Table 1.

Groundwork phase—activities and domains for the development of the Better Hearts Better Cities initiative in São Paulo, Brazil

Process phase	#	Activity	When	Main actors	Dose/input (time required to develop/implement or activity frequency)	Target (of action; unit of analysis)	Actions (brief)	Purpose (brief)	Expectation/outcome (brief)
Groundwork	1	Targeting Brazilian cities	2016/2017: Salvador da Bahia, Rio de Janeiro, São Paulo	NF	Field visits, follow-ups. Total of approx. 3–4 months	Ministry of Health (Dept. of Primary Care and NCDs) and city health authorities	Building the case with key leadership figures	To identify a suitable city to run the BHBC initiative	Critically discuss opportunities; identify appropriate target city; obtain permission to engage
	2	First touch points	June–July 2017	NF	Concept note: 1 month field visits, virtual networking and country representatives One meeting (City Hall)	Primary care and NCD focal points in local government	Encourage São Paulo to be part of the BHBC initiative	Recognize role of local leaders, demonstrate systems perspective and understand challenges; promote partnership	Generate enthusiasm and stimulate discussion, leading to a letter of intent
	3	Field visit I: launch visit and feasibility analysis	25 Jul–4 Aug 2017	NF	11 days	Ecosystem stakeholders (hospitals, academics, primary care providers, politicians)	Extensive stakeholder mapping and situation analysis	Introduce initiative and identify support; start to frame implementation format	Establish working groups; confirm buy-in; identify possible champions; co-create target activities, locations and groups
	4	Stakeholder meetings and workshops	Between 2017 and mid-2018	NF	2017/2018: approx. every 3 months	City Hall	Keeping stakeholders up to date and ready for new insights	To maintain relationships and create a platform to showcase value-add in the face of changing political contexts	Build relationships and establish strong engagement at the local operational level
	5	Field visit II: Stakeholder consolidation and alignment	14–29 Sept 2017	NF	2 weeks	Secretary of Health; potential local partners; primary healthcare providers; situational assessment partner	Stakeholder engagement; understanding context	To share decision-making, remain sensitive and responsive to needs, promote compatibility across the initiative	Consolidate high-level commitment to the initiative and working partnerships; check in on current activities
	6	Field visit III (A): tender process and preparatory meetings	Full tender process: Nov 2017–Jan 2018 Field visit: 6–15 Dec 2017	NF	9 days Several preparatory meetings 1 workshop (district officials, Santa Marcelina and Tellus) (see below)	Public agents responsible for primary care and NCDs in local government	Selection of implementation partner and governance committees	Formalize commitment to the initiative, including shared decision-making	Selection of implementation partner and sites; confirmation of committee members; local government acceptance of preconditions
	7	Field visit III (B): workshop with technical leads	14 Dec 2017	NF with support from Tellus team	1 half-day (4 hours)	Representatives with coordinating, strategic, technical and medical roles	Kick-off workshop with technical leads	Open forum to discuss predefined questions and encourage further inquiry to address doubts and concerns	Introducing the initiative and informing strategic action; exchange between actors to promote trust and positive engagement
	8	Project kick-off	23 Feb 2018	Tellus team	Workshop preparation: 10 days Workshop: 1 day	– East zone coordination – Itaquera supervisors – Social organization partners – Government representatives	Project kick-off with Tellus	Build relationships amongst stakeholders, confirm next steps	Validation of schedule and process; strengthening of relationships; ownership

BHBC Better Hearts Better Cities, NCD noncommunicable disease, NF Novartis Foundation