Set up

Identify funding opportunities

The immediate need is to secure resources for implementing steps 1-4, including coordination, governance, stakeholder engagement, workshops, communication, and community outreach. Time-limited investment may also be required for initial implementation and value demonstration of newly designed interventions.

Allocating resources (people or money) ensures that stakeholders have a vested interest in the initiative’s success. However, consider using catalytic funding from foundations or impact investors who are willing to provide time-limited support to get the initiative off the ground.

It is worth mentioning that implementation and governance of the interventions (steps 5 & 6) would ideally be funded from city or health system operational budgets. For stepwise implementation, consider performance-based or stage-gated funding models in which funding increases as interventions are scaled successfully.

Map & engage the broader stakeholder landscape

To ensure successful CARDIO implementation, it’s crucial to engage all relevant stakeholders. This includes not only those already involved in heart health management, but also those who should become more actively engaged.

Stakeholders will be involved in CARDIO4Cities in multiple ways, including providing input to the rapid assessment, participating in workshops, and supporting – or even managing – the implementation of interventions. Therefore, a comprehensive stakeholder map provides the basis for outreach. Stakeholders include city government and health department representatives, primary and specialist health providers, community health workers, pharmacists, patient advocacy groups, civil society organizations, health insurers, data and technical experts, potential funders and others.

Consider a meeting to engage a broader set of stakeholders early. A key principle of CARDIO4Cities is intersectoral collaboration, and early engagement will generate support and increase the likelihood of success. A webinar can be useful to introduce CARDIO4Cities, answer questions, and allow time for networking and follow-up conversations. However, many key stakeholders may not be aware of other groups with potential synergistic roles and activities in improving heart health, and an in-person meeting can foster new intersectoral opportunities.

Establish the governance structure

With commitment secured, it is time to establish a more formal governance structure.

The city Steering Committee creates a formal setting for initiating CARDIO4Cities, reviewing progress, providing advice, and engaging additional stakeholders as needed. The committee sets targets and approves priorities, monitors progress by periodically reviewing data collected in the measurement system, provides broad strategic direction, and represents the city program to outside stakeholders. It should include senior stakeholders, e.g., the city health commissioner and senior health system executives.

The Operational Committee orchestrates the initiative and creates the operational roadmap, prepares and conducts workshops, manages analyses and planning activities, and ensures that stakeholder needs are met. It requests feedback and support from senior stakeholders and advisors in the Steering Committee.

Implementation Working Groups can be created to plan and roll out specific interventions. They complement the work of the Operational Committee and include members with expertise specific to the task at hand. These groups are very hands-on and could include city authority program leads, health practitioners, medical and patient association representatives, data specialists, community representatives, and researchers. It is important to identify the working group leads early on.

Collect evidence for target setting & designing the roadmap

Setting targets in the next step requires an overview of the current status of CV risk factor management. Assemble relevant data on the current cascade of care (prevalence, and diagnosis, treatment and control rates) for each risk factor, and on major adverse cardiac event (MACE) incidence. In addition, identify current CV disease area strategies and interventions that are already being implemented; map them against the CARDIO4Cities Logical Framework. The Workshop Preparation file under Resources recommends additional evidence that can help inform and accelerate discussions in subsequent workshops.

Visualize the data where possible: a visual representation of the cascade of care, showing the percentage of patients screened, diagnosed, treated, and controlled, helps stakeholders quickly grasp the magnitude of the problem and where the system is underperforming. Comparing data across districts or clinics can also help identify patterns and areas for targeted improvement.

Time and resources permitting, consider implementing additional analyses in a very focused manner. CARDIO4Cities in Practice provides details on using quantitative (Intervention “Targeting of high risk populations”) and qualitative (Intervention “Detecting barriers to care”) analysis to provide additional insights for target setting and co-design of the population health roadmap.