Surveys for Urban Equity: getting, and using, the data needed to respond to neglected non-communicable diseases in urban areas in LMICs

Lead Research Organisation: University of Leeds
Department Name: School of Medicine

Abstract

Non-communicable diseases (NCD) are a major public health issue in South Asia (S Asia), accounting for 60% of deaths. Urbanisation is a key driver, increasing mental stress and injuries and risk factors such as tobacco use, poor diet and inadequate physical activity. Public health decision-makers in LMICs need unbiased, precise and accessibly-presented data to inform equitable urban development. Nationally representative surveys are the main data source used to inform decision-making in LMICs, e.g. Demographic and Health Surveys (DHS) and STEPS NCD Risk Factor Surveillance are used in over 90 LMICs. This approach has many problems: it excludes unofficial poor settlements and peri-urban areas beyond administrative boundaries; definitions of a 'household' overlook multiple occupancy by poor urbanites; current methods for ranking wealth are not sensitive to urban poverty; and NCDs currently assessed in these surveys do not include injuries and mental ill-health, conditions that disproportionately affect the urban poor. These methodological constraints leave policy makers with no way of understanding or responding to the NCD burden and inequities found within urban areas in LMICs. Furthermore, the way data is currently presented - in long wordy reports - undermines decision-makers' ability to find and interpret data for planning and managing health programmes. We will capitalise on existing partnerships and develop new ones, to i) identify and test questions on mental health and injuries, ii) test cheap and efficient novel methods to reduce bias in urban surveys iii) explore alternative approaches to defining households, measuring and ranking wealth iv) develop data visualisation tools to support decision-makers' use of survey data. We will conduct this foundation work in Nepal, Bangladesh and Vietnam as their different urban characteristics increase our works applicability to other LMICs and we have existing strong partnerships. We will hold two meetings and facilitate ongoing interaction with international and national bodies to share expertise and build capabilities on the novel survey methods, measures of wealth and NCDs, data visualisation and use of data to address urban inequities. We will conduct a systematic search of questionnaires and draw on our own work assessing injuries and mental health to identify the best questions for LMIC urban areas. We will finalise the questionnaire in collaboration with government stakeholders after checking its comprehensibility in urban slums.
We will pilot our novel survey sampling and mapping methods in Kathmandu, where our initial pilot of these methods was curtailed by the 2015 earthquake. Our novel methods use satellite imagery, mobile phone and census data, to identify the entire urban population including those not captured by the census. Once sampled, we will use a web-based app to accurately map communities. Smaller feasibility studies of the methods and developed questionnaire will be conducted in Hanoi and Dhaka.
We will explore household types and identify wealth indicators in urban slums. Using our pilot data, we will explore associations between household consumption, assets and income to develop an appropriate measure of urban wealth. In each country, we will assess the extent to which data is used in urban planning and management through interviews with decision-makers. Through the establishment of communities of practice within municipalities, we will co-produce appropriate data visualisation tools to support planning and management. This foundation grant has the potential to i) transform survey methods used in all LMICs, enabling more accurate assessment of health inequities in urban areas ii) provide questions on mental health and injuries for use in other surveys in LMICs, and iii) ensure data informs the health-sector response to NCDs in LMICs.

Technical Summary

Rapid urbanisation is driving the NCD epidemic in S Asia. For decision-makers to respond to NCDs among the urban poor, proper measurement of disease prevalence and risk factors is a crucial first step. In over 90 LMICs, household surveys - e.g. DHS and STEPS - provide vital data to inform the health sector nationally. However, the way these surveys are currently designed and presented undermines their use to plan and monitor intra-urban health and respond to the needs of the poor. Data on mental ill-health and injuries - NCDs experienced disproportionately by the urban poor - are not collected; the urban poor are under-represented in sampling frames; and methodologies for calculating wealth quintiles and definitions of a household are not sensitive to urban poverty. We will use existing validated questionnaires, and our own work assessing injury and mental health, to develop a questionnaire on NCD risk factors, injury and mental ill-health relevant to urban areas. We will use qualitative methods in urban slums to explore household types and indicators of wealth, and test the questionnaire. We will test the feasibility, cost and appropriateness of novel sampling methods using (a) satellite imagery, mobile phone and census data to identify the entire urban population including those not captured by the census, and (b) gridded sampling to select areas. Once sampled, we will use a web-based app to accurately map sampled areas. In Kathmandu, we will sample 1200 households to see the extent to which our approach identifies the urban poor, and to estimate key indicators with a maximum margin of error of +/- 4.27% at 95% confidence. Smaller feasibility studies of the methods and questionnaire will be conducted in Hanoi and Dhaka. Throughout we will work closely with governments to understand data needs and co-produce appropriate data visualisation tools to enable use of data generated for equitable planning and monitoring in urban areas.

Planned Impact

Understanding the health needs of the urban poor is vital to addressing the changing disease burden in rapidly urbanising LMICs. Our work to improve the representation of the poor in surveys, which inform the allocation of resources, will ensure that the health issues of the poor are no longer concealed by the better health outcomes among the urban wealthy.

Our project also emphasises support to municipalities to use this improved data on poor people in urban areas. This means that this more accurate understanding of urban health inequities is likely to have a substantial impact on decision-making and resource allocation leading to improvements in health services (preventative and curative) and ultimately, the health of the urban poor. In the long term, more equitable allocation of resources to improve the health of the urban poor will have wide social and economic benefits across LMICs. For the urban poor, ill-health - particularly chronic health problems such as mental ill-health, injuries and CVD-diabetes - can result in catastrophic expenditure on health and loss of daily wages. While in rural areas major gains have been made in providing free, quality primary care services, this is not the case in urban areas, where the poorest predominantly use private clinics risking poor quality care and financial exploitation. Focusing resources on prevention and improving quality health services accessible to the urban poor is vital. If healthy in mind and body, poor urbanites can begin to realise the benefits from the economic and social advancement that urban living can bring. This will benefit individuals and communities, and ultimately enhance the economic and social development of LMICs.

The other, more immediate beneficiaries include: i) LMIC municipal and national governments; ii) global health and survey organisations; iii) LMIC health research and survey institutions; iv) donors; v) academics.The Pathways to Impact outlines our strategies for realising benefits for these stakeholders. They will benefit in the following ways:
i) LMIC governments: Improved capability and experience of local government staff in using data for planning and management of urban health. The provision of a visualisation tool and the training/guides to its use will enable benefits to spread beyond the small number of officials that we will engage directly.
ii) Global health organisations: if our survey methods are found to be effective at improving the representation of the urban poorest, and affordable, they have the potential to be adopted by survey programmes such as DHS and WHO's STEPS. Given that these surveys are conducted in over 90 LMICs, the potential for impact on the lives of the urban poor is significant. The identification of appropriate mental health and injury questions to be included in household surveys will make a major contribution to the tools that can be recommended by WHO, benefiting any academic or organisation seeking to measure these neglected NCDs in urban areas. Our existing links with DHS and WHO indicate their interest in neglected NCDs and new approaches to deal with the methodological problems created by urbanisation in LMICs.
iii) LMIC research institutions: Enhanced skills in novel methods and increased leadership taken in ensuring appropriate design of surveys and use of survey data. These skills will be concentrated in our partner organisations in the three countries, but the outputs and networks created in this foundation work will increase their accessibility for others.
iv) Donors: better data to inform funding decisions to address inequities.
v) Advancements in knowledge on novel survey methods to improve representation of 'hidden' populations, on measuring injury and mental ill-health, understanding urban poverty and ranking wealth is expected within this foundation stage. The Academic Beneficiaries section provides further details.

Publications

10 25 50

 
Description Background: The methods used in low- and middle-income countries (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi, and summarise feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences.

Methods: We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets.

Results: We found that a common household definition excluded single adult (46.9%) and migrant headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying (14.3%) adults. Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative area-microcensus design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork.

Conclusions: This evidence of exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning, and underscores the need to modernise survey methods and practices.
Exploitation Route The findings should be used to inform survey design in LMICs to ensure that poor urban residents are not excluded from current survey designs.
Sectors Communities and Social Services/Policy

Healthcare

Government

Democracy and Justice

URL https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226646
 
Description Findings have been used by local governments to understand better how to interpret urban data and how to design future city-level data collect. UN agencies e.g. UNFPA and World Food Programme have used details of our methods - including our methods manuals - to inform data collection for UN programmes. Our testing of injury questionnaires in urban areas has led to revisions of the Demographic and Health Survey Injury module which is used in over 170 countries to assess health indicators. Our work to understand urban poverty at area as well as household level are informing the development by UNHABITAT of a Participatory Slum Upgrading Index to measure indicators within SDG 11 on Sustainable Cities.
First Year Of Impact 2019
Sector Communities and Social Services/Policy,Healthcare
Impact Types Societal

Policy & public services

 
Description Influence in the Use of Novel Survey Methods, Nepal
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Contribution to a national consultation/review
 
Description SUE-tested survey questions agreed for inclusion into the DHS Accident and Injury module - International consultation exercise
Geographic Reach Multiple continents/international 
Policy Influence Type Contribution to a national consultation/review
URL https://userforum.dhsprogram.com/index.php?t=msg&goto=17382&S=Google
 
Description WHO Urban Health Strategy
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a guidance/advisory committee
 
Description Funding from World University Network
Amount £6,000 (GBP)
Organisation Worldwide Universities Network 
Sector Academic/University
Country United Kingdom
Start 03/2018 
End 05/2018
 
Description IDEAMAPS Ecosystem
Amount $1,690,337 (USD)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 09/2022 
End 09/2025
 
Description Living in the city: Building collaborations to strengthen health systems to respond to the needs of newly urbanised populations in Africa and Asia
Amount £99,650 (GBP)
Funding ID NIHR130103 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 03/2020 
End 05/2021
 
Description PARTNERSHIPS FOR EQUITY AND INCLUSION
Amount £126,404 (GBP)
Funding ID EP/T024402/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 05/2020 
End 11/2022
 
Description Pilot improved household survey and microcensus tools/methods and compare a standard household survey with gridded population survey
Amount $200,000 (USD)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 03/2018 
End 10/2019
 
Description Research Programme Consortia FCDO Lot 1 Health Systems
Amount £7,000,000 (GBP)
Organisation UK Department for International Development 
Sector Public
Country United Kingdom
Start 04/2020 
End 04/2026
 
Title A Leaflet for Depressed Responsents 
Description HERD International developed a leaflet on depression for patients if identified as depressed during PHQ9 administration. This leaflet was shared with Bangladesh and Vietnam teams. 
Type Of Material Improvements to research infrastructure 
Year Produced 2017 
Provided To Others? No  
Impact Adopted version of the leaflet will be used by Bangladesh and Vietnam partners while conducting survey questions (PHQ-9). 
 
Title Enumeration-Listing-GIS Field Guide 
Description University of Southampton (UoS) and HERD International developed a 3-day course and manual called "Enumeration-Listing-GIS Field Guide" to train Enumerators and Listers to implement SUE novel methods and tools. 
Type Of Material Improvements to research infrastructure 
Year Produced 2017 
Provided To Others? No  
Impact World Vision International (WVI) used SUE survey planning and enumeration-listing manuals to design and implement a survey of 780 households in 39 clusters in six districts of Mozambique. 
 
Title Methods Manual 
Description University of Leeds (UoL) developed a methods manual detailing the participatory methods to be used with urban communities, the individual interviews with decision makers and the methods for running communities of practice with municipal officers. UoL worked with partners in all countries to develop interview and focus group guides to implement these methods. UoL worked with HERDi to develop a training course for all partners on the participatory methods. 
Type Of Material Improvements to research infrastructure 
Year Produced 2017 
Provided To Others? No  
Impact The SUE survey methods were shared, as was the update on slum definitions and measures of slum characteristics discussed at the Bellagio meeting. 
 
Title SUE Survey Planning Team Guide 
Description University of Southampton (UoS) and HERD International developed and delivered a 2-day course and manual called "SUE Survey Planning Team Guide" to support survey planning teams to design surveys in complex urban environments using SUE novel methods and tools. 
Type Of Material Improvements to research infrastructure 
Year Produced 2017 
Provided To Others? No  
Impact World Food Programme (WFP) used SUE survey planning and enumeration-listing manuals to design and implement a survey of 500 households in 35 clusters in Kinshasa, DR Congo in December 2017. 
 
Title Surveys for Urban Equity 
Description This dataset contains results and documentation from three cross-sectional urban household surveys done in Kathmandu (Nepal), Dhaka (Bangladesh) and Hanoi (Vietnam) in 2017 and 2018. The surveys primarily aimed to test the feasibility of using new urban household survey methods that try to better cover/capture informal/slum settlements using sampling frame data generated from random forest models that incorporate census data (which is often outdated and inaccurate) with multiple remotely-sensed covariates, such as urbanisation and infrastructure data. Additionally, the surveys also aimed to gather data on a range of topics including many that are not commonly collected in household surveys, particularly of urban areas: A) basic socio-demographic details of household members, B) household characteristics, assets, income and expenses, C) household migration and social capital, D) household member injury and injury related death, and, for one individual per household, E) migration, social capital and depression/mental health. See the "Readme - dataset file descriptions.docx" file for a description of all files and datasets available, plus additional relevant references. 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? Yes  
Impact Change in the injury questions in the DHS injury module - used in over 170 countries Informed work by UNHABITAT to develop a Participatory Slum Upgrading Index. 
URL https://archive.researchdata.leeds.ac.uk/620/
 
Description  
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? Yes  
URL https://archive.researchdata.leeds.ac.uk/620/
 
Description Bellagio Group 30 November 2017, Bellagio Italy on Slum Area Characteristics 
Organisation University of Warwick
Department Health Sciences Research Institute
Country United Kingdom 
Sector Academic/University 
PI Contribution 30 November 2017, Bellagio Italy Helen Elsey and Dana Thomson from the SUE project joined a cross-discipline, cross-agency group of participants, including National Statistical Agencies, researchers, non- governmental organizations (NGOs), program managers, multilateral UN Agencies, bilateral donors, professional associations, and policymakers to map out an agenda to take vital steps to define and pinpoint urban areas with the greatest levels of deprivation. This would provide Municipalities, City managers, countries, NGOs, donors, and policymakers more granular data with which to prioritize interventions and investments to improve the study of urban health outcomes. By disaggregating the disease and deprivation burden of slum and non-slum urban residents alike, it will be easier to highlight issues of importance for people who live in slums and focus attention on these issues for policy makers. The Bellagio group developed a roadmap to move three key actions forward on international and local stages: 1. Identify techniques in use today to identify slum populations prospectively and retrospectively, analyzing the strengths and weaknesses of the various techniques; 2. Provide recommendations on how countries can integrate slum/non-slum urban designations in their censuses and surveys; and 3. Develop a global research agenda to understand which methods are most robust in identifying slum areas, including testing potential new techniques using geospatial data and machine learning. Helen worked closely with a smaller group of participants to propose a 5 point characterisation of slum areas. These 5 characteristics were based on the domains used in the area mapping of slum areas within the SUE surveys . This is the first time a global group has agreed an area definition of slums. this is a crucial first step in being able to measure area effects, but also in being able to target slum areas with interventions. Dana was made connections with
Collaborator Contribution The University of Warwick (NIHR urban slum health unit, led by Prof Lilford) organised the event and covered costs of accommodation and venue.
Impact The slum area characteristics identified in Bellagio have now been taken up by multiple organisations, including UNHABITAT and others working on slum health. A publication including the definition and the possible ways of measuring slum-areas has been submitted to the Journal of Urban Health: Dana R. Thomson , Catherine Linard Sabine Vanhuysse Jessica E. Steele , Michal Shimoni José Siri Waleska Caiaffa , Megumi Rosenberg , Eléonore Wolff , Taïs Grippa , Stefanos Georganos , Helen Elsey "Extending data for urban health decision-making: A menu of new and potential area-level health determinants datasets in LMICs" This is multi-disciplinary collaboration including geographers with GIS specialisms, social scientists, survey experts, policy makers and public health professionals.
Start Year 2017
 
Description Expert advisor to UNHABITAT Participatory Slum Upgrading Index 
Organisation UN Habitat, Kenya
Country Kenya 
Sector Charity/Non Profit 
PI Contribution In order to measure SDG11 on sustainable cities, UNHABITAT need a way to measure progress on slum upgrading. Currently there is no tool/measure to assess whether an area is a slum or not. Building on our work in the SUE study, UNHABITAT asked me to join their expert group to review the domains to be assess in a slum measure called the Participatory Slum Upgrading Index. I have commented on the draft tool and process of assessment proposed by UNHABITAT. The tool is being revised and I will comment on the next version.
Collaborator Contribution UNHABITAT's original draft of the PSU drew on our SUE findings and also the systematic scoping review conducted with the IDEAMAPS network. The IDEAMAPS network grew from the collaborations established in the SUE study. Through the network we conducted as scoping review of the domains of deprivation identified in other urban LMIC research. This review has just been published and has also informed the development of the PSUI.
Impact Abascal, A. et al. (2022) '"Domains of deprivation framework" for mapping slums, informal settlements, and other deprived areas in LMICs to improve urban planning and policy: A scoping review', Computers, Environment and Urban Systems. Pergamon, 93, p. 101770. doi: 10.1016/J.COMPENVURBSYS.2022.101770.
Start Year 2019
 
Description Healthy Places Special Interest Group, Faculty of Public Health 
Organisation Faculty of Public Health
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution As chair of this SIG, I have worked with other SIG members to develop the action plan for the SIG. I have ensured that this action plan includes a focus on urban health in low income countries as well as the UK. This has led to the undertaking of a scoping review on urban agriculture as a means for improving health and social outcomes for the urban poor in low income countries.
Collaborator Contribution Members of the SIG and a PH registrar are supporting the review. This led to the publication of the 'Domains of deprivation' paper - see publication list. Another Public Health registrar working with the GCPS team on the Urban CHPS study has contributed to the SIG by facilitating meetings to contribute to a capacity strengthening initiative led by WHO and aimed at local government officers and health providers in LMICs. The experiences of working with district public health teams in Ghana has informed the focus and content of the training materials for this WHO initiative.
Impact Domains of Deprivation publication: Abascal, A., Rothwell, N., Shonowo, A., Thomson, D. R., Elias, P., Elsey, H., Yeboah, G., & Kuffer, M. (2022). "Domains of deprivation framework" for mapping slums, informal settlements, and other deprived areas in LMICs to improve urban planning and policy: A scoping review. Computers, Environment and Urban Systems 93 101770. https://doi.org/10.1016/J.COMPENVURBSYS.2022.101770
Start Year 2023
 
Description Slum mapping event at World Urban Forum 
Organisation University of Twente
Country Netherlands 
Sector Academic/University 
PI Contribution I helped design a workshop session for the World Urban Forum 2020 on mapping informal settlements and what this can mean for household survey design.
Collaborator Contribution Monika Kuffer from Twente shared their work on remote sensing data for identifying and classifying slum areas.
Impact Proposal for network of researchers from University of Nigeria, Slum Dwellers international, University of Chicago for Slum Mapping methods
Start Year 2020
 
Description Transcultural Psychosocial Organisation (TPO) 
Organisation HealthNet TPO
Country Netherlands 
Sector Hospitals 
PI Contribution HERD Nepal shared the SUE methodology with TPO
Collaborator Contribution HERD International (Nepal) collaborated with a national organisation Transcultural Psychosocial Organisation (TPO) for conducting sessions on mental health and depression in the field researchers training. TPO also provided technical inputs during development of one pager protocol and information leaflet for questionnaire respondents who might indicated during the PHQ9 questionnaire that they were suicidal.
Impact Protocol for dealing with severe mental health issues should they arise among survey respondents and a leaflet for respondents on mental health and services available. This leaflet and protocol has been shared with partners in Hanoi and Dhaka for adaptation to their own contexts and use during their up-coming surveys.
Start Year 2017
 
Title Gridded Population Sampling: Dana Thomson consulting 
Description Dana Thomson was the technical advisor to our SUE project, the novel sampling methods that she worked on during SUE were part of a range of her research activities, including her own PhD studies, that contributed to the development of a web tool for developing a sample for a survey using population estimates derived from multiple data sets. See this website for further details: https://danathomson.com/2021/01/13/gridsample/ 
Type Of Technology Webtool/Application 
Year Produced 2020 
Open Source License? Yes  
Impact The software has been used by international organisations in immunisation campaigns and disaster management. 
URL https://danathomson.com/2021/01/13/gridsample/
 
Description Bellagio Meeting (Italy Nov 2017) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The Bellagio Meeting (Italy Nov 2017) provided a vital opportunity to link with UN agencies, such as UNHABITAT, UNFPA, USAID, WHO, Gates Foundation and the International Society on Urban Health. Dana Thomson and Helen Elsey were able to share the SUE novel methods, particularly gridded sampling and the observation form to assess slums providing a measure of the area effect. The group proposed a definition of urban slums which will be refined and shared across global agencies and ultimately influence how slums are measured in LMICs.
Year(s) Of Engagement Activity 2017
URL https://unhabitat.org/distinguishing-slum-from-non-slum-areas-to-identify-occupants-issues/.
 
Description Conference Presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact SUE team member Ak Narayan Poudel presented a paper called 'Understanding Urban Poverty from the Perspective of Urban Poor Communities in three cities-Dhaka, Hanoi and Kathmandu' on 15th International Conferecne on Urban Health at Kampala, Uganda (26-30 Nov 2018). The presentation encouraged the participants to think about urban poverty and inequality, and how these can be reduced. This also fuelled the questions and discussion about use of participatory methods for community-based wealth/poverty ranking.
Year(s) Of Engagement Activity 2018
 
Description Conference presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact SUE team member Dana Thompson, Helen Elsey, Ak Narayan Poudel presented a paper called 'Novel survey methods to improve representation of the urban poor' on 15th International Conferecne on Urban Health at Kampala, Uganda (26-30 Nov 2018). This pre-formed panel presentation talked about the use of novel survey methods to improve the representation of the urban poor by using Gridded Sampling, OpenStreet Map for Enumeration, One-stage cluster sampling. The presentation encouraged the participants to think and employ the new approach of conducting survey to improve representation of urban poor in national surveys, which are generally excluded from the surveys, such as- street sleepers, guards, people living in hostels etc. This presentation sparked the questions and discussion about use of new survey methods for national level surveys.
Year(s) Of Engagement Activity 2018
 
Description Conference presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Helen Elsey (on behalf of Tolib Mirzoev) along with Ak Narayan Poudel and Tarana Ferdous presented a paper on 'Improving governance through enhancing evidence-based urban health planning - insights from three cities' at 15th International Conference on Urban Health, Kampala (18-23 Nov 2018). This was the pre-formed panel presentation which included findings from Nepal, Bangladesh and Vietnam. This session was of interest and relevance to academics, policymakers and practitioners who wished to advance their understanding of how city authorities can strengthen evidence-informed planning for improving urban health governance. There was good questions and answers session afterward, which was useful for both presenters and audience to improve understanding on the topic.
Year(s) Of Engagement Activity 2018
 
Description Conference presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Helen Elsey presented a paper (on behalf of Tim Ensor) called 'Measuring wealth and poverty in urban areas' at 15th International Conference on Urban Health at Kampala, Uganda (18-23 Nov 2018). Helen presented the findings from household surveys and participatory methods in Kathmandu, Dhaka and Hanoi to understand indicators of wealth and poverty in urban area. The presentation concluded that there is a need of combination of qualitative and quantitative methods as none of the single methods could not sufficiently capture all aspects wealth/poverty of urban households. The presentation fuelled questions and discussion afterward and participants were really engaged.
Year(s) Of Engagement Activity 2018
 
Description DFID Global Statisticians Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This is a regular DFID virtual meeting entitled 'Making stats work: connections across DFID'. Statisticians and health advisors and information specialists from across DFID invited the SUE study team to present their study methods on 20th Feb 2018. Dana Thomson presented the gridded sample method and Helen Elsey talked through the mental health questionnaire and slum area measures. The meeting culminated in a further invitation to present SUE study findings at a DFID 'lunch and learn' session attended by health and information advisors across all of DFID countries in November 2018.
Year(s) Of Engagement Activity 2018
 
Description Engagement with Policy Makers in Hanoi Province 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact SUE team organised one-day workshop with Hanoi province officials at Hanoi regarding the outcomes of SUE findings on different components of the project in Hanoi- such as Data for Decision Making, poverty and vulnerability from participatory methods, findings from surveys regarding mental health and injuries, and use of novel survey methods. The officials were very interested with the finding of the SUE study and there were good discussion after ward on each of the components presented. They were mainly interested on use of participatory methods on poverty measurement, participatory decision making, data visualisation/data management, and use of novel survey methods. There will be follow up discussion with the officials in few months and plans to use the novel SUE methods in future government surveys.
Year(s) Of Engagement Activity 2019
 
Description Engagement with group developing the Washington Group Affect questions 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Email links with the Washington group responsible for developing the depression and anxiety questions to be used in the Extended Washing Group Disability questionnaire. This connection has led to the addition of these newly developed questions to the Dhaka and Hanoi surveys and will allow a comparison with the PHQ9 in those contexts.
Year(s) Of Engagement Activity 2018
 
Description Feedback to DHS on injury questions 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact SUE team member Hilary Wallace, along with other SUE members is providing feedback to DHS on injury questions as there is an opportunity till 15th of March 2019 to provide feedback on the DHS questionnaire. The feedback is provided on the basis of our experience of using injury questions in SUE survey. This is a good opportunity for us to say on the questions.
Year(s) Of Engagement Activity 2019
URL https://userforum.dhsprogram.com/index.php?t=index&cat=10&
 
Description Injury Seminar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact We presented SUE findings related to injuries from Nepal's data at University of Leeds on 25th Sept 2018. Participants were from University of Leeds, NIHR Global Health Unit on Injuries, and Senior Lecturer of University of West of England (Julie Mytton, who also conducts injury research in Nepal). The seminar helped to disseminate SUE findings as well as encouraged collaboration between other stakeholders for future funding applications.
Year(s) Of Engagement Activity 2018
 
Description Input into UN-HABITAT report 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact SUE team had received a special opportunity to write a short note (report) about slum area measures for UN-HABITAT report. 'We drew on the findings of an expert working group of academics, NGOs, UN and donors working on slum health, who met in Bellagio, Italy in November 2017 to propose key dimensions or characteristics of slum areas. We extracted questions from UNHABITAT's Urban Inequities Survey4 to measure each of the characteristic. Insecurity of tenure was the one domain that we were unable to measure through area observation alone, and from our pilot experience, this can only be collected during household interviews'. This message was provided to UN-HABITAT through a short-report. We are hoping that UN-HABITAT will consider our suggestion and include these issues in their upcoming slum area measurement questions.
Year(s) Of Engagement Activity 2018
 
Description International Conference on Urban Health 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Dana Thompson (UoS) (with HERD/CIPRB/ ARK/HUPH/UoL) presented a paper (oral) titled "Feasibility of survey methods aimed at better representing the urban poorest: Kathmandu, Nepal" at the International Conference on Urban Health, Coimbra Portugal 26-29 Sept 2017.
As a result of contacts made at the ICUH, Dana R Thomson (UoS) was invited to 'Bellagio Conference' Italy in Nov 2017 to agree global definitions of slum areas.
Year(s) Of Engagement Activity 2017
URL http://www.icuh2017.org/
 
Description International Conference on Urban Health 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Helen Elsey (PI of SUE project) with HERD/CIPRB/ ARK/HUPH/UoL presented a poster titled "Defining Households and Understanding Poverty in Urban Slums: Informing Survey Design in Nepal, Bangladesh and Vietnam" at the International Conference on Urban Health, Coimbra, Portugal (26-29 Sept 2017). As a result of contacts made at the ICUH, Helen was invited to 'Bellagio Conference' Italy in Nov 2017 to agree global definitions of slum areas. Helen also presented poster entitled Understanding child-care and early childhood development in urban slums: a mixed methods study from Dhaka, Bangladesh
Authors: Helen Elsey, Mahua Das and Joe Hicks (University of Leeds, UK); Rumana Huque, Shammi Badrul, Fariza Fieroze (The ARK Foundation, Bangladesh) ; Hilary Wallace (University of Western Australia) Riffat Shawon, Sylvia Junnatul Ferdoush and Mashreky Saidur (CIPRB, Bangladesh)
Year(s) Of Engagement Activity 2017
URL http://www.icuh2017.org/
 
Description Involvement in NIHR Global Health Unit on Slum Health 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Helen Elsey (HE) (PI of SUE project) is involving in scientific advisory group of 'NIHR Global Health Unit on Improving Health in Slums' since May 2018. She is continuously involving in meetings, conferences, seminars and workshops to promote health, equality and well-being of people living in slum areas.
Year(s) Of Engagement Activity 2018
 
Description National Annual Health Review, Nepal 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact HERD International (Nepal) presented a poster on "Getting and Using Gridded Population Data to respond to NCDs in Urban Areas" at the National Annual Health Review conducted by Ministry of Health, Nepal.
Year(s) Of Engagement Activity 2013,2017
 
Description Paper presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Dana R Thompson (one of the SUE member from University of Southampton, with other SUE colleague- Radheshyam Bhattarai from HERDi, Nepal) attended World Data Forum conference at Dubai from 22 to 24 October, 2018. They presented 'Experience of SUE novel survey methods' and received positive feedback on the methods. Purpose of the presentation was to disseminate SUE novel survey methods which was found to be more inclusive (in terms of including urban in surveys). This presentation gained very good attention and responses from audiences. There were around 80 participants in the presentation. As mentioned earlier, our SUE survey methods have been already applied by WFP in different countries and have gained popularity. We have invited to speak at Urban Health Conference at Uganda too.
Year(s) Of Engagement Activity 2018
URL https://undataforum.org/
 
Description Paper presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Tolib Mirzoev (TM) (with HERDi, Nepal; ARK Foundation-Bangladesh and HUPH, Vietnam) presented a paper entitled 'Understanding the extent of evidence-informed nature of urban health planning: Lessons from three Asian cities' at the 5th Health System Research Conference at Liverpool. Main purpose of the presentation was to disseminate findings of the SUE research to winder audiences and highlight issues of 'evidence-based policy making'. There were around 60 participants at the presentation. There was a discussion session at the end of the presentation, which was very engaging and useful to disseminate SUE findings, highlight importance of data based policy making and increase collaboration for future partnerships among national and international organisations.
Year(s) Of Engagement Activity 2012,2018
URL http://healthsystemsresearch.org/hsr2018/
 
Description Paper presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Helen Elsey (with HUPH, Vienna; HERDi, Nepal and CIPRB, Bangladesh) presented a paper at 5th Health System Research Conference at Liverpool, UK (8-12 Oct 2018). The title of the presented paper was 'Stimulating multi-sectoral responses to create an urban health system able to improve health and social outcomes for, and with, the urban poor'. The purpose of the presentation was to disseminate the SUE study findings to wider audiences participating at the conference, look for partnerships with like-minded organisations for future studies and improve health outcomes of urban poor with multispectral involvement. Around 50 participants from different organisations and countries were present at the presentation and we had three round group discussions during the presentation, which were really useful to improve health of urban poor.
Year(s) Of Engagement Activity 2018
URL http://healthsystemsresearch.org/hsr2018/
 
Description Presentation of paper Supporting local government to use data to address urban health inequity' at 5th Health System Research Conference at Liverpool (8-12 Oct 2018) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Duong Minh Duc (DMD) from HUPH, Vietnam presented a paper entitled 'Supporting local government to use data to address urban health inequity' at 5th Health System Research Conference at Liverpool (8-12 Oct 2018). Purpose of the presentation was to disseminate SUE research findings related to urban health inequity at slum area of Hanoi. There were around 50 participants in the presentation. There were group discussions and question answer sessions, which were really useful for future research and collaboration with like-minded organisations in different countries.
Year(s) Of Engagement Activity 2018
URL http://healthsystemsresearch.org/hsr2018/
 
Description Regional Public Health Conference, Bangladesh 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact ARK Foundation and CIPRB (Bangladesh) participated in 8th Public Health Conference organized by Bangladesh University of Health Sciences on 29th December 2017 to present poster on "Defining Households and Understanding Poverty in Urban Slums: A Qualitative Study to Inform Household Survey Design in Nepal, Bangladesh and Vietnam". Dr Shawon Riffat (CIPRB) also presented a poster entitled : Understanding child-care and early childhood development in urban slums: a mixed methods study from Dhaka, Bangladesh
Year(s) Of Engagement Activity 2017
 
Description Rumana Huque was member of Independent Review Team of 'Annual Programme Review 2019' of 4th Health sector programme of Bangladesh. She translated her experience of SUE in the policy dialogues and the report, especially on urban health thematic area. 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Rumana Huque co-PI of the SUE study in Bangladesh was member of Independent Review Team of 'Annual Programme Review 2019' of 4th Health sector programme of Bangladesh. This is the national health sector plan for Bangladesh and is key to determining the future direction and focus of the health sector response in Bangladesh. She translated her experience of SUE in the policy dialogues, this including sharing the experience of working with City Corporations in Dhaka and the challenges of having and using data on the health of the urban poor to improve the equitable delivery of health services and prevention in urban Bangladesh. She raised the profile of urban health and deepened the understanding of the Ministry on these issues and improved the strategic response to improving urban health in Bangladesh.
Year(s) Of Engagement Activity 2018
 
Description Understanding and Tackling Population Undercounts 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Understanding and tackling population undercounts, held at Save the Children, 13th December 2017. Participants were Kim Bradford-smith, senior statistician, DFID
Roy Carr-Hill, UCL , Anna Darling, LUMOS, Helen Elsey (UoL) Dana Thompson (UoS) , Cynthia Koons (Save the Children). The SUE survey methods were shared by Dana Thomson and Helen Elsey, as was the update on slum definitions and measures of slum characteristics discussed at the Bellagio meeting.
Year(s) Of Engagement Activity 2017
 
Description Urban Health System Conference, Bangladesh 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact ARK were invited to attend the conference, 'Urban Health System Conference' on 28th February 2018. They participated in sessions on the 'Urban Health Systems Strengthening Project' disseminated their 'lessons learned. SUE team member, Tarana Ferdous participated in the conference.
Year(s) Of Engagement Activity 2018