Local authorities and local partners should own the design, implementation and monitoring of interventions and solutions to fight hypertension and cardiovascular disease.

For maximum impact and long-term sustainability, local authorities and decision makers should own the cardiovascular (CV) population health approach, starting with priority setting and design. The CARDIO interventions that are the most useful in a certain context (according to the priority setting) can then be co-developed and planned with all partners in the multisector collaboration. Usually, a local steering committee, chaired by city authorities, with representatives from all sector partners, is formed to drive and oversee the implementation of the population health approach and its measurement system. This allows to continuously monitor progress, outcomes and impact, and provides regular opportunities to adjust interventions if necessary. As the chair of the steering committee, city authorities must own the urban population health approach, also because most of the CARDIO interventions should be funded by local resources.

Key interventions and indicators
  • From the onset, ensure health authorities are in the driver seat to provide accountability and ownership, and co-design interventions and solutions based on their priority health needs
  • Beyond health authorities, create ownership among local multisector partners, patient/professional associations and community members, so all can commit to the objectives, plan and outcomes of the population health approach and ensure long-term buy-in. Ideally, this happens by forming a steering committee with representatives from all partners and chaired by city health authorities
  • Openly discuss what works and what doesn’t in the steering committee, and use collected evidence to make joint strategic decisions
  • Involve end users, such as health providers and patients early on to support the development of interventions that are tailored to their needs, hence also increase their future adoption
  • Fund the majority of interventions locally to ensure sustainability and scale, and foster accountability

The indicators below can come from a variety of sources (primary and secondary data collection, national or regional surveys and databases).


Evaluation of the co-creation planning process 

  • Establishment of the steering committee for the CV population health approach
  • Diverse stakeholder representation (government, NGO, academic, professional associations, patient associations, private sector, civil society, etc.)
  • Validated roadmap and operational plan for improving CV health
  • % of funding by local stakeholders/other
  • Intervention design reflects the needs of both the co-creators in the steering committee and the end users

Stakeholder-owned/funded interventions in operational plan – including but not limited to:

  • Update of hypertension and CV risk reduction guidelines with latest available evidence and standardization of CV risk management
  • Training and continuous medical education of health workers and supportive supervision of primary health services
  • Hypertension patient registry or other form of patient data collection to monitor the cascade of care (screened, diagnosed, treated, controlled)
  • Increased health literacy of patients and their families, leading to improved self-management

Progress, outcome and impact monitoring of the CARDIO interventions implemented

  • % of population covered with access to improve quality of care and preventive services
  • % of hypertension patients diagnosed, treated, controlled
  • % of primary health budget and funding dedicated to CV care (there may be joint metrics with other CV risk factors)
  • # of acute CV events avoided
  • # of policies with proven health benefits that have been promoted (e.g., tobacco or sugar tax, total ban on salt and trans fat in processed food, etc.)
  • Impact measurement of policies introduced

Additional external resources

Better Hearts Better Cities Dakar (French)

Better Hearts Better Cities Sao Paulo (Portuguese)

Reference documents and literature

Recommendations described herein were developed by the Novartis Foundation and/or its partners as part of the Better Hearts Better Cities and other initiatives; before local implementation, interested parties must ensure compliance with all applicable laws and regulations, including local industry codes and institutional policies. Links and content may be subject to change without notification.

The Terms of Use of the Novartis Foundation apply.