Community-led Responsive and Effective Urban Health Systems (CHORUS)



The world is urbanising: by 2050, about 70% of the world’s population is expected to live in urban areas presenting huge health and health system challenges. The growing numbers of urban poor bear the brunt of these challenges, including the double burden of communicable and non-communicable diseases, exposure to environmental and man-made hazards and limited access to quality, affordable health care. Due to the informality of their living and working conditions, the urban poor are frequently overlooked in data, programmes and policies. This is particularly true for those facing exclusion due to factors such as their ethnicity, religion, caste, disability; factors exacerbated as they intersect with the gendered exclusion of women/girls. There is therefore an urgent need for health systems to build their resilience and respond to these challenges

Programme approach

CHORUS is a 6-year research programme consortium focused on urban health systems with funding from Department for International Development (DFID) of £7.9 million. We will undertake research that responds to the practical challenges of delivering equitable health in urban areas in 4 partner countries: Bangladesh, Ghana, Nepal and Nigeria; selected because all have fast growing cities, are DFID priority countries and have major inequalities. Our approach is based on four ‘pillars’:

i) linking the plurality of private, NGO and government providers;

ii) building collaboration across sectors (e.g. water and sanitation, transport) to address wider determinants of health;

iii) strengthening health systems to prevent and respond to the double burden of non-communicable (NCDs) and communicable disease (CDs);

iv) Identifying, reaching and engaging the urban poor.

We will work in two cities in each of our partner countries to develop implementation research projects. We will determine the exact focus of our projects following engagement with communities and stakeholders in the inception phase. Our demand-led approach will follow five interlinked phases i) participatory needs assessment with communities; ii) analysis of existing data and literature, as well as the policy, economic and political environment iii) co-creation of health systems interventions iv) implementation research and v) effectiveness and cost-effectiveness evaluation. Cutting across all projects there will be an emphasis on:

● Research uptake, to ensure that the research is incorporated into city, national and global policy and practice

● Capacity building of partners and stakeholders in research methods, policy-research priority setting and research uptake; and

● Gender, intersectionality and equity issues arising from situation analyses which are central to the design of interventions and capacity building across the consortium.

Project Team

The programme is a collaboration between the University of Leeds, University of York, HERD International Nepal, ARK Foundation Bangladesh, University of Ghana and University of Nigeria

The project team comprises:

Project Management

Professor Tim Ensor Research Co-Director

Dr Helen Elsey, Research Co-Director

Dr Irene Agyepong, RPC CEO

Ms Polly Spooner, Acting Programme Manager

Dr Mahua Das

Country leads

Dr Justice Nonvignon, University of Ghana

Professor Rumana Haque, ARK Foundation, Bangladesh

Dr Sushil Baral, HERD International, Nepal

Professor Obinna Onwujekwe, University of Nigeria

Professor Zahidul Quayyum, BRAC James P Grant School of Public Health


Dr Tolib Mirzoev, University of Leeds

Dr Rebecca King, University of Leeds

Dr Joseph Hicks, University of Leeds

Dr Bassey Ebenso, University of Leeds

Bryony Dawkins, University of Leeds

Panel of experts

The programme will draw on an expert panel to advise and support project development and peer review. The panel includes expertise in community engagement, water and sanitation, mapping and visualisation and injury and disability.