(2004; 98 pages)
In order to select and develop interventions aimed at enhancing rational drug use by consumers, it is important that the problems identified in step 1 are prioritized and choices made about which problems to address. The more focused rational medicines use interventions are, the more likely it is that consumers will understand them. In order to prioritize the problems, criteria need to be developed that are relevant to the operational setting in which the problem is to be addressed, and relevant to the people who are affected by the problem. This chapter first discusses how you can prioritize drug use problems (step 2 in the development of effective consumer oriented rational drug use interventions), and then how through a participatory process, using research methods given in Chapter 3, you can analyse the problems and identify possible solutions (step 3).
A process of prioritization can be carried out by policy-makers or health professionals but it can also be a participatory process in which various stakeholders are fully involved in identifying problems, setting and defining criteria and discussing how the priorities should be set. If stakeholders are involved there is likely to be more ownership of the problem and support for the result of the priority setting process.
To identify problems, define criteria and prioritize problems you could hold FGDs with people who are affected by the problem (stakeholders), such as:
• men/women in the community
• health workers in primary health care centres
• provincial/district health policy-makers.
It is best to hold separate discussions for each of these categories, as community members may not openly discuss their views with health policy-makers. But limit the number of participants. For our purpose it is important to choose key people who are knowledgeable, and whose views matter. In some cases, where community members are vocal and willing to express their views in ‘mixed’ groups, it may be possible to hold group discussions with people representing a variety of stakeholders. In such cases, good moderation is essential, to ensure that all parties speak up.
The group discussions can be used to achieve various objectives:
Present the problems identified. You can explain what essential drugs experts consider to be important public health problems. The various groups of stakeholders should be given the opportunity to comment on the list of problems identified and to add to it.
Develop criteria for priority-setting. You can ask the respondents to explain why each problem is important. Ask probing questions about why this is the case. In this way you can help to elicit criteria which determine why a problem is important.
Set the priorities. This can be done in discussion and also with the use of tools such as rating, see below.