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(As contained in Administrative Order No. 2011-0008 dated July 12, 2011)

In developing countries, the rapid rate of urbanization has outpaced the ability of governments to build essential infrastructure for health and social services. Among many features of urbanization in developing countries include greater population densities and more congestion, concentrated poverty and slum formation, and greater exposure to risks, hazards and vulnerabilities to health (eg. violence, traffic injuries, obesity, and settlement in unsafe areas). The concentration of risks is seen in the poorest neighborhoods resulting to health inequities.

From the above, it will require more than the provision and use of health services to improve the health of urban populations. UHSD must help cities address the challenges of rapid urbanization brought about by the interplay of different social determinants of health.

A.    Goals
1.    To improve Health System Outcomes    Urban Health Systems shall be directed towards achieving the following goals: (i) Better Health Outcomes; (ii) More equitable healthcare financing; and (iii) Improved responsiveness and client satisfaction.
2.    To influence social determinants of health    The DOH must help influence social determinants of health in urban settings, with focused application on urban poor populations particularly those living in slums.
3.    To reduce health inequities    Urban Health Systems Development seeks to narrow the disparity of health outcome indicators between the rich and the poor.

B.    General objective: To address the Urban Health challenge

C.    Specific objectives:
1.    To establish awareness on the challenges of Urban Health;
2.    To initiate inter-sectoral approach to Urban Health Systems Development; and
3.    To guide LGUs to develop sustainable responses to the Urban Health challenge

III.    Components
The following are the developmental components of the UHSD Program:

1.    Programs and Strategies
–    Healthy Cities Initiative (HCI): the approach of continuously improving health and social determinants of health, and continually creating and improving physical and social environments shall be continued and further strengthened.
–    Reaching Every Depressed Barangay (RED)/Reaching the Urban Poor (RUP): a strategy of going to every depressed barangay to reach the urban poor, vulnerable groups and hidden slums to increase access to health services.
–    Environmentally Sustainable and Healthy Urban Transport (ESHUT) initiatives which include the development  or enhancement of existing projects that improve the policy, design and practice of an urban transport system and lead to improvement of health and safety of urban population.

2.    Planning Tools and Framework
–    Urban Health Equity Assessment and Response Tool (Urban HEART): a tool to facilitate identification of and response to health equity concerns. It is used as a situational assessment, monitoring and planning tool particularly for Highly Urbanized Cities, in tandem with the Local Government Unit (LGU) Scorecard.
–    City-wide Investment Planning for Health (CIPH): a framework for the development of public investment plans in health covering the utilization, mobilization  and rationalization of the city’s relatively abundant resources, more extensive capabilities and stronger institutions to attain health system goals.

3.    Capability Building
Short Course on Urban Health Equity (SCUHE) is a 6-month course offered to cities and urban stakeholders that aims to improve the knowledge, practice and skills of health practitioners, policy and decision-makers at the national, regional and city levels to identify and address urban health inequities and challenges, particularly in relation to social determinants of health.

IV.    General Principles
1.    Healthy urbanization.  Urban Health Systems (UHS) must promote healthy urbanization so that cities develop in ways that achieve better health and avoid risks to ill health under conditions of rapid urbanization.
2.    Inter-sectoral action. UHS must be designed through inter-sectoral collaboration with people and institutions from outside the health sector to influence a broad range of health determinants and generate responses producing sustainable health outcomes.
3.    Inter-city coordination.  Inter-city coordination between contiguous cities is important because a city, particularly if it is not a Highly Urbanized City may not have all the resources, institutions and capacities to be able to respond to the entire health needs of its constituents, and may thus benefit from resources, institutions and capacities of other cities through inter-city or inter-LGU coordination.
4.    Social cohesion.   Social cohesion is action through core groups.
5.    Community participation. Community participation must be integrated in all aspects of the intervention process, including planning, designing, implementing, and sustaining any project/program.
6.    Empowerment.  Empowerment is enabling individuals and communities to have ultimate control over key decisions involving their wellbeing through strategies such as building knowledge and purchasing power, and mechanisms to increase client accountability.

The DOH approach in the reform of urban health systems is the management of social determinants of health in urban settings, with focused application on poor populations, particularly those living in slum communities/settlements to address equity concerns.
Briefer on the Urban Health Equity Assessment and Response Tool (Urban HEART)

I.    Rationale:

Rapid unplanned urbanization gives rise to urban poverty, health problems, and health inequities in the cities. Disparities in health system outcomes between the affluent and the poor are becoming more prominent in highly urbanized areas as government sectors find it hard to cope with the increasing demands of the fast growing population of urban poor.

To address the above concerns, the Urban HEART or the Urban Health Equity Assessment and Response Tool was developed by the WHO Centre for Health Development in Kobe, Japan to assist Ministries of Health of countries in systematically generating evidence to assess and respond to unfair health conditions and inequity in the urban setting. It was initially launched in Tehran, Iran on April 2008, and the Philippines along with Iran, Zambia, and Brazil were the pilot sites to test the Urban HEART in each country.

Seven cities initiated the use of the Urban HEART in the Philippines in 2008-2009, namely: Paranaque City, Taguig City, Olongapo City, Naga City, Tacloban City, Zamboanga City, and Davao City. The cities helped develop the tool for applicability in varied urban settings in the country.

Urban Health Systems need to establish evidence on the status of the disadvantaged population in the highly urbanized areas in order to develop objective interventions to address inequities. Department Memorandum No. 2010-0207 dated August 20, 2010 on the “Use of the Urban Health Equity Assessment and Response Tool in Highly Urbanized Cities” is intended to help Highly Urbanized Cities (HUCs) generate systematic data on health inequities to guide effective interventions.