of the interventions.
Mixed methods implementation research is used to understand the process, facilitators and barriers to impact of the health system interventions from the perspectives of the stakeholders.
STAGE 5:
Evaluation of impact, costs and sustainability
Within our mixed method research, we study the reach of the implemented interventions to urban residents of all ages, genders and disability living in low-income neighbourhoods to understand who may be excluded from the benefits or how interventions may need to be tailored to meet the diverse needs of urban populations. As far as our timeline allows, we look at the extent the interventions continue to be delivered after our own implementation research has ended. Understanding the sustainability of the interventions is vital to inform policy and practice. Our team of health economists, spread across CHORUS partners, use a variety of methods to assess the costs to the health system and to patients of implementing the interventions.
To support the CHORUS vision to help build responsive, resilient and equitable urban health systems, our four research pillars are supported by our core foundations and principles of the consortium: capacity strengthening, research uptake for impact, redressing gender and social inequities; equitable partnerships and quality research. Explore more below.
