From 2017 until 2022, the USAID-funded Building Healthy Cities (BHC) project used a health equity lens to refocus city policies, planning, and services in Smart Cities in India, Indonesia, Vietnam, and Nepal. Smart City planning is intrinsically linked to health; transportation, sanitation, education, recreation, technology, and the environment all affect the health of an urban population. When decision-making across these areas is harmonized, people have improved access to health services, decreased environmental and lifestyle risk factors for chronic diseases, and a lower burden of infectious diseases.
Over five years, BHC trained 3,700 people on a range of urban health-related topics; engaged 29 community organizations in BHC initiatives; and influenced 17 city or state policies through data-driven decision making.
BHC’s Core Values
Through its work, BHC identified three core values of healthy urban planning: multi-sector engagement, citizen empowerment, and data for decision making. These values were included in all BHC work and have been incorporated into city governments to continue practicing after the project ends. BHC created multi-sector health working groups that are now run by city officials. The project also increased awareness about citizen reporting systems, especially among vulnerable populations, to increase citizen participation and improve data quality.
Systems Approach to Urban Health
BHC used a systems-thinking approach to help city planners and administrators build relationships with citizens and civil society organizations and create traceable, transparent, and collaborative policy initiatives.
BHC and stakeholders in Indore, Makassar, Da Nang, and Kathmandu used a dynamic systems mapping process to create maps that “live” and change with the context, and are updated continually with data from other BHC-supported activities and new evidence provided by stakeholders. These maps informed the development of Healthy City Action Plans. The process was transparent, inclusive, and evidence-based, and appealed to multiple city departments and other stakeholders who were ready to take up the work.
Photos from systems map workshops in Indore, Makassar, and Da Nang.
Cities across South and Southeast Asia struggle with common and intersecting challenges (e.g., sanitation, waste management, and air pollution) that negatively affect health outcomes. BHC engaged community members to find ways to mitigate the specific issues they face on a day-to-day basis.
In Indore, BHC trained community members as “clean air guides” (CAGs) to raise awareness of and develop solutions to air quality problems. These CAGs use real-time data from the low-cost air quality sensors that BHC installed to inform their work.
As part of the community awareness campaigns, each CAG held an Air Quality Rally in their neighborhood. The group also participated in a city-wide rally organized by the Indore Municipal Corporation
To keep a city clean, waste must be managed properly by individuals, communities, and the government. BHC used the circular economy model to support livelihoods and community development in Indore, Makassar, and Da Nang.
BHC’s Kaya Kalp pilot in Indore collected and reused waste material in parks and green spaces.
BHC built swings, benches, and other play equipment for children with reused waste materials collected in communities.
During community data collection, BHC heard that COVID-19 severely affected the income of community residents, especially women. The women we spoke to advocated for skills-based, resilient income-generating options, so BHC supported livelihoods training for 116 women and girls (aged 18 to 45). In an effort to support Indore’s “Say No to Single-Use Plastic,” BHC trained women to sew eco-friendly cloth bags. So far, this group has earned INR 10,000.
Building Healthy Cities, with other partners, held workshops in the Barrang Lompo Senior High School with the goal of decreasing the amount of waste that ends up in the landfill, by finding alternate uses for that waste. Senior high school students learned how to create eco-bricks and gained basic knowledge in managing and reducing non-organic waste.
In Makassar, BHC conducted a community-led participatory research study on the need for and feasibility of a community-level waste management program implemented across the city.
In Da Nang, BHC focused on making schools “Waste Free”, tying together good practices in food safety, sustainable waste management and recycling. The team implemented trainings to support healthier behaviors in teachers and students.
Citizen Reporting Systems
City living is never perfect. There will always be broken traffic lights and clogged drains. Everyone must take part in creating safe and healthy cities. Equitable and effective citizen feedback mechanisms such as citizen reporting systems (CRSs) help governments stay abreast of these problems.
BHC assessed Indore and Makassar CRSs’ reach, particularly among urban poor communities, and effectiveness in responding to citizens’ needs and grievances. BHC then worked with city governments to increase awareness and improve the systems. In Da Nang, BHC also supported the government in a communications campaign to increase awareness of its Call Center 1022.
BHC trained call takers for Makassar’s 311 call center as a follow-up on the recommendations of the project.
BHC used journey maps to document the experience of citizens who were trying to overcome a specific service challenge in each city—for example access to health services in Indore, pedestrian safety in Makassar, and food safety in a traditional market in Da Nang—and tracked citizen and city official perspectives and change at the neighborhood level.
Improving the ease with which high-quality data is shared and used encourages new pathways for cross-sector collaboration and reduces the negative impacts of highly siloed activities. Integrating available data and enabling analysis across sectors increases its quality, accessibility, and timeliness for decision-making. Departments can capture real-time conditions and distribute resources accordingly. A flexible and user-friendly data-sharing platform is needed to support this type of data integration, as is training and support to populate, use, and maintain it.
BHC supported Indore’s goal of expanding the data sources in its central dashboard, the Integrated Command and Control Center. BHC incorporated real-time air quality monitoring data into the dashboard and developed training materials on data integration and visualization for staff.
In Makassar, BHC worked with three key city departments and the University of Oslo to adapt DHIS-2 software to improve data integration. This involved training 10 city sectors and staff at all 47 puskesmas (community health centers) on stakeholder engagement, data aggregation and preparation, and capacity building for government departments. The multi-sector integrated data system is now fully operated by the city of Makassar and used for regular data monitoring and evaluation and to develop targets and prioritize funds in annual work plans.
Nutrition and Food Safety
Nutrition and health have overlapping multi-sector determinants and their associated morbidities are intertwined; poor health puts children at greater risk of becoming malnourished, and malnourished children are at greater risk of becoming ill.
BHC worked in Indore, Makassar, and Da Nang to assess and define ways to strengthen the systems that support better nutrition, particularly for children. Related to good nutrition is safe food, which reduces infections and food poisoning that lead to weight loss and chronic malnutrition. BHC collected data to assess people’s knowledge and attitudes about food safety in each city and explore user-friendly ways to prevent and report food-borne illness.
BHC conducted a rapid feedback survey in Indore’s renowned street food markets to understand citizens’ knowledge and attitudes about food safety and hygiene, and to measure changes in consumption practices post COVID-19. BHC also worked with the street food handlers association to understand why its members continue certain behaviors and to inform them of best practices for selling safer and healthy foods.
In Makassar, BHC partnered with the city government to organize and facilitate a 5-day stunting prevention training for health workers.
In Da Nang, BHC supported the development of a mobile application and webpage for citizens, and developed materials for teachers to help students learn about safe food practices.