Urban Health Data Hub, Promoting Evidence Use in Urban Health Systems in Budhanilkantha Municipality: CHORUS-II 

Background  

The growing numbers of urban poor around the world face several health challenges including the double burden of diseases, exposure to environmental and human-made hazards and limited access to quality and affordable health care. In the context of the urban poor being overlooked in data, programmes and policies, this study aims to strengthen the urban system in Nepal. This study is part of the community-led Responsive and Effective Urban Health System – CHORUS implemented by the International Research Project Consortium (RPC) in Bangladesh, Ghana, Nepal and Nigeria. The Study in Nepal generates useful evidence to inform national and sub-national policies and program to address the quality healthcare needs of urban populations. This study’s objective is to strengthen the health system that improves urban poor access to primary health care. Our study focusses on four key themes which we call CHORUS Pillar. These include: 

1. Linking the plurality of health care providers. 

2. Building multi sectoral collaboration to address wider determinants of health. 

3. Strengthening systems to prevent and respond to the double burden of non-communicable (NCDs) and communicable diseases (CDs). 

4. Identifying, Reaching and engaging the urban poor. 

CHORUS Projects in Nepal 

We have two major studies on health system strengthening being implemented in Pokhara Metropolitan City in Kaski, Gandaki Provinces and Budhanikantha Municipality in Kathmandu, Bagmati Province Nepal.  

1. Project One: Understanding the approaches to strengthen the service delivery of non-communicable disease programmes for urban poor at the primary health care setting in Pokhara 

2. Project Two: Co-Designing Urban Health Data Hub: A Comprehensive Initiative in the Budhanilkantha Municipality of Kathmandu, Nepal 

In CHORUS, we also have four other projects under the Innovation Fund scheme led by early/mid-career researchers. These projects include: 

1. Pathways to effective coverage for mental health services among urban adolescents 

2. Ethnographic Study of Intersecting Inequities of Urban Poor in Kathmandu, Nepal 

3. Assessing Urban Poverty and Deprivation in Nepal 

4. Media’s role in informing urban health policy: A cross country study of Bangladesh and Nepal 

CHORUS Project 2: Promoting Evidence Use in Urban Health Systems in Budhanilkantha Municipality, Nepal  

The rapid urbanization in Nepal has brought both opportunities and challenges, particularly in the realm of public health. The urban metropolitan cities of Nepal, characterized by rapid urbanization and population growth (66.2% of the urban population in 2021 compared 17.1% of urban population in 2011) is tackling with pressing environment and health challenges in recent years. As urbanization continues to shape the landscape of communities, addressing the intricate challenges of urban health becomes imperative. Governments and development institutions face challenges in obtaining quality, up-to-date data for research and data driven policy solutions. To bridge these challenges, this project proposes an initiative to implement an Urban Health Data Hub in the Budhanilkantha municipality of Kathmandu, Nepal. 

Objectives of study  

1. Develop a comprehensive urban health data hub: develop an UHD-Hub that coordinates multiple data sources and provides a comprehensive data platform for urban health system strengthening.
2. Co-design and municipal leadership: ensure the data hub is co-designed with municipal stakeholders including community and led by the Budhanilkantha municipality office, promoting local ownership and sustainability.
3. Facilitate stakeholder collaboration and evidence-based advocacy for the use of the UHD-Hub: enable stakeholders, including government agencies at local, provincial and federal level, intersectoral bodies in municipality, NGOs/CBOs, to utilise the UHD-Hub for evidence-based advocacy and decision-making to address urban health challenges.
4. Strengthen urban health systems: improve local (municipal) health systems by providing disaggregated and reliable data for policy development, resource allocation, intervention design, and programme planning and monitoring to address urban health needs.
5. Improve urban health outcomes, promote equitable health gains: use the UHD-Hub to inform and implement targeted interventions aimed at improving health outcomes, particularly for the urban poor.

Methods 

The study will employ multi-phase approach, comprising of comprehensive review of the health information systems and data sources related to health sectors, secondary data analysis, social mapping and household survey, co-designing and developing and implementing an Urban Health Data Hub in the Budhanilkantha municipality of Kathmandu. 

Phase 1: Context Review of Health Data of Nepal 

The first phase is multifaceted methodology that includes document review, data mapping, data integration processes and formative research. Document review examines reports, policies, and datasets related to health, education, infrastructure, and other sectors within the urban municipality. Data mapping aligns health indicators with elements in other sectors, defining the structure and format for data integration. Formative research engages stakeholders to assess urban health data complexities, gaps and opportunities. 

Phase 2: Social mapping and Descriptive Household Survey 

The social mapping, combined with transect and research walk, will be employed to map one of the 13 wards of Budhnilkantha municipality comprehensively. It will encompass demographics, living conditions, settlement patterns, and social infrastructure such as roads, schools, religious structures, and health facilities. Social mapping will visualize health-related factors, integrated into an urban health portal. The descriptive household quantitative survey will be performed to assess the proportion of NCD and its associated behavioral risk factors among 960 households through one stage cluster sampling. The study design will be cross sectional with quantitative approach using semi structured questionnaire to measure the prevalence of biological risk factors (raised blood pressure, overweight, raised blood glucose) and behavioral risk factors (tobacco use, harmful use of alcohol, low fruits and vegetable consumption, average population salt intake and physical activity). This information is crucial for developing an urban health data hub that can provide insights into prevalence of disease, identify high-risk groups, assess healthcare needs, and formulate targeted interventions. 

Phase 3: Development and Implementation of Urban Health Data Portal 

The third phase focus on the development of a centralized Urban Health Data Hub for Budhanilkantha municipality of Kathmandu. This dynamic portal will feature data visualizations of current, real-time, and forecasting health data with major of focus on non-communicable disease of the urban municipality. Crucially, the co-design approach will be employed to engage municipal officials actively in the development process of urban health data portal that involves the identification of essential contributors for a co-design approach. We aim to assemble a diverse and representative group from the same municipality, ensuring that key actors actively participate in the study process. There will be a sense of ownership and commitment among key stakeholders and municipal officials, while also fostering a collaborative environment that supports the sustainable development and utilization of the Urban Health Data Hub in the long run. After development of urban health data portal, the project will focus to implement the Urban Health Data Hub on the website of Budhanilkantha municipality. The co-design process will continue to ensure the continuous integration of the portal into the existing infrastructure. The approach will be instrumental in fostering data accountability and ownership within the municipality. This approach empowers key stakeholders to actively contribute to shaping interventions that address the health needs of the community. 

Phase 4: Evaluation 

The final phase focuses on the effective utilization and evaluation of the urban health data portal for Budhanilkantha municipality. This includes stakeholder training, data integration, awareness campaigns, and supporting evidence-based decision-making, along with creating a sustainability plan. An organizational website will be developed to share project information and insights, accompanied by a comprehensive evaluation of the pilot project focusing on feasibility, acceptability, sustainability, and scalability. Through interviews, group discussions, and cost analysis, stakeholders’ perspectives and experiences will be captured. The findings will be documented in a detailed report to refine the intervention, address challenges, and inform future decision-making in the realm of sustainable metropolitan development in Nepal. 

Expected Outputs 

The project aims to achieve a comprehensive contextual understanding of health data landscape, examining data structures, governance frameworks, and stakeholder dynamics. This understanding serves as the foundation for creating an Urban Health Data Portal in Budhanilkantha municipality, providing centralized visualizations for current, real-time, and forecasting health data. This data hub will enhance data accountability, community involvement, and fostering co-design health interventions. It is a significant step towards leveraging digital technologies for informed decision-making and improved healthcare outcomes in urban municipalities of Nepal, with potential scalability of study findings to other municipalities and emphasis on sustainability of the urban data for evidence-based decision-making. 

Partners

This programme is a collaboration among the University of Leeds, University of York, HERD  International Nepal, ARK Foundation Bangladesh, University of Ghana, University of Nigeria, BRAC University and London School of Hygiene and Tropical Medicine

More Details

www.chorusurbanhealth.org

Follow in Twitter

www.twitter.com/ChorusUrban