8.1.4 Identify and prioritise problems
Prioritisation is the process of informed decision-making about what to do first, second, third and so on, when there are competing claims on human and other resources. It is impossible to solve all problems at once because there are always many resource constraints. In order to select your priority activities — in this case, with the aim of reducing vaccine-preventable diseases through delivery of an effective immunization programme — you should consider the criteria below for each of the problems you have identified:
- magnitude of the problem — what percentage of the population is at high risk of developing the disease, or is already affected by it?
- severity of the problem — how serious is the disease in question, in terms of its impact on health and the risk of death?
- socioeconomic impact of solving the problem — how will the social and economic circumstances of individuals, families and the community benefit if immunization coverage increases?
- feasibility of tackling the problem — do solutions exist, and is it realistic to increase immunization coverage with the available technical resources, personnel and organisational capabilities?
- affordability of tackling the problem — is the financial support adequate for an improved immunization programme?
- acceptability to the beneficiaries of tackling the problem in the ways suggested — does it meet community and government concerns?
Consider two diseases: pneumonia and the common cold. Which of these has the greatest magnitude and which has the greatest severity?
The number of people who suffer from a common cold is much higher than the number with pneumonia, but pneumonia is a much more serious disease than the common cold. So the magnitude of the problem is greater for the common cold, but the severity of the problem is greater for pneumonia.
A simple scoring chart, like the one in Table 8.1, can help you to rank priorities for each of the health problems identified in your needs assessment. For each problem, you decide on a score from 1 to 5 for each column, where:
- 1 = concern about this criterion is very low
- 5 = concern about this criterion is very high.
| Problem | Magnitude | Severity | Impact | Feasibility | Affordability | Acceptability | Total score | Rank |
|---|---|---|---|---|---|---|---|---|
| Neonatal tetanus | ||||||||
| Measles |
In the example in Table 8.1, neonatal tetanus and measles are listed as health problems that can be reduced by immunization. How would you score each of these conditions based on your knowledge of these diseases and their impact in your community?
We can’t guess what scores you wrote in Table 8.1, because local circumstances will vary in different communities. But you should have given a lower ‘magnitude’ score and a higher ‘severity’ score to neonatal tetanus than you did to measles. More children suffer from measles than tetanus, and measles kills a higher number of children than any other vaccine-preventable disease worldwide (higher magnitude). But the majority of children infected with measles recover, whereas over 70% of babies with neonatal tetanus will die (higher severity). To take another example, you may have decided that the feasibility of vaccinating children once against measles is greater than the feasibility of vaccinating pregnant women, and all women of childbearing age at least twice (preferably three to five times) with tetanus toxoid.
When you have given a score to each problem in your priority chart, you add up the scores and enter this figure in the ‘Total score’ column. You then assign a rank to each problem according to its total score. The highest scoring problem has a rank of 1; the next highest scoring problem has a rank of 2, etc. Conducting an assessment like this will help to clarify your thinking about which problems to tackle first. This will also enable you to explain the reasons for your priorities to community members, so they understand why you have prioritised certain activities.
8.1.3 Immunization needs assessment