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. 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. 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. The box below 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.
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 the table below 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.
| 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 the table above:
The table above gives a lot of information about this situation:
The second option you have available in prioritising health problems is to ask a group of stakeholders, such as community members or other health professionals, 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.