a bodyweight scale, measuring tapes, a tablet, and visually engaging instructions and record-keeping materials for health professionals and patients. The tool also contains a foldable stand and a backpack for use beyond the health facility. The devices can be operated by the patients themselves, or with the assistance of a medical professional. Over 500 primary healthcare facilities across three cities in Brazil – São Paulo, Patos and Aracaju – have adopted this innovation. The screening corner in primary healthcare centres initially offered mainly blood pressure measurement, and following its success, was expanded to include measurements for the other main CV risk factors (diabetes, high cholesterol and obesity). Positively screened people are promptly referred to consultation. –Rolling out the screening corner in the first health centres of São Paulo led to a 22% increase in the average monthly blood pressure measurements, totalling approximately 150,000 additional measurements over the 24-month study period (56 additional monthly measurements per facility). –The average cost per additional blood pressure measurement was less than $1, calculated by dividing the total cost of installing the screening corner by the incremental number of blood pressure measurements. –In a second phase, a portable version of the screening corner in a backpack was developed, delivering blood pressure measurements for $0.44, which is 85% below the external benchmark for incremental cost-effectiveness per blood pressure measurement. A replication roadmap has been developed with the municipal health departments to quickly adapt and implement the screening corner. To ensure that this innovative approach to early detection is integrated into the workflow of managing CV risk in the health centres, a formal integration process was developed with the health providers.A collaborative model to scale early detection of CV risk The screening corner’s success was driven by a combination of people-centred and iterative innovation. While the screening corner contains technology and produces data to ensure evidence- based healthcare improvement, the concept is fully integrated into CV risk management in primary healthcare. This proved essential to ensure the innovation addresses the need and transforms primary healthcare from being reactive to more proactive and potentially preventive. During the design phase, it was ensured that the innovation was sustainable and scalable, both operationally and financially. Integrating the innovation into the standard operating procedures of the health centres and the local budgets while using real-time data on its results to monitor progress and impact, were crucial for this PPP to achieve impact. The design thinking approach played a crucial role in engaging all partners, including city health officials, primary healthcare providers and health system managers.48 It allowed for the co-creation of this simple yet transformative solution. Continuous improvement of the innovation was central to the optimization of the screening corner. Moving forward, including this innovative way to accelerate early detection of CV risk in urban populations requires cities to invest in a minimal infrastructure to expand the screening corner. While fully digitized screening models are now also available for self-screening in health facilities of certain high-income countries, the model developed in Brazil proved highly cost-efficient and rapidly deployable in any kind of setting. That is why the Novartis Foundation makes the solution publicly available for replication and expands its reach through the CARDIO4Cities initiative, which is being implemented in many more cities worldwide. To re-engineer urban CV health, new approaches have to engage end users and take a people-centred approach to the design phase of the innovation. 28 Shaping Tomorrow: Responsible Innovation for a Brighter Future

Shaping Tomorrow Responsible Innovation for a Brighter Future 2025