Urban health capacities: assessment and response action guide

assessment and response action guide Urban health capacities

assessment and response action guide Urban health capacities Urban health capacities: assessment and response action guide ISBN 978-92-4-009785-8 (electronic version) ISBN 978-92-4-009786-5 (print version) © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Contents Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Setting up the local team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Step 1: Defining the scope of an assessment . . . . . . . . . . . . . 9 Step 2: Profiling existing capacities . . . . . . . . . . . . . . . . . . . . . 17 Step 3: Gathering information . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Step 4: Analysis and recommended actions . . . . . . . . . . . . . 25 Step 5: Reviewing and reporting . . . . . . . . . . . . . . . . . . . . . . . 31 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Annex 1 . Suggested programme for a capacity assessment . . . . . . . . . 36 Annex 2: Example tables for a hypothetical case . . . . . . . . . . . . . . . . . . . . . . . . 37 Annex 3: Approach to development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Acknowledgements: This Action Guide was written by Rene Loewenson (Training and Research Support Centre, Harare, Zimbabwe) and Francisco Obando (WHO) under the guidance of Nathalie Roebbel (WHO) and Tamitza Toroyan (WHO). WHO is also grateful to the numerous external experts and practitioners who led and participated in the pilots of this Action Guide and accompanying Primer, providing critical review feedback, informing the content and process involved: African Region: • Kwekwe Zimbabwe: Sheunesu Ngwenya (Kwekwe City Council, Harare, Zimbabwe) and Tserayi Machinda (Urban Councils Association of Zimbabwe, Harare, Zimbabwe) • Lira, Uganda: Waiswa Kakaire and Junior Alves Ssebbanja (ACTogether, Kampala, Uganda), Alfred Ogwang (Urban Authorities Association of Uganda, Kampala, Uganda) • Lusaka, Zambia: Victor Kagoli (Lusaka District Health Authority, Lusaka, Zambia), Fastone Goma and Muwasa Mukupa (Centre for Primary Care Research, Lusaka, Zambia) • Turkana, Kenya: Pascal Mukanga and Allan Ouko (Konkuey Design Initiative, Nairobi, Kenya) • Technical support to pilots: Rene Loewenson (Training and Research Support Centre, Harare, Zimbabwe) European Region: • London, United Kingdom of Great Britain and Northern Ireland: Bianca D’Souza, Clara Lovett, Alice Walker, and Clara Giraoud (Greater London Authority, London, United Kingdom of Great Britain and Northern Ireland) • Utrecht, Netherlands (Kingdom of the): Sybrit van den Berg, Miriam Weber, Renske Verstege (Utrecht Local Authority, Utrecht, Netherlands (Kingdom of the)) Western Pacific Region: • Suva, Fiji: Wally Atalifo, Marama Dimudre, Roselyn Danford, Ashlyn Lal, Tomasi Bati, Petero Sanele, Nicky Prasad (Suva City Council, Suva, Fiji) vi • Donggu - Gwangju Metropolitan City: Eunjeong Kang (Soonchunhyang University, Asan, Republic of Korea), Hyran Kim (Gwangju Dong-gu, Gwangju, Republic of Korea) Region of the Americas: • Bogota, Colombia: Adriana Ardila Sierra, William Robles Fonnegra, Kimberly Piñeros Chia, Angie Castañeda Casallas, Diana Cuaspa Sanabria, Sofia Rios Oliveros (Secretaría Distrital de Salud de Bogota, Bogotá, Colombia) in the context of a partially implemented assessment process Eastern Mediterranean Region: • Qatar: Hatoun Saeb (Ministry of Public Health, Doha, Qatar) in the context of a pilot training session The following WHO Staff contributed important technical feedback: • Headquarters: Stephanie Burrows, Hyung-Tae Kim, Monika Kosinska, Susannah Robinson, José Siri (Department of Social Determinants of Health); Yasmine Anwar, Faten Ben Abdelaziz, Trinette Lee, (Department of Health Promotion); Abraham Mwaura (Department of Environment, Climate Change and Health) • Regional Office for Africa: Doris Gatwiri Kirigia and Peter Malekele Phori (Health Promotion and Social Determinants of Health), Antonio Palazuelos Prieto (Social Determinants of Health) • Regional Office for the Americas: Francisco Armada (Consultant), Diego Bejarano (Consultant), Maria Pilar Campos Esteban (Department of Health Promotion) • Regional Office for Europe: Matthias Braubach ( Environment & Health Impact Assessment) Kira Fortune (Healthy Cities,Health Promotion&Well-being), Pierpaolo Mudu (Environment and Health) • Regional Office for the Eastern Mediterranean: Samar Elfeky (Health Promotion) • Regional Office for South-East Asia: Suvajee Good (Family Health, Gender and Life Course) • Regional Office for the Western Pacific: Isabel Espinosa, (Gender, Equity and Human Rights), Ratu Saula Golea Volavola (Pacific Island Countries), Joana Madureira Lima (Health-enabling Society), Josaia Tiko (Healthier Populations) WHO acknowledges the financial support of Bloomberg Philanthropies. vii Glossary: Connective capacities – The capacities required for the integrated, coordinated multisector practice and policy-making that creates urban health. These capacities bring together sector- specific technical and policy knowledge, skills and abilities across sectors and levels of governance, enabling multilevel, multidisciplinary urban policy- making and practice. They lie within four key areas: 1. Informed decision-making, monitoring and evaluation 2. Policies, programmes, innovation and change 3. Resource (human, financial and infrastructure) management 4. Partnerships, participation and knowledge sharing Health outcomes – A change in the health status of an individual, group or population which is attributable to a planned intervention or series of interventions, regardless of whether such an intervention was intended to change health status. Social determinants of health – Non-medical factors that influence health outcomes. The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. Urban health – The art and science of improving health and health equity in cities, including by securing the resilience and sustainability of health- supporting natural and human systems; more than the sum of its parts, it ensures that people, institutions, and environments interact to create healthy situations and that every person has the chance to thrive, now and into the future. It’s a measure of the health of urban dwellers as continually created by their complex interactions with urban physical and social environments, and by the decisions and institutions at all scales that shape these interactions. Urban health goal – The specific object of an ambition or effort within an area of urban policy or practice that ultimately also improves health, e.g., the effective integration of migrants to contribute to the economy ultimately also improves mental health; or access to and quality of drinking water ultimately also reduces communicable disease. viii Executive Summary Executive Summary The key to maximizing urban health is through strengthening and leveraging specific sets of capacities that connect diverse urban work across sectors and levels of governance. These “connective capacities” play a vital role at individual, organizational and systemic (cross-organizational) levels in achieving urban goals across all sectors, to support city-dwellers’ health and well-being. These connective capacities span four key areas: 1. Informed decision-making, monitoring and evaluation 2. Policies, programmes, innovation and change 3. Resource (human, financial and infrastructure) management 4. Partnerships, participation and knowledge sharing Assessing and using capacities that create synergies across sectors and levels of governance can significantly improve urban health and well-being. The Urban health capacities assessment and response primer describes these capacities in detail and why they are essential to achieving holistic delivery of urban health goals. In turn, this Action Guide provides a step-by-step process for facilitators implementing capacity assessments with stakeholders involved with urban health. The Action Guide is primarily targeted at local authorities and those working with them, to support them in carrying out a successful participatory self-assessment of capacities for urban health. Used alongside the Primer, the capacity assessment process in this Action Guide supports the achievement of any urban health goal, via five iterative steps: Urban health capacities - assessment and response action guidex With explanatory text and tables to fill in, the Action Guide takes users through each step in the process to identify the urban health goal(s) of the local authority and the capacities needed to achieve them. It guides the development of a plan to leverage capacity assets, and mitigate for or strengthen capacity gaps. A series of videos available at online shows the facilitation and implementation of the five steps, using a hypothetical example. To achieve a successful capacity assessment process that can form a basis for stronger urban health provision, users should read both the Primer and this Action Guide – both short documents – before beginning to plan and facilitate an assessment tailored to a specific urban context. By assessing and developing strong connective capacities of staff, organizations and cross-organizational systems, urban health actors can deliver integrated, effective policies and practice that span sectors, disciplines and levels of governance, optimizing the use of limited resources to achieve urban health goals. Step 1: Defining the scope of an assessment by identifying a chosen health goal Step 2: Profiling existing capacity levels Step 3: Gathering any extra information required Step 4: Analysing findings and identifying recommendations Step 5: Reviewing recommendations and reporting to relevant authorities, as the basis for action to achieve the urban health goal, leveraging or strengthening the required connective capacities Executive summary xi Look out for all the components of the Urban health capacities assessment and response resource kit: 1. Primer – aims to foster self-assessment and understanding of the capacities needed to perform key functions for holistic, coordinated policy-making and practice that improve the health and well-being of city dwellers. 2. Action guide – provides step-by-step guidance enabling local authorities and other urban actors to assess the capacities vital for providing holistic, joined-up urban initiatives, and generate a plan to achieve an urban health goal that leverages and strengthens these capacities. 3. Training video – shows how to facilitate a capacity self-assessment process, guiding assessment facilitators through the concepts and methods of the capacity assessment. 4. City examples – tell stories of instances capacity self-assessment and response exercises were carried out in different localities globally to assess capacities for urban health, ultimately improving health. Urban health capacities - assessment and response action guidexii Introduction Introduction The World Health Organization (WHO) has developed this Action Guide to enable local government actors and partners working in urban health to assess the capacities vital for delivering holistic, integrated action for urban health. It guides action to leverage and strengthen these capacities. The Action Guide is designed specifically for assessment of the “connective capacities” that enable cross- sectoral, multiscale and multidisciplinary approaches that underpin urban health delivery. These capacities fall into four broad areas: 1. Information for decision-making, monitoring and evaluation 2. Policies, programmes, innovation and change 3. Resource (human, financial and infrastructure) management 4. Partnerships, participation and knowledge sharing The connective capacities and their central role in successful urban health provision are profiled in detail in the WHO Urban health capacities assessment and response primer, which accompanies this Action Guide. The Primer aims to foster understanding of the capacities needed to perform key functions at individual, organizational and systemic (cross-organizational) levels. Together, the Primer and this Action Guide support policy-makers and practitioners to achieve goals that improve city-dwellers’ health and well-being, through coordinated policies and action. This Action Guide is particularly relevant for local authorities, given their mandated duty and function in urban health and well-being, and their power to convene other stakeholders. It enables them to undertake a participatory self-assessment of individual, organizational and system-level capacities to achieve prioritized urban health goals, following the five steps in Box 1 on page 4, and completing the accompanying tables. This Action Guide is aimed at the local authority facilitator and co- facilitator (if applicable) of a capacities self-assessment (both termed “facilitator” in this document). It will be useful to anybody wishing to conduct an assessment and response exercise. To implement an Urban health capacities - assessment and response action guide2 assessment, facilitators should first carefully read the Primer and the Action Guide. Both were tested in pilot self-assessments carried out in 2023 and 2024 by WHO and partners in selected cities of Latin America, East and Southern Africa, the East Mediterranean and Western Pacific regions and Europe to ensure they are fit for purpose and meet the needs of diverse users. A capacity self-assessment can be carried out at the beginning, middle or end of a planning or electoral cycle, and this context may affect its purpose and contribution. Whatever the case, the overall urban health goals and programme of work to achieve these goals should be in place before beginning the assessment. Facilitators must understand the priority goals and programmes, and have a broad understanding of the context and challenges, so they are equipped to implement the assessment. Having in-country or regional mentors to conduct the assessment is useful. These can be from WHO or from another city that has already conducted an assessment. The video series accompanying this Action Guide shows how to implement the process, outlining the concepts and methods for the capacity assessment to enable an assessment team to carry out the process confidently and mentor others to do so, where needed. The team implementing the capacity assessment in Kwekwe, Zimbabwe, 2023. ©WHO/TARSC. Introduction 3 Box 1: Action Guide At-A-Glance • Defining the shared health goal, challenges and priority capacities • Setting up and briefing the team • Sharing and obtaining information to assess • Rating capacity levels, assets and gaps • Analysing the findings to identify actions and formulate recommendations to strengthen prioritized capacities • Reporting on the analysis and proposed actions, and engaging audiences • Monitoring implementation PREPARING THE ASSESSMENT; SETTING UP THE TEAM STEP 1: SCOPING STEP 2: PROFILING STEP 3: GATHERING INFORMATION STEP 4: ANALYSIS AND RECOMMENDED ACTIONS STEP 5: REVIEWING AND REPORTING Identifying and inviting relevant stakeholders Reading the Primer and Action Guide P R O C E S S S T E P I S S U E S C O V E R E D Introducing the assessment purpose and process, the four capacity areas and the types of capacity Identifying the health goal, challenges and capacities, checking against the Primer Completing the Step 1 Table Identifying and rating levels of assets and gaps in prioritized capacities, checking against the Primer Identifying information needs to address Filing in the Step 2 Table Gathering any further information needed from documents and key informants Completing the STEP 2 Table Reviewing and analysing the information on capacities, to propose actions, their timing, roles, resources and importance Completing the Step 4 Table Drafting, reviewing and producing a report for different audiences, and engaging them with the assessment findings. Identifying a mechanism for monitoring uptake and progress Completing a summary report Urban health capacities - assessment and response action guide4 Setting up the local team Setting up the local team The assessment is best implemented by a team of key stakeholders that spans sectors, levels and disciplines relevant to the priority urban health goal. This enables the process to build a more comprehensive shared understanding and analysis – important later for uptake of the recommended actions. The team includes a facilitator or two co-facilitators, who either initiated the assessment or are appointed by the initiator. We recommend having two facilitators for a capacity assessment, at least one of whom can participate in meetings in person. This enables one to manage discussions while the other records them. Alternatively, teams can identify a member as rapporteur to record discussions. The facilitators should bring together a local team of approximately six members to implement the capacity assessment. A team may contain more members if needed, but larger groups may be more difficult to facilitate. Team size will depend on the number that is relevant for the key urban health goal(s) to be assessed, with people from: • Technical staff of local government departments that cover health, social welfare, environment and other areas relevant to urban health, and those that cover planning, financing, personnel and stakeholder and community relations. Box 2: Implementing a stakeholder analysis A stakeholder is any person or institution with a direct or indirect interest in a process or situation. Stakeholder analysis provides one way of identifying these different actors. Primary stakeholders are directly affected, involved or influential, while secondary stakeholders are indirectly affected, involved or influential. To implement a stakeholder analysis for an urban health goal, facilitators should list those from the state at local and national level; community associations and civil society; technical agencies, commercial organizations, funders and others. They should then choose those stakeholders they rate as more important or more directly involved, influential or knowledgeable for the goal in question. Urban health capacities - assessment and response action guide6 • Technical staff of relevant central government agencies working locally in urban areas. • Non-state technical, civil society, private- sector and funding agencies that co-operate with authorities on urban health. Facilitators should consider the interacting systems and stakeholders that play a role in the priority area of work in their context, as explained in the Primer. A stakeholder analysis, as briefly outlined in Box 2, can help facilitators identify possible team members, select those most important to the capacity assessment, and secure their participation. A key consideration is also whether those identified are likely to have the interest and time to commit to the process. Using the background information provided in the Executive Summary of the Primer, facilitators should invite the team members to join the participatory self-assessment of connective capacities needed to achieve specific urban health goals. Prior to the team’s first meeting in Step 1 (see below), or after identifying the urban health goal for which to assess capacities, facilitators may need to adjust the team to ensure it has the right members, by: a. Checking the team contains the necessary people and institutions for the identified urban health goal, and inviting others if needed. b. Checking with team members whether they can commit to participating in all four steps of the process (about 10 hours of their time in total, across at least four weeks). If this is difficult for very senior people, facilitators should ask for mid-level delegated personnel who can consult senior levels where needed. This is the stage to set dates and broad times for team meetings to correspond with each step of the assessment process, noting suggested timings in Annex 1. If times need to be adjusted due to unexpected events or commitments, facilitators should try to hold sessions as close to agreed dates as possible. With participants identified and the person recording the information in place, facilitators are ready to implement the process. At each step, we recommend that facilitators reread the relevant sections in the Action Guide and Primer, and prepare the relevant table to fill in. This will make it easier to facilitate the process and to guide the team discussion on what is in focus at that step. Setting up the local team 7 Urban health capacities - assessment and response action guide8 STEP 1: Defining the scope of an assessment Step 1: Defining the scope of an assessment In Step 1, the facilitator convenes the capacity self-assessment team, introduces them to the assessment process and oversees the team’s identification of an urban health goal for which to assess existing capacity. Introduce the rationale and process of a capacities self-assessment As a facilitator, in your introduction with the full team, outline the aims and scope of a capacity assessment and response, referring to the key information in the Primer, and the broad process for the work outlined in Box 1 on page 4. Key questions for the team’s discussion: What specific challenges are being encountered in achieving the goal within each of the four capacity areas? What capacities are required to meet those challenges? Step 1: Defining the scope of an assessment Step 2: Profiling capacities for a chosen urban health goal Step 3: Gathering further information (where needed) Step 4: Analysis and recommended actions Step 5: Reviewing and reporting. The scoping meeting may be held online, but is best held in person, to enable the facilitators to ensure that team members understand: • the nature of “connective capacities” in different areas and levels, with their different outcomes, as outlined in the accompanying Primer • the focus on holistic, integrated approaches • the agreed choice of a prioritized urban health goal for the assessment process, that is manageable and shared, and the challenges it raises. Urban health capacities - assessment and response action guide10 The facilitator should also explain the time requirements for the assessment, obtain agreed timings from the team and ensure commitment to participation in all steps of the process. It is important that you manage team expectations and the perspective of different areas of urban health which team members may bring as priorities. We recommend that you choose one overall goal where the broad programme of work – what you are doing or plan to do to achieve the goal – is understood. As a facilitator, you should take time to introduce the capacities within the four areas and different levels noted in the Primer. (See Box 3) Reassure teams that they do not need to use the wording in the Primer, as these are generic terms for guidance. Explain that the team will articulate and record capacities for their chosen health goal and challenges in their own words, to make these clear in the local context. The generic capacities in the Primer serve as a reference to ensure nothing has been overlooked in the team’s listed capacities. They also help clarify whether these are individual or organizational capacities (noting that the boundaries can be blurred) or whether they are systemic and require interaction across multiple organizations. Finally, the introduction covers what constitutes a successful assessment, noting that it comprehensively captures both capacity assets and gaps across individual, organizational and systemic levels. This raises understanding of capacity gaps and assets for meeting health challenges and achieving urban health goals, informing prioritization, resource allocation and planning to leverage capacity assets and synergies across organizations – including strengthening areas where there are gaps. A capacity assessment may identify actions that can be taken locally, and issues to present to levels higher than the local authority. It can, therefore, assist in performance reviews, strategic reviews, and monitoring and evaluation or improvement cycles, and in linking benchmarks and outcomes to capacity issues. Step 1: Defining the scope of an assessment 11 Box 3: Defining connective capacities In your introduction with the team, define the term “capacities” as the ability to perform, solve problems, define objectives, and understand and deal with development needs to achieve objectives in a sustainable manner. Capacity entails individual skills and expertise, nested within organizational processes and systems operating within the wider context of systems or networks across organizations. The assessment Primer provides more detailed information on all the areas covered in this box, so facilitators and the team can be clear on capacities and their outcomes. In the scoping meeting, the team will be introduced to four categories of capacities identified in the Primer: 1. Informed decision-making, monitoring and evaluation or capacities to assess the distribution and determinants of urban health and disease, using the right metrics and observation systems that reflect perspectives of all urban health actors, particularly local communities. 2. Policies, programmes, innovation and change, or capacities to think, reflect and act strategically on interventions, and to implement plans, innovations, practice and programmes. 3. Resource (human, financial and infrastructure) management, ensuring that sufficient resources are allocated to the right issues and problems, at the right scales, and to the right people and institutions, and that the people involved are adequately trained. 4. Partnerships, participation and knowledge sharing to co- design, implement and co-produce interventions in a whole-of-society approach that engages effectively across different sectors and stakeholders. Urban health capacities - assessment and response action guide12 Select the urban health goal for which to assess capacity After the introduction, the team will identify the goal for which to assess capacity, along with any challenges for the local authority and area, with a focus on priorities in holistic, integrated work on urban health and well-being. Using a broad definition of health and well-being that covers positive and negative health outcomes and the determinants of health, the team can identify their prioritized goal by referring to: a. The strategies or goals of any given sector – including housing, education, transport, culture or retail – and how they influence health and other sectors b. Physical settings such as public spaces, movement corridors like routes to school, cycle paths, squares, parks and gardens, campuses, and others. c. National and local authority health strategy goals and any existing capacity, service or performance benchmarks (referring to internal plans or strategies). d. Health outcomes or rising health burdens that need to be addressed, (e.g. increased prevalence of depression, obesity or asthma). with attention to equity and particularly exposed or vulnerable communities e. Health and well-being challenges and goals raised as priorities by communities and other stakeholders, which the local authority is expected to deliver on (e.g. tackling illegal drug use or offering support for the elderly). The goal may be a specific policy goal; a system goal, such as improving housing standards, or a programmatic goal, such as introducing a health- related multisectoral innovation linking food markets to waste management and clean energy. The team may initially list several urban health goals in an open-ended discussion, taking into account areas (a) to (e) above. As a facilitator, guide the team to discuss, identify and agree on one overall prioritised goal, noting the reason for the choice. This will make the process manageable, given that a goal will have multiple programme interventions and challenges, each of which may demand multiple capacities. Examples of such goals could be improving urban health through promoting urban food systems, reducing falls in older age groups, or improving access to water and sanitation – keeping in mind that a broad goal may have different specific areas of intervention and challenges. If this is the first time the team is implementing the process, you may choose less complex goals with links across sectors that are easy to identify and manage locally. The whole process can later be repeated with other health challenges or goals not covered in this round, with relevant new team members. If you are not able to achieve team consensus on the selected goal, it can be helpful to use a ranking and scoring method to finalize the top health goal and its challenges. (See Box 4) Step 1: Defining the scope of an assessment 13 Identify the challenges to achieve the goal and the required capacities For the prioritized health goal, the team should indicate the challenges for that goal and the capacities needed (see the Step 1 Table on p.16). This should be an open, participatory discussion by the team, with members identifying the challenges within each of the four areas (see Box 3), and defining the capacities needed to meet those challenges in their own words, in a way that is relevant to their own context and goal. Guide the choice of the capacities by asking the team to consider: a. The nature of the goal and challenges, and how critical the capacity is for the achievement of the goal b. Whether the capacity is at individual, organizational and cross- organizational (system) level c. What capacity is required now and for the future achievement of the goal. Use the Step 1 Table to discuss and record first the prioritized goal, the specific challenges or requirements relating to it within each of the four areas, and the capacities needed to address each challenge. When you have a list of capacities from the open discussion, the team can together review the capacity list in the Primer, using the assessment framework as a checklist. From this, they can suggest other capacities Box 4: Ranking and scoring capacities List the goals identified by the team on a flip chart, one below each other. Give each team member three counters or markers (these can be anything, from post-its to pebbles) and ask each to place their counters against the three goals they think are the top priorities (they could also put two or three against one goal). When all have voted, count the total counters for each goal listed and write the totals next to the goal on the flip chart. This shows the top priority goal and the next priorities in order. Discuss the result. Can the findings be taken as a consensus view of the team? If not, discuss what is not agreed, noting the reasons for the top few choices, to reach a resolution. Urban health capacities - assessment and response action guide14 they see as priorities but may have left out, to add to the Step 1 Table, noting whether each is at individual, organizational or systemic level. Teams should agree on definitions of levels of capacities (individual, organizational or systemic) for their context. For example, one team may decide to refer to capacities of their own department as organizational, and those of other departments within the municipality and external organizations as systemic. Another team may decide to refer to capacities of all departments within the municipality as organizational, and capacities among external institutions as systemic. It may not always be easy to reach consensus on identifying the level of a capacity, as the boundary or difference between individual, organizational or systemic capacities may not always be clear. If the time available does not permit such consensus, to avoid prolonging the process, the facilitator can record the list of prioritized capacities and use the Primer after the session to identify whether a capacity is at individual, organizational or systemic level, noting this in brackets after each capacity on the list. The team can then review and validate this at the beginning of the next session. Ensure that the meeting is recorded systematically in the Step 1 Table below (available separately as a Word table), capturing the prioritized goal, the challenges identified for that goal within each of the four capacity areas defined in the Primer, and the capacities needed to meet the challenges. You could have the Step 1 Table on a flip chart ready to fill in during the meeting, or a rapporteur can complete the table on a computer. The latter allows you to record, add and edit information as you progress during the meeting. Afterwards, the facilitators can make sure that each challenge within the four areas is listed in its own cell, with each capacity listed against the challenge in its own cell, as this will make the information easier to work with during the next step. Now that the team has some experience with the process and has clarified the health goals and prioritized capacities, relook at the timeframes set, using the table in Annex 1. If needed, make adjustments to ensure that all participants agree on and can commit to the timelines. For an example of a completed Step 1 Table from a hypothetical case, see Annex 2. Check for facilitators: When assessing capacities for integrated urban health programmes, you must have a number of systemic capacities on the list. Step 1: Defining the scope of an assessment 15 Table 1. Step 1: the prioritised goal, challenges and capacities CONNECTIVE CAPACITY AREA Write the prioritized health goal here. For example: • Improve health-promoting food systems Specific challenges to address or achieve the goal Capacities needed and their level – individual (I), organizational (O), systemic (S) Information for decision-making, monitoring and evaluation List the identified challenges for this category, one per cell, adding rows as needed. For example, if the goal is improving health- promoting food systems, a challenge relating to information may be: “testing which foods do/do not meet food standards”. List the capacities identified to meet the challenge(s), one capacity per cell, adding rows as needed. After each capacity, indicate the level using (I), (O) or (S). For example, if the goal is improving health- promoting food systems, and the challenge is testing which foods do/do not meet food standards, the relevant capacities (each in their own cell) may be: • Equipment for food sampling and testing (O) • Expertise in food sampling and analysis (I) • A database of test results and foods that do or do not meet food standards (O) Policies, programmes, innovation and change List the identified challenges for this category, one per cell, adding rows as needed List the capacities identified to meet the challenge, one per cell, adding rows as needed. After each, indicate the level using (I), (O) or (S). Resource (human, financial, infrastructure) management List the identified challenges for this category, one per cell, adding rows as needed List the capacities identified to meet the challenge, one per cell, adding rows as needed. After each, indicate the level using (I), (O) or (S) Partnerships, participation and knowledge sharing List the identified challenges for this category, one per cell, adding rows as needed List the capacities identified to meet the challenge, one per cell, adding rows as needed. After each, indicate the level using (I), (O) or (S). Urban health capacities - assessment and response action guide16 STEP 2: Profiling existing capacities Step 2: Profiling existing capacities Key questions for the team’s discussion: What information do we have that can help us rate each capacity? Based on this information, what rating should each capacity receive on a scale from 1 to 3? If there is insufficient information to rate a capacity, where can it be obtained? Who can provide it? In Step 2, the team draws on their collective knowledge to bring together information on each of the capacities identified in the previous step. This information should cover the level of capacities available in and beyond the local authority organization, and the capacity gaps. From this, the team will also identify those capacities that need further information (to be gathered in Step 3), and the secondary data sources or key informants to provide this. The information will be used to rate each capacity. Reread the Primer and prepare the Step 2 table Reread Sections IV and V of the Primer on capacities and outcomes, as this may help you to think about current levels of capacities in relation to those needed to achieve a health goal. Use the Step 2 Table below (adding rows as needed) to record the information and rate each capacity. (A downloadable Word version of this table is available.) Before the Step 2 session, prepare the Step 2 Table using the template on p.22 by entering the following information from the Step 1 Table: • the priority health goal • each of the capacities needed and their level, i.e. individual (I), organizational (O) or systemic (S), within each of the four capacity areas. Leave columns 2, 3 and 4 blank to fill in during the session, and provide the prepared table electronically for the Step 2 session rapporteur, and in print for the team to use in the session. Urban health capacities - assessment and response action guide18 Fill in the Step 2 table as a team In the Step 2 meeting, for each of the capacities within the four areas, the team will draw on their own knowledge and information to discuss and reach consensus on: a. Information on the level of the capacity, and related challenges, gaps and assets that can be used to rate the capacity. This should include all information on the capacity level, assets and gaps, based on team knowledge and available information, whether positive or negative, including any comment explaining the rating. b. The rating the team gives to the capacity, from 1-3, using the Capacity Rating Scale below. Add a comment where needed to explain the rating given. Capacity Rating Scale 0 Not enough information or consensus to provide a rating 1 No capacity: Attributes not in place 2 Developed capacity: Attributes are in place, or partially in place, but have not been used or funded sustainably 3 Demonstrated capacity: Attributes are in place and have been used in the response to a real event or tested through exercises, or are scaled up and funded sustainably. Step 2: Profiling existing capacities 19 The team discusses the current level of each capacity, and the facilitator enters the information in column two of the table. This may be qualitative, such as “no policy in place” or “sufficient kits to gather water samples”, or it may be quantitative, such as “only 5% of health promotion posts filled” or “70% of budget needs met in past two years”. As noted above, it is important to include all information on the capacity level, assets and gaps, based on team knowledge and the information members have available, whether positive or negative. Using the information provided, the team then rates each capacity from 1 to 3, and the facilitator enters the rating number in column 3. If the information is insufficient for the team to give a rating, the rating in column 3 is entered as zero. If the team feels strongly, based on the information available, that the rating lies between 1 and 2, or between 2 or 3, then either add a plus sign or a minus sign. For example, if a capacity is not quite a 2 then use 2-. If team members raise points in discussion on the ratings which are relevant to the capacities, or which explain the ratings given as 1, 2 or 3, include this in column 2 of the table, along with the information on the capacity level. During the Step 2 meeting with the team, you or a rapporteur can record this electronically on the Step 2 Table or in a Google doc, or on a flip chart before transcribing it electronically. If the information is recorded digitally, it is helpful to project it onto a screen. The team can check their comments are reflected adequately by the rapporteur. If the team has enough information to rate all the capacities, there is no need to gather further information from key informants or relevant documents. In this case, the team skips to Step 4. However, if any of the capacities are rated as zero, the team will need to gather further information (see Step 3) to be able to decide the rating to apply. This information can come from: • Secondary data sources, i.e. existing available data, judged to be relevant, reliable and credible. In practice, the type of data will vary by context and urban setting. • Interviews with key informants, i.e. local personnel with experience, information or knowledge relevant to the capacity area. If the key informants are not obvious, the team can carry out a stakeholder analysis to identify the primary stakeholders who may provide information on the capacities, and choose who would be best to interview. The team will also identify the questions they need to ask each key informant, to provide information on the relevant capacity. This should include asking all informants to rate the capacity using the 1-3 ratings noted on the previous page. • Other sources, such as observational assessments by the team. For each capacity rated as zero and needing further information, the team should identify the information to be gathered and the sources of that information. The team can allocate responsibility for gathering the information to different members, based on their institution and role, and agree on feasible timing. This is normally within a week. During the meeting, you should enter in the final column of the Step 2 Table: • information to obtain from key informants, and questions to ask them • the specific source or key informant providing the information • the team member responsible for gathering that information, and by when. Urban health capacities - assessment and response action guide20 Shade the ratings and ensure the Table is easy to understand After the meeting, it is very useful if the facilitator shades each cell in the column with the rating colour (See the Capacity Rating Scale on p. 19), to provide a visually clear dashboard. Shade the cell light red if a capacity is rated as (1); light yellow if rated as (2) and light green if (3), using the red- yellow-green colour shading shown above. If the capacity is rated as zero (0), it is left unshaded. For an example of a completed Step 2 Table from a hypothetical case, see Annex 2. Assessment induction workshop, Doha, Qatar, 2023. ©WHO. Step 2: Profiling existing capacities 21 Table 2. Step 2: the capacities, their levels, ratings and information to gather Priority health goal: state here CAPACITY (List the capacities identified in Step 1, one per row.) List the information on the capacity level, assets and gaps, based on team knowledge and available information. Include all information on the capacity level, positive and negative, including any comment explaining the rating. Indicate the 0-3 rating* and shading Information to gather, the source and responsible team member for capacities rated 0 (i.e. those needing further information). Informed decision making, monitoring and evaluation Policies, programmes, innovation and change Resource (human, financial and infrastructure) management Partnerships, participation and knowledge sharing * as per coloured ratings chart on the previous page Urban health capacities - assessment and response action guide22 STEP 3: Gathering information Step 3: Gathering information In Step 3, team members identify information from secondary sources or key informant interviews to justify the allocation of a rating (1, 2 or 3) to a capacity previously rated zero. If there are no capacities rated zero in the Step 2 profiling session, no further information gathering is required, and the team can skip this step and progress to Step 4. Use the same table filled in during Step 2 to enter the new information, filling in parts of column 2 that were left blank or incomplete with new information gathered in Step 3: • For secondary or observational data, the facilitator adds all relevant information obtained on the capacity level in the second column of the relevant row. They leave column 3 with the rating blank for the team to do the rating in Step 4. • For key informant feedback, the facilitator should add all relevant information provided by the key informant on the capacity level in the second column and the rating 1, 2 or 3 in the third column. They then shade the rating with the relevant colour. • In the final “comment” column, note the source of the new information. You can provide team members gathering information with electronic copies of the table as completed at the end of Step 2, showing the information and ratings already agreed, with blank cells for capacities where information and ratings are to be added. This can be provided as individual copies or as a shared Google doc for team members to fill in. Members can also supply newly gathered information to you, as facilitator, to fill in the table ready for the Step 4 meeting. If the information gathering takes place over more than one week, you, as the facilitator, can check on progress weekly, review the information collected for clarity and relevance, and give feedback to team members. If the information gathering is a week or less, you can do this review during Step 4, with the proviso that there may be need for a further round of information gathering by the relevant team member to address any gaps or queries. Prepare the Step 4 Table You, as the facilitator, should copy and paste the information from the completed Table 2, including all the new information, into the first two columns of the Step 4 Table (on p. 30), leaving the remaining two columns blank: a. In column 1, add the capacities exactly as listed in column 1 of the Step 2 Table. b. In column 2, paste the rating and all the information on the capacity level from columns 2 and 3 of the Step 2 Table, with the cells shaded using the appropriate colour for each rating. Print this table for the team to refer to in the next step, and provide it electronically for the rapporteur to complete based on the discussions. For an example of a completed Step 2 Table from a hypothetical case, see Annex 2. Urban health capacities - assessment and response action guide24 STEP 4: Analysis and recommended actions Step 4: Analysis and recommended actions In Step 4, the team reviews and analyses the information gathered and recommends actions to achieve the goal, including actions to leverage or strengthen capacities. Review and validate new information from Step 3 The facilitator provides the compiled inputs in one table as the basis for discussion. The team will: • review any new information and key informant ratings added during Step 3, and note any issues that need clarification or are contested. This may require the relevant team member to provide clarification or further information, so the analysis and evaluation can continue. • confirm and validate the information and the capacity ratings provided by key informants, if no issues need further clarification or information. • rate capacities that have new information from secondary data gathered during Step 3, using the rating scale from Step 2 (shown again below), shading the cells appropriately. 0 Not enough information or consensus to provide a rating 1 No capacity: Attributes not in place 2 Developed capacity: Attributes are in place, or partially in place, but have not been used or funded sustainably 3 Demonstrated capacity: Attributes are in place and have been used in the response to a real event or tested through exercises, or are scaled up and funded sustainably. Key questions for the team’s discussion: What action can we take to leverage our capacity assets? Additionally, what short- term actions can we take to mitigate capacity gaps, and what medium- to long- term actions can we take to strengthen these gaps? How important is each action? Urban health capacities - assessment and response action guide26 Identify priority actions to achieve the goal, leveraging capacity assets and addressing gaps This process will lead to a completed Step 4 Table, which includes a prioritized list of actions to achieve your goal. If you did not need to gather information and skipped Step 3, you will still need to prepare the Step 4 Table in advance of the session in order to complete it with the team. Refer back to Step 3 and review the section titled Prepare the Step 4 Table for guidance. The Step 4 Table can now be discussed by the team, to identify actions to: 1. sustain, build on and leverage strong capacity assets. 2. strengthen and use capacity assets that are in place, but not fully developed or used, or sustainably supported. 3. address capacity deficits, through actions within the local authority or in partnership with other sectors and stakeholders. For each capacity area, this calls for discussion and decision-making. Use the previously prepared Step 4 Table to record the discussion and decisions. For each capacity, the discussion should systematically consider and identify: a. What specific issue needs to be addressed, given the information. Is there a need to sustain or leverage a capacity, strengthen or use it, or address a deficit? b. What action can be taken, within what timeframe (in months and years) and by whom to address this issue, and what resources are needed to sustain or leverage the capacity, strengthen or use it, or address a deficit, as relevant. The team should discuss, agree and record in column 3 of the Step 4 Table: • the recommended action • the timing (specifying time frames, e.g. three months, six months, a year) • the responsible institutions • the resources needed c. For each proposed action, the team should discuss, agree and record in the fourth column of the Step 4 Table the level of importance of taking action on and committing resources to address the capacity measure, taking into account: • The current capacity level, noting the rating and shading that shows how wide the gap to address is. • The positive or negative impact of that capacity for achieving the relevant health goal – noting how critical it is for the goal, and whether a shortfall could be a block to achieving the goal. • The extent to which the capacity can be modified or strengthened, if there is a deficit. • The feasibility of the recommended action – noting whether the resources, support and actors exist to implement it. • How far the action is necessary to enable other actions to be taken – noting whether it is an essential early action as a foundation or enabler for other key actions. The team should agree on whether an action is of low, medium or high importance, and the facilitator should capture this in the Step 4 Table. Step 4: Analysis and recommended actions 27 Box 5. Costings It may not always be possible to provide costings for resources needed. If costings are not available, information on resources can be provided qualitatively. If costing information is available – in plans or investment documents, for example – the facilitator can pause the session once all other information has been discussed and added, to allow team members time to collect the costings, and reconvene to add them in a later continuation of Step 4. To support the discussions in this step, it is useful that the facilitator and team review the team’s discussions and section V of Primer, Outcomes from applying connective capacities, again. This may also stimulate ideas on actions. The team may wish to recommend more than one action per capacity gap or asset. This should be shown in the table by adding a new row for each action. The table can be filled in progressively by a team member as the discussions take place. It can be reviewed in a second round of discussion to check decisions and actions and assess whether synergies and links across areas are adequately addressed. This step of analysis and evaluation is usually carried out in one meeting, but may take place in more than one, if needed. Urban health capacities - assessment and response action guide28 Review the Step 4 Table to identify synergies and links across capacities Once the team has discussed all capacity areas, filled in the table and agreed on actions for each area, it should review the results of the discussion in the table to check for and note key synergies and links across capacities. For example, the facilitator(s) may ask: • Which capacities are essential to leverage and make best use of other capacities? • Which capacities are likely bottlenecks for other areas, if not addressed, or for achieving the health goal? • Which capacities can help to leverage action on other areas, or to leverage capacity inputs of other stakeholders? • Where may funds be sourced? This review can inform further revisions to decision-making and the actions, roles, timings and resources in the table. The team may, for example, decide that even if costly, addressing a capacity deficit is so critical for an urban health goal or for making better use of other key capacities, that action and resource allocation is essential. Or it may, in contrast, decide that while desirable, a capacity asset or deficit may not need to be urgently addressed and no immediate action should be taken, as the capacity has weak impact on health goal, or is less remediable or feasible. The team can add such points as relevant in the review and amend the recommended actions and roles. Identify the target audience of a report including the assessment findings and recommendations At the end of Step 4, the team should identify to whom to present the assessment findings and recommendations for integration into planning, budgeting and programming, as well as which areas are already being acted on within existing programming and resources. It is important that the team keep these target groups in mind when preparing the report in Step 5. The team may also discuss how the capacity ratings and recommended actions in the final report may be used to plan, allocate or negotiate for resources; to support dialogue on partnerships and city-to-city twinning; for performance monitoring, improvement cycles and evaluation, for engaging partners on resource mobilization, or in reporting and accountability on health goals. The completed Step 4 table should be produced for the next step of final review, recommendation and reporting. For an example of a completed Step 4 Table from a hypothetical case, see Annex 2. Step 4: Analysis and recommended actions 29 Table 3. Step 4: the capacities, their levels and ratings, and proposed actions Health goal(s) CAPACITY (from Step 1) Capacity rating and information on the capacity (Include red, yellow or green colour shading) Proposed action(s) (Include the timing, who should take the actions, and with what resources) The importance of the action (Note whether high, medium or low, and comment on why, using criteria in 1-5 above) Information for decision making, monitoring and evaluation Policies, programmes, innovation and change Resource (human, financial and infrastructure) management Partnerships, participation and knowledge sharing Urban health capacities - assessment and response action guide30 STEP 5: Reviewing and reporting Step 5: Reviewing and reporting In Step 5, the team reviews its findings and recommendations, to produce a report for relevant authorities and stakeholders, as the basis for action to achieve the chosen urban health goal(s), including activities to strengthen and create the required connective capacities. This final step is to review the team’s findings from the capacity assessment and its recommendations for planning and programming, and provide a consolidated report for relevant authorities and stakeholders. As facilitator, you may draft the report yourself, or work with selected team members to do so, before presenting the draft for team review. The team should also compile a list of the relevant planning and programming forums where the report will be submitted. The information in the tables produced at each step of the assessment provides the raw material for this report. Depending on the context and audience, the facilitator and team should decide whether to produce a longer or shorter summary report. If a detailed report is needed, it may be structured as: 1. A two-page executive summary as a possible standalone document for policy actors, covering the capacity assessment background and process, who the report is for, the capacity recommendations to achieve the prioritized health goal, and the evidence supporting them. 2. In no more than a page, a brief outline of the assessment context, methods and aim; why the selected goal was chosen, the process and terms used, and the team composition. 3. A page-long section on the assessment findings, with subsections on (i) the scoping of prioritized capacities, summarized within the four broad capacity areas and (ii) the profiling and rating of capacities, including the information gathered. 4. A page-long section on the analysis and recommended actions for the prioritized capacities, with comments on their importance, feasibility, and the required resources and roles. 5. An appendix with the completed table from Step 4, giving the detailed information used for the report. A shorter report should comprise a three-page summary, introducing the assessment method and health goal, summarizing the priority capacities identified within the four capacity areas (noting, in particular, those seen to be fully available and those with greatest deficits), and outlining the recommendations rated as highly important. The report should refer to the completed table from Step 4, given as an appendix, as providing detailed information on the prioritized capacities and actions. The team will review the draft report and make any further inputs needed, either in a meeting or electronically by sharing a draft, co-ordinated by the facilitator. Urban health capacities - assessment and response action guide32 For the follow-up: • The report should be formally shared with the local authority leadership for official consideration, review and adoption of relevant proposed actions. • If a monitoring and co-ordination mechanism is not already included in the recommended actions from the assessment, the team may agree to continue to review implementation of the recommended measures. • The team may suggest linking the assessment with existing performance monitoring processes, or suggest how it can be embedded in programme planning. It may also make links to the local government association, for wider dissemination and dialogue on issues that have regional or national implications. • The report may be a part of a succession plan to hand over to the next local government administration. The capacity assessment rating dashboard in Step 4 can also serve as a tool for performance review, improvement cycles, or monitoring and evaluation. In this context, it should be used at agreed intervals to monitor changes in the capacities (with a new column for each review updating the ratings), for reporting on progress, and to review and revise actions as needed. The coloured dashboard can provide a quick visual check on progress. Once the team has completed the process for a particular goal, it may also go back to Step 1 to work on other relevant or emergent health goals, as discussed earlier. For an example of completed self-assessment tables for Steps 1,2 and 4 from a hypothetical case, see Annex 2. Step 5: Reviewing and reporting 33 Conclusion The connective capacities that link sectors and levels of governance are essential to achieving holistic delivery of urban health goals. Stronger connective capacities play a vital role at individual, organizational and systemic levels, enabling diverse urban actors to deliver significant benefits to city dwellers’ health by achieving targets and solving challenges in any sector – including health, mobility, land use, food production, economic development, education and beyond. This Action Guide forms the basis for urban actors to successfully develop and leverage these powerful, often overlooked, capacities. It supports users to carry out a targeted assessment of connective capacities for a chosen urban health goal, as the foundation for evidence-based action to leverage, strengthen and develop these capacities. Through clear steps to identify the scope of an assessment, profile existing capacity levels and analyse their findings, the Action Guide enables users to make recommendations to diverse stakeholders to deliver the connective capacities needed to achieve a chosen urban health goal. This process creates synergies across sectors and levels of governance that are often siloed, unlocking strategic, collaborative policy-making and practice. In this way, the assessment of connective capacities forms the basis for integrated solutions that can benefit the health and well-being of all urban dwellers. Urban health capacities - assessment and response action guide34 Bibliography The following documents were consulted in the development of this guide:1–10 1. Boyce MR, Katz R. Rapid urban health security assessment tool: A new resource for evaluating local-level public health preparedness. BMJ Glob Heal. 2020;5(6). doi:10.1136/bmjgh-2020-002606 2. Brown H, Katscherian D, Spickett J, Maycock B, Hendrie D. EnHealth Guidance – Health Impact Assessment Guidelines. 2017. https:// www.health.gov.au/resources/publications/ enhealth-guidance-health-impact-assessment- guidelines?language=en. 3. CDC, American Public Health Association, Association of State and Territorial Health Officials, et al. National Public Health Performance Standards. 2011. doi:10.1097/00124784- 200509000-00011 4. Farvacque-Vitkovic C, Kopanyi M. Better Cities Better World. Washington, DC: The World Bank; 2019. doi:10.1596/978-1-4648-1336-8 5. Loewenson R, Simpson S, Dudding R, Obando F, Beznec P. Making Change Visible: Evaluating Efforts to Advance Social Participation in Health, An Implementer’s Resource. 2021. https:// www.tarsc.org/publications/documents/MCV Implementers Resource 2021 for web.pdf. 6. National Association of County & City Health Officials. Local Public Health System Assessment Instrument.; 2013. 7. Scaling up Nutrition UN Network. Nutrition Capacity Assessment Guidance Package - Part I. 2016. https://www.unnutrition.org/library/tools/ nutrition-capacity-assessment. 8. Shrimpton R, Hughes R, Recine E, et al. Nutrition capacity development: A practice framework. Public Health Nutr. 2014;17(3):682-688. doi:10.1017/ S1368980013001213 9. Training and Research Support Centre (TARSC), Ifakara Health Development Centre, Regional Network on Equity in Health in East and Southern Africa (EQUINET). Organising People’s Power for Health. 2006. https://www.tarsc.org/publications/ documents/EQUINET PRA toolkit peoples power for health for upload.pdf. 10. World Bank. Global Facility for Disaster Reduction and Recovery. City Resilience. https:// www.gfdrr.org/en/crp#:~:text=The City Resilience Program (CRP,unlock economic and social potential. Published 2018. References 35 Annexes Annex 1 . Suggested programme for a capacity assessment STEP TIMING PROCESS ROLES Before Step 1: Invite team Before the self- assessment begins Facilitator(s) identify about six assessment team members and obtain confirmation of their participation. • Facilitator(s) • Team members • Mentor Step 1: Introduction Scoping Week 1 3-hour session Facilitator(s) outline the aims and scope of the overall WHO programme to assess and strengthen capacities for holistic, integrated approaches for urban health, as well as the scope of the assessment, and the processes involved. Team identifies the prioritised health goal and challenges. For each prioritised challenge, members indicate the most important capacities needed in their own words, and use the framework and list in the Primer to check and add further capacities. Record the information in the Step 1 Table. Facilitator(s) All team members participate Step 2: Profiling In Week 1 or 2 2- to 3-hour session (leave at least a day between Steps 1 and 2 for facilitators to prepare the table) Team uses own knowledge and information to identify and reach consensus on each selected capacity, the level of the capacity and the rating they would apply to this level. Record the information in the Step 2 Table. Team identifies capacities for which further information needs to be gathered; the secondary sources and key informants, and the team roles and timeframe for gathering information. Facilitator(s) All team members participate Step 3: Gathering information (if needed) Week 2 and/or 3 Time depends on information to gather. Team members gather information on identified areas and sources, and input to the table. Facilitator reviews and includes the information in the Step 2 Table, for team review. Facilitator(s) All team members Facilitator(s) Step 4: Analysis and recommended actions Week 4 3 to 4-hour session* Team reviews the information gathered, assigns ratings, and identifies capacity issues to be addressed, actions to be taken and resources to apply. Discussion, decision making and reporting in a Step 4 Table on the actions, timings, roles and resources, and the importance of actions, using the decision-making criteria. Facilitator(s) All team members participate Facilitator(s) Step 5: Reviewing and Reporting Week 4 or 5 1 day to write the report 2-hour session Facilitator and selected team members draft the final report and recommendations. The team reviews the final report to make inputs, and agrees on whom to engage and who presents the report, and how to monitor progress on implementation. Facilitator(s) / team All team members * If information is queried at this stage, time may need to be added to clarify or to gather further information, including on costings. Urban health capacities - assessment and response action guide36 Annex 2: Example tables for a hypothetical case This annex provides examples of completed tables from a capacity self-assessment for urban health for a hypothetical case. These tables are also used in the video “How to implement an assessment of capacities for urban health” provided on the WHO Urban Health Website. The hypothetical example is set in a middle-income country with sufficient political stability for longer-term work. In one part of the city, over the past two years, small and medium-scale entrepreneurs have implemented a series of innovative activities, working with the community to stimulate local urban agriculture, awareness, local processing and consumption of healthy foods. The entrepreneurs and community have engaged the local authority based on their experience, with evidence of its impact on employment, incomes, diets and health. For the health goal in this example, the local authority aims to scale up the initiative city-wide. In so doing, it intends to improve local jobs, incomes and green zones, and to expand residents’ access to healthy and affordable food, to reduce malnutrition and food-related non-communicable diseases. The local authority therefore embarked on a capacity assessment to support its intention. The video shows the process, while this annex shows the completed tables from those Steps 1, 2 and 4 in the process, circled in the adjacent graphic. The tables are not intended to be prescriptive, but to show examples to support facilitators in the capacity assessment, as set out in the Primer and Action Guide. Annexes 37 STEP 1: SCOPING STEP 2: PROFILING STEP 3: GATHERING INFORMATION STEP 4: ANALYSIS AND RECOMMENDED ACTIONS STEP 5: REVIEWING AND REPORTING • Defining the shared health goal, challenges and priority capacities • Setting up and briefing the team • Sharing and obtaining information to assess • Rating capacity levels, assets and gaps • Analysing the findings to identify actions and formulate recommendations to strengthen prioritized capacities • Reporting on the analysis and proposed actions, and engaging audiences • Monitoring implementation Identifying and inviting relevant stakeholders Reading the Primer and Action Guide Introducing the assessment purpose and process, the four capacity areas and the types of capacity Identifying the health goal, challenges and capacities, checking against the Primer Completing the Step 1 Table Identifying and rating levels of assets and gaps in prioritized capacities, checking against the Primer Identifying information needs to address Filing in the Step 2 Table Gathering any further information needed from documents and key informants Completing the STEP 2 Table Reviewing and analysing the information on capacities, to propose actions, their timing, roles, resources and importance Completing the Step 4 Table Drafting, reviewing and producing a report for different audiences, and engaging them with the assessment findings. Identifying a mechanism for monitoring uptake and progress Completing a summary report P R O C E S S S T E P PREPARING THE ASSESSMENT; SETTING UP THE TEAM I S S U E S C O V E R E D Urban health capacities - assessment and response action guide38 STEP 1 TABLE: THE PRIORITIZED GOAL, CHALLENGES AND CAPACITIES AREA The prioritized health goal Scale-up of an existing initiative city-wide to improve economic, green zone and employment issues and to expand access to healthy, affordable food for the population Specific challenges to address to achieve the goal Capacities needed and their level – Individual (I), organization (O), systemic (S) Information for decision-making, monitoring and evaluation Engaging local vendors and community on their food sources. • Expertise to gather evidence with vendor/ community inputs for an online database of sources of key foods, registered food vendors, and sale volumes of healthy locally produced foods, to use for planning (I/O) Providing information to help small food entrepreneurs register, establish and run their businesses. • Skills and know-how to develop information on laws, standards, and services for food entrepreneurs for different points of the food chain (I/O) Policies, programmes, innovation Expanding access to healthy and affordable foods in school lunches. • School focal points with know-how on health and nutrition (I) • Procurement contracts between schools and urban farmers and markets (S) Expanding access to healthy and affordable foods in urban markets. • Clear standards and guidance for food sector through partnership with government sectors, stakeholders, community (O/S) Improving locally grown food and marketing through stimulating, facilitating or expanding urban agriculture. • Setting up of green zones for urban agriculture • Laws for health and environment in urban agriculture (S) Resource (human, financial, and infrastructure) management Cutting down on or simplifying bureaucratic red tape that small food entrepreneurs need to comply with. • ‘One window’ options for registration and licensing of enterprises (O) Identifying infrastructure and zoning changes for processing and marketing of healthy foods. • Setting zoning and by-laws that enable and regulate urban agriculture and food-market standards (O) Identifying incentives, levering investment funds for processing and marketing of healthy foods. • Identification of incentive options with enterprises (e.g., technology loans, bulk purchase of inputs) (O/S) • Budget set for incentives at city level, with potential funding sources identified (O) Partnerships, participation and knowledge sharing Providing information on healthy foods and food practices to households, schools and schoolchildren. • Community members or stakeholders with know-how on food related-health (I/S) Establishing a cross-sectoral mechanism for the city to plan, advise on, ensure, monitor and report on implementation. • Personnel with skills to co-ordinate stakeholders and manage implementation (I) • Relevant stakeholders identified and partnerships built (S) Annexes 39 STEP 2 TABLE: THE CAPACITIES, THEIR LEVELS, RATINGS AND INFORMATION TO GATHER (OR GATHERED) Green font text represents information added after Step 3 information gathering Priority health goal: Scale-up of an existing initiative city-wide to improve economic, green zone and employment issues and to expand access to healthy, affordable food for the population CAPACITY List here the information on the capacity level, assets, gaps based on team knowledge/information. Include all information on the capacity level in this column, whether positive or negative, including any comment explaining the rating Indicate the 0-3 rating* and shading Information to gather, the source and responsible team member for capacities rated 0 (i.e. those needing further information gathering) Information for decision-making, monitoring and evaluation Expertise to gather evidence with vendor/ community inputs for an online database of sources of key foods, registered food vendors, and sales volumes of heathy locally produced foods to use for planning (I/O) The local authority has databases on services and the capacity to set up a food database and collect this information, but hasn’t yet done so, so it’s not in place. At the same time there are many street food vendors that are difficult to collect information from. 2- Skills and know-how to develop information on laws, standards, and services for food entrepreneurs for different points of the food chain (I/O) Adequate capacities among entrepreneurs, the community and the local authority, and materials developed in the initiative that that can be used. 3 Policies, programmes, innovation and change School focal points with know-how on health and nutrition (I) The Ministry of Education has not yet identified focal points or skills for this, and needs to link with the health ministry on this. 0 changed after key informant interview to 1 The team member from the health dept to interview the Ministry of Education on capacities for this. Key informant on policy setting interviewed from Ministry of Education. Procurement contracts between schools and urban farmers or markets (S) There is no experience or capacity for this within the existing stakeholders. 1 Urban health capacities - assessment and response action guide40 Priority health goal: Scale-up of an existing initiative city-wide to improve economic, green zone and employment issues and to expand access to healthy, affordable food for the population CAPACITY List here the information on the capacity level, assets, gaps based on team knowledge/information. Include all information on the capacity level in this column, whether positive or negative, including any comment explaining the rating Indicate the 0-3 rating* and shading Information to gather, the source and responsible team member for capacities rated 0 (i.e. those needing further information gathering) Clear standards and guidance for the food sector through partnership with government sectors, stakeholders or communities (O/S) The local authority has capacities to set standards and convene partnerships, having won an award for standards set on air pollution, but has not yet done so for the food issue. 2 Setting up of green zones for urban agriculture [O] The planning department can do this in theory, but it requires political approval and approval from central government level. 2- Laws for health and environment in urban agriculture (S) The local authority has capacities to set standards. It was recognized as leader in setting standards, nationally, for the past five years. 3 Resource (human, financial and infrastructure) management ‘One window’ options for registration, licensing of enterprises (O) This requires changes in law and devolution of institutional powers from central level. 1 Setting of zoning and by-laws that enable and regulate urban agriculture and food market standards (O) The local authority has capacities to set standards. 3 Identification of incentive options with enterprises (e.g. technology loans, bulk purchase of inputs) (O/S) Some capacities within the business association and council, with a need for technical support on financial options. 0 changed after key informant interview to 2- The entrepreneur and the local authority planning department to interview 2 key informants from the council and the business community to identify incentive options and what capacities are needed for this. Budget set for incentives at city level, with potential funding sources identified (O) The local authority has capacities to set its own budgets but less capacities to identify and leverage other funding sources. 2- Annexes 41 Priority health goal: Scale-up of an existing initiative city-wide to improve economic, green zone and employment issues and to expand access to healthy, affordable food for the population CAPACITY List here the information on the capacity level, assets, gaps based on team knowledge/information. Include all information on the capacity level in this column, whether positive or negative, including any comment explaining the rating Indicate the 0-3 rating* and shading Information to gather, the source and responsible team member for capacities rated 0 (i.e. those needing further information gathering) Partnerships, participation and knowledge sharing Community/stakeholders with know-how on food related-health (I/S) Adequate capacities, due to significant local and international investment, among entrepreneurs, the community and the local authority, and materials developed in the initiative that can be used. 3 Personnel with skills to co- ordinate stakeholders and manage implementation (I) If delegated from existing personnel, this could be feasible, but the local authority has some staffing gaps. 2 Relevant stakeholders identified and partnerships built (S) The local authority has capacities to set up a multi-stakeholder forum in this area, as has been done for other issues such as traffic safety, but it has not yet done so. 2 Urban health capacities - assessment and response action guide42 STEP 4 TABLE: THE CAPACITIES, THEIR LEVELS AND RATINGS, AND PROPOSED ACTIONS Priority health goal: Scale-up of an existing initiative city-wide to improve economic, green zone and employment issues, and expand access to healthy, affordable food for the population CAPACITY The rating of and information on the capacity, shading the cell with the colour shading of the capacity area (from Step 2) The proposed action(s), the timing, by whom the actions should be taken, with what resources The importance of the action, noting if high, medium or low and commenting on why Information for decision-making, monitoring and evaluation Expertise to gather evidence with vendor/ community inputs for an online database of sources of key foods, registered food vendors, and sales volumes of healthy, locally produced foods, to use for planning (I/O) 2- The local authority has databases on services and the capacity to set up a food database and collect this information, but hasn’t yet done so, so it’s not in place. At the same time there are many street food vendors that are difficult to collect information from. In the next year, the local authority to set up a working group involving vendors association and local authority officials to identify and gather data on foods sold and the community members involved, to show the need for the initiative and get support for and monitor it. Medium importance Feasible and will leverage recognition from key actors. Skills and know-how to develop information on laws, standards, services for food entrepreneurs for different points of the food chain (I/O) 3 Adequate capacities among entrepreneurs, the community and the local authority, and materials developed previously that can be used. The local authority and entrepreneurs to resource work to adapt and distribute information from the previous pilot initiative to key stakeholders in the next 6 months. High importance Very feasible and a key measure to get support and involvement of key stakeholders across the city. Policies, programmes, innovation and change School focal points with know-how on health and nutrition (I) 1 The Ministry of Education does not yet have identified focal points or skills for this, and would need to link with the health ministry on this. The Education Ministry to provide terms of reference with input from the health ministry, and ask schools to identify a focal person in each school and the health department to train focal points on healthy foods and initiatives to implement, to be done within a year. High importance Very feasible and a key measure to get informed involvement of schools across the city. Procurement contracts between schools and urban farmers/markets (S) 1 There is no experience or capacity for this among existing stakeholders. Urban farmers and schools will be trained and coached in how to generate the contracts by the municipality. High importance Very feasible, this know- how is a strength of the municipality. Annexes 43 Priority health goal: Scale-up of an existing initiative city-wide to improve economic, green zone and employment issues, and expand access to healthy, affordable food for the population CAPACITY The rating of and information on the capacity, shading the cell with the colour shading of the capacity area (from Step 2) The proposed action(s), the timing, by whom the actions should be taken, with what resources The importance of the action, noting if high, medium or low and commenting on why Clear standards and guidance for food sector through partnership with government sectors, stakeholders, community (O/S) 2 The local authority has capacities to set standards and convene partnerships, having won an award for standards set on air pollution, but has not yet done so. The local authority to draft and discuss draft standards and guidance with government sectors, stakeholders and community, to finalize for council and government adoption in the next 18 months. Low importance This will take time and resources, and can be done over time as experience is built from the scale-up process. Setting up of green zones for urban agriculture [O] 2- The planning department can do this in theory, but it requires political approval and approval at central government level This requires change at the national level. The team will raise the issue at the national level in the next 6 months, but will need to review after their feedback. Medium importance An important enabler, but not feasible for local level, so depends on the national response. Laws for health and environment in urban agriculture (S) 3 The local authority has capacities to set standards. It was recognized as leader in setting standards nationally for the past 5 years. The local authority to draft and discuss draft standards and guidance with government sectors, stakeholders and community, to finalise for council and government adoption in the next 18 months. Low importance This will take time and resources and can be done over time as experience is built from the scale-up process. Resource (human, financial and infrastructure) management ‘One window’ options for registration and licensing of enterprises (O) 1 This requires changes in law and devolution of institutional powers from central level. This requires change at the national level. The team will raise the issue with the national level in the next 6 months, but will need to review after their feedback. Medium importance An important enabler, but not feasible for local level, so depends on the national response. Setting of zoning and by-laws that enable and regulate urban agriculture and food market standards (O) 3 The local authority has capacities to set standards. The local authority to draft and discuss draft standards with government sectors, stakeholders and community, to finalize standards for council and government adoption in the next 18 months. Medium importance This will take time and resources. It is not urgent, but can be done with available capacities. Urban health capacities - assessment and response action guide44 Priority health goal: Scale-up of an existing initiative city-wide to improve economic, green zone and employment issues, and expand access to healthy, affordable food for the population CAPACITY The rating of and information on the capacity, shading the cell with the colour shading of the capacity area (from Step 2) The proposed action(s), the timing, by whom the actions should be taken, with what resources The importance of the action, noting if high, medium or low and commenting on why Identification of incentive options with enterprises (e.g., technology loans, bulk purchase of inputs) (O/S) 2- Some capacities within the business association and council, with a need for technical support on financial options Hold meetings in next 6 months to identify incentives with enterprises, convened by the business association. Medium importance Feasible - the relevant stakeholders are in place. Budget set for incentives at city level, with potential funding sources identified (O) 2- The local authority has capacities to set its own budgets, but less capacity to identify and leverage other funding sources. The planning department to assess costings and set a budget for incentives at city level. Council economic department to engage local stakeholders to identify potential funding sources in the next year. Medium importance Feasible, but requires background stakeholder analysis and engagement. Partnerships, participation and knowledge sharing Community/stakeholders with know-how on food related-health (I/S) 3 Adequate capacities among entrepreneurs, the community and the local authority, and materials developed in the initiative that can be used. The local authority, community and entrepreneurs to resource work to adapt existing materials and disseminate in the next 18 months. High importance Feasible, and a key measure to gain informed involvement of community and stakeholders across the city. Personnel with skills to co- ordinate stakeholders and manage implementation (I) 2 If delegated from existing personnel, this could be feasible, but the local authority has some staffing gaps. The local authority to identify a co-ordinator from existing personnel in the next 6 months, and propose in the next year for council to approve a new post for the Food Smart City. High importance Feasible to identify an existing person as an interim measure and necessary to manage the scale-up. If the programme is yielding results, may win support for a new staff position. Relevant stakeholders identified and partnerships built (S) 2 The local authority has capacities to set up a multi- stakeholder forum in this area, as has been done for other issues such as traffic safety, but it has not yet done so. The local authority to establish and invite stakeholders to a multi- stakeholder forum in the next 6 months. High importance Very feasible, and a key measure to gain involvement of key stakeholders across the city. Annexes 45 Annex 3: Approach to development This Action Guide was developed in tandem with the accompanying Primer, which provides more detail about the approach to development. Importantly, review feedback from expert consultations and city pilots was used to shape the guide. City pilots conducted in Lira, Kwekwe and Turkana. They were adjusted slightly and translated for subsequent pilots in Utrecht, London, Bogota, Qatar, Donggu - Gwangju Metropolitan City, and Suva. The feedback from the use of the instruments was used to finalize the drafts and to produce accompanying materials, mainly a series of training videos and a collection of implementation city examples. All the reviewers of the Primer and accompanying Action Guide, as well as the piloting participants, were asked to declare any conflicts of interest on the WHO form for declaration of Interests by WHO experts. These forms were collected and reviewed by the Secretariat. None declared an interest that was considered significant. Urban health capacities - assessment and response action guide46

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