Identifying and Reducing Social Inequalities in Health: Community Informed Qualitative Adaptation of Who's Urban Health Assessment and Response Tool with Focus on Action

Background

Urban poverty is growing to represent the dominant face of vulnerability in India and the Global South. There is a need to develop working examples of adaptable, scalable methods for understanding and assessing social determinants of urban health and well-being and catalyzing grassroots demand/actions in reducing social inequalities in access to health, basic services, entitlements, also inform public policy.

Methodology

Refinement, simplification, scale-up use of qualitative adaptation of WHO’s Urban Health Equity Assessment and Response Tool (HEART) piloted by Urban Health Resource Centre in Indore (2011) was done. Urban HEART’s quantitative indicators, were further simplified to qualitative indicators informed by slum-women’s groups' observations, to assess water-supply, drainage, access to healthcare, education, debt, livelihood regularity, governance and associated social determinants of urban-health in slums/informal settlements in Agra, India.

Results

A more replicable and scalable HEART methodology informed by experiential knowledge of slum women’s groups evolved. The updated assessment and response tool uses simple local language that can be understood, used by less educated, illiterate slum-dwellers and by academics, policy makers/implementers. Posters (prepared by slum-women's group members) featuring community assessments of 40 slums on 45 indicators depict slum situation using Green dots for good performance, Yellow for mediocre, and Red for poor in different slums. This adaptation emphasizes community response for each indicator in different slums. Actionable, qualitative indicators, e.g frequency of Auxillary-Nurse-Midwife (ANM) visits instead of under-five mortality-rate, absence of toilets in most houses, have enabled communities use their knowledge to develop and implement context-responsive and cost-effective action-plans.

Significance/Recommendations

This approach facilitates communities to focus energies on relevant problems through periodic assessment. In addition to being low-cost, the indicators are similarly understood by illiterate slum-women and academic researchers. UHRC recommends that focus on community participation and leadership be a central tenet of social-sector and multi-sectoral urban poverty/vulnerability action research in the Global South.