One way of prioritizing the problems is to rate them according to the criteria you have selected. You should examine each problem in the light of the criteria and you can award a mark or a rating (for instance on a scale of 1 to 5). If you do this for each of your problems you will come up with a number of points for each problem, which can enable you to make a quantitative comparison for priority-setting. The problem with the highest total rating should be the most important.
You will need to consider whether all the criteria are of equal value. If, for example, you decide that one of your criteria - such as the appropriateness of a community intervention - is essential, you may focus your discussion on the problems that score high on that criterion, and then check which ones score high on other criteria as well.
Rating1 is a useful way of shedding light on a difficult choice, but evaluating complex problems with a numerical value can produce questionable results. Rating should be seen as a tool to help you understand your choices and to provide you with a framework for discussing priorities. It should not be used to impose a choice according to a set of rules. The rating technique should be used to support informed discussion on prioritizing problems for action - not as a means to avoid difficult discussion.
1 Instead of rating you can also rank problems in terms of the criteria. For each criterion you rank the problems, assigning 1 (most important) to 5 (least important) problem. The difference with rating is that you can only assign a rank once: so, as in a competition, only one problem gets the first prize (rank 1); and only one problem ranks 2. This method leads to a lively discussion on which problem is most important, but can also be distorting, as some problems may score equally for one or more of the criteria.
When you rate problems you will find that it is not as easy as it seems. You may lack the necessary data to rate the problems; or problems may be so different that it is hard to prioritize them. Some problems are related. For example, misleading drug promotion on Viagra results in its overuse as an aphrodisiac. Below, we discuss an example to clarify how rating can be used to prioritize problems.
Figure 4. Rating matrix
CRITERION Rate (1-5) |
problem 1 |
problem 2 |
problem 3 |
problem 4 |
problem 5 |
Scale of the problem |
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Health risks |
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Costs |
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Appropriateness of an intervention |
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TOTAL RATE |
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RATING TO HELP IN THE PROCESS OF PRIORITIZING: AN EXAMPLE
Background Information
In recent research three problems have emerged in a community:
Problems
• Over-use of cough mixtures
• Over-use of analgesics
• Misuse of antibiotics
In analysing these problems three criteria have been identified for priority-setting:
Criteria
• Scale of the problem
• Health risks
• Costs
• Appropriateness of an intervention
It has been agreed that one intervention will be developed to focus on one problem. A rating exercise is carried out with a group of stakeholders to select a priority.
Rating the problems
When you rate you look at one problem at a time and measure it against your criteria.
Scale
You can choose which scale to use - in this case a scale of 1-5 has been chosen. You need to make sure that everyone knows whether 1 is more serious or less serious. (In this case a high rating means more serious).
Stakeholder meeting
First cough mixtures are considered and discussed at some length by the stakeholder meeting. People regard the health risks as not very important. The economic waste is considered rather important. Resistance was not considered to be a major factor but it was not insignificant as a few of the combination cough mixtures contained antibiotics. After much discussion of the three problems the table is completed as follows:
|
Rating |
Over-use of cough mixtures |
Over-use of analgesics |
Misuse of antibiotics |
Scale of the problem |
3 |
3 |
5 |
Health risks |
2 |
2 |
5 |
Costs |
4 |
2 |
4 |
Appropriateness of an intervention |
3 |
3 |
5 |
Total |
12 |
10 |
19 |
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The discussion and the rating exercise have helped the group to see that they regard the misuse of antibiotics as an urgent priority.
You will need to consider whether all the criteria are of equal value. If, for example, you decide that one of your criteria e.g. the appropriateness of a community intervention - is essential, you may focus your discussion on the problems that score high on that criterion, and then check which ones score high on other criteria as well.
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