(2004; 98 pages)
4.2 Prioritizing problems: the criteria (Step 2)
Criteria which are commonly used to prioritize problems are:
Scale of the problem
One important question is how many people are affected by the drug misuse problem? Is misuse common or rare? Does it concern a common health problem, and therefore affect many people?
The drug use problem can affect the health of individuals taking the medicines in various ways. You should consider the seriousness of the adverse effect of the medicines involved. For example, overuse of paracetamol can be described as a problem, but the adverse effects of this medicine (in normal dosages) are minimal. The health risks related to the way that the drug is administered should also be considered. For example, unhygienic injections can lead to abscesses and serious infections.
Health consequences can be severe when life-threatening conditions, such as malaria with convulsions in small children, are treated incorrectly. Failure to provide the right treatment can lead to death. Palliative medicines can be relatively safe as medicine, but still have adverse health effects because they mask the severity of a disease. For example, the use of cough and cold remedies can mask the severity of a pneumonia episode. Drug use practices can have further negative health effects, because they contribute to microbial resistance. Inappropriate dosage of antibiotics leads to resistance, so the antibiotics become less effective when really needed.
The costs related to drug use problems should also be considered. Overuse of unnecessarily expensive medicines is a major problem that needs to be addressed. People may spend their scarce resources on non-essential vitamins and cough/cold remedies, leaving them with less to spend on food for their children. Poor people frequently borrow money to obtain medicines for sick family members. Problems related to inappropriate self-medication can lead to hospitalization, which is costly for them.
Appropriateness of a community intervention to deal with the problem
This criterion deals with the extent to which the people affected by the problem actually recognize it as serious, and whether a community intervention is an appropriate way to deal with it. For example, if the problem is related to health workers’ prescription practices, it does not make sense to prioritize it for community action. If the issue is very sensitive (such as use of medicines to induce abortions in a country where abortion is illegal), the feasibility of starting a health communication campaign is questionable.