Slum-community Federations adapt WHO Urban-HEART to assess and address health inequities at ward-level in Indore, India

Introduction: Urban Health Equity Assessment and Response Tool (HEART) developed by WHO has helped tackle health-inequities at city-level but not ward-level. In Indian cities most quantitative indicators suggested by WHO Urban-HEART are unavailable at city or ward-level. We hypothesized that slum-level community organizations working towards betterment of their neighbours have knowledge and potential to compare slums using qualitative indicators and plan context responsive interventions to reduce health inequities in the ward.

 

Objectives: Facilitating slum-level community organizations use adapted Urban-HEART to map inequities and start a community-intervention to reduce health inequities.

Design/Method: Urban-HEART adaptation to compare slums/neighbourhoods was carried out for 12 slums (23,000 population) of Indore with a Federation of 37 women groups. Since 2008 this Federation is coordinating with various stakeholders to facilitate access of urban poor families to entitlements, health services, water supply, sanitation facilities and their linkage to government Schemes/services. Through a consultative approach local indicators were developed with Federation members and the 12 slums were compared on various indicators related to health and well-being. A colour-coded criteria was used to compare neighbourhoods/slums (red- most needy, yellow-moderately needy and green-not needy). Federation members were encouraged to develop and kick-start an action-plan to address key problems.

Results: Federation members compared slums using their rich local knowledge and developed a response plan, which they have started implementing. A consultative approach using a visual colour-based method helped quickly differentiate slums on different indicators without being daunted by unavailability of standard quantitative indicators or conducting an expensive survey.

Conclusion: An adaptation of urban-HEART to assess slums/neighbourhoods and community action to address health needs is possible through consultative and relatively inexpensive approach utilizing knowledge and commitment of slum-level community organizations.

 

Key words: metrics, India, urban slums