Identifying and prioritising health problems
By the end of your needs assessment work, you will have identified a number of health problems in your community. These problems may include a high incidence of malaria, TB, HIV/AIDS, and childhood diarrhoea. You should ensure that you have a list of all the problems you have identified.
You may also have identified some of the possible causes of health problems (Figure 13.1). These could include unhealthy practices such as smoking cigarettes or excessive alcohol consumption. Another possible cause that you might have been able to identify is unhelpful beliefs, such as that malnutrition is caused by bad spirits, or that dirty water causes malaria. Peer influences could also be identified as a cause of some health problems (Figure 13.2). For example, an individual who has malaria may want to visit the health facility to get treatment. However, his friend may want him to go visit a traditional healer.
Once you have identified and listed the main community health problems and their causes, the next step is to prioritise these problems — because it may be difficult for you to address all of these problems at the same time. Prioritisation is the process of arranging the problems in order of the urgency in which they need to be addressed. Highly urgent and important problems are put at the top of your list — and less important and less urgent problems put at the bottom. During needs assessment you may identify as many as 20 different community health problems, but you cannot address all of these at the same time. You now have to prioritise and put them in the order of importance to the health of the community.
Problem prioritisation is not arbitrary, but should use certain established criteria. There are five basic criteria you can use to prioritise problems. Look carefully at Box 13.1. It describes the criteria you can use to prioritise the problems you have identified in your community, in order to decide which ones should be tackled first.
Box 13.1 Criteria to prioritise problems
- Magnitude of the problem
- Look at the prevalence of the problem. Is there a lot of it in your community?
- Are a large number of people affected by the problem?
- Is the problem widespread in the community?
- Severity of the problem
- Does the problem lead to serious illness, death or disability?
- Feasibility of the intervention
- Are you able to solve the problem with the resources you have?
- Can the problem be tackled with the resources you have?
- Government concern
- Do the official people want you to tackle this problem?
- Community concern
- Does the community really want to deal with the problem?
Activity 13.1 Scoring criteria for prioritisation
Knowing the criteria alone cannot help you to set priorities. This activity will demonstrate to you how to score these five criteria, so that you are able to arrange your problems in order of their importance. In the example set out in Table 13.1, each health problem has been scored on a range of one to five. A minimum score would be one. This indicates that there is very little concern for that health problem. The maximum score of five would be given for a problem that was thought to be very severe. The scores for each problem have been added up in the final column, and a rank has been given for each problem. The rank indicates the priority — a problem that is ranked 1 is the most important.
Table 13.1 Prioritising — scoring and ranking health problems.
| Problem identified | Score for each criterion | Total score | Rank | |||||
|---|---|---|---|---|---|---|---|---|
| Magnitude | Severity | Feasibility | Government concern | Community concern | ||||
| 1 | Malaria | 5 | 5 | 5 | 5 | 5 | 25 | 1 |
| 2 | HIV/AIDS | 5 | 5 | 5 | 4 | 3 | 22 | 3 |
| 3 | TB | 5 | 5 | 5 | 5 | 4 | 24 | 2 |
| 4 | Diarrhoea | 4 | 4 | 4 | 2 | 3 | 17 | 4 |
| 5 | Typhoid | 3 | 3 | 4 | 2 | 3 | 15 | 6 |
| 6 | Intestinal parasite | 4 | 2 | 5 | 3 | 2 | 16 | 5 |
Now answer these questions on the data in Table 13.1:
- According to this scoring system, which is the most important health problem?
- Which health problem is considered by the community to be the least important?
- Which health problem is considered to be the smallest health problem overall?
Table 13.1 gives a lot of information about this situation:
- Malaria has been given the highest rank in this ranking system.
- Intestinal parasites have been scored by the community as the least important health concern for them.
- Typhoid has only scored 3 in the magnitude column and is ranked 6 out of the six health problems — so is considered overall to be the smallest health problem.
The second option you have available in prioritising health problems is to ask a group of stakeholders, such as community members or other health workers, to prioritise the problems according to their knowledge and experience.
How many problems do you select to address? That really depends on your capacity, and the resources you have to deal with them.