Mapping health-inequities in a municipality of East India: Indian Adaptation of WHO Urban-HEART

Introduction: Ward is the smallest administrative and political unit of civic administration in Indian cities. Services at ward-level are provided by multiple agencies, often working independently. WHO Urban Health Equity Assessment and Response Tool (HEART) has supported urban policy makers in 17 cities worldwide in tackling urban health inequities. This tool has not been used in India.

 

Objectives: Adapt and use Urban-HEART to map and respond to health inequities at city-level.

Design/Methods: Municipal Body of Bally city was facilitated to use WHO Urban-HEART, with multi-sectoral stakeholders (elected representatives, State government’s Departments and non-government organizations) engaged in implementing health, nutrition, hygiene, sanitation and housing programs across 3,00,000 population in 35 wards and 135 slums in Bally city. Given the unavailability of quantitative data, a consultative approach helped evolve qualitative indicators to compare wards on health outcomes and social determinants of health: housing and physical infrastructure, social and human development, poverty and economics and governance. Colours were used to rank wards on various indicators (red- most needy, yellow-moderately needy and green- not-needy). City-level (ward-wise) map was used to aid discussion.

Results: Twelve wards were in the red category on health outcome indicators i.e., high home deliveries and/or low immunization coverage. Similarly 10 Wards were in red category on housing and physical infrastructure indicators. Using findings, stakeholders identified priority indicators to work on and actions for needy wards.

Potential Value: Where quantitative WHO HEART indicators are not available, qualitative adaptation of Urban-HEART indicators using local knowledge of diverse stakeholders can be used. Spatial city maps serve as an effective visual tool with potential to be adapted for other topics. Discussions using maps can simplify and expedite inequity mapping exercise.

 

Key words: metrics, India, urban poverty