CHAPTER 5

• Population


  • Compare population growth rate with desired rate
  • Compare population growth rate with growth rate of economy
  • Identify areas growing much faster than the rest
• Age structure of population


  • Relate to leading causes of illness
  • Young population usually afflicted by communicable diseases
  • Old population afflicted by non-communicable diseases
  • Gives idea of size of specific population groups to be covered by special programs
• Geographical distribution


  • Relate to access to health service
  • Programmes to improve transport and communication
  • Urban growth and slums and their implications
  • Identify underserved population
  • Identify size of indigenous, marginalized population
  • Identify percentage population at lowest economic status
• Health status


  • Compare overall crude birth rate, infant mortality rate, child mortality rate, maternal mortality rate to national targets
  • Note range and average of each rate among major geographical areas
  • Identify least healthy areas
  • Examine age and sex patterns of deaths
  • Knowledge of epidemiology of leading disease problems
• Areas of inquiry for health resources

  • Inter sectoral relationships
  • Intra sectoral relationship
  • Health facilities
  • Health manpower
  • Health financing
  • Status of health project
• Prioritization


  • The essence of planning is in setting priorities
  • Priority setting occurs throughout the planning process and at different levels of decision making
  • Ranking of diseases or conditions to determine which merit emphasis
  • Requires good judgement and ability to synthesize details and balance variables
• Criteria for ranking identified disease/condition problems

  • Vulnerability of problems to technology
  • Magnitude of the problem
  • Social concern
  • Existing health policies
• Criteria for determining priority among programmes


  • Expected potential impact
  • Expected or potential scope
  • Feasibility (technical/operational)
  • Community acceptance
  • Social need
  • Accepted obligations of the agency
• Use of cost-effect and cost-benefit analysis should be employed in association with other criteria, not singly
• Other criteria for prioritization (community health issues)

  • Need among vulnerable populations
  • Community's capacity and willingness to act
  • Ability to have measurable impact
  • Availability of hospital and community resources
  • Whether the issue is a root cause of other problems
  • Trending health concerns
  • Importance to community members
  • Evidence that an intervention can change the problem
  • Alignment with organization's existing priorities
  • Hospital's ability to contribute finances and resources
  • Potential challenges or barriers
  • Opportunity to intervene at prevention level
• Select community health priorities

  1. Select a prioritization committee

  2. Discuss the data

  3. Review community assets

  4. Build consensus around priority needs

  5. Validate selected priorities

  6. Present priorities to senior leadership and board for approval
• Prioritization techniques include multi-voting, strategy lists, nominal group technique, Hanlon method, and prioritization matrix
• Factors to consider when analysing population

  • Compare population growth rate with desired rate
  • Compare population growth rate with growth rate of economy
  • Identify areas growing much faster than the rest
• Age structure of population

  • Related to leading causes of illness
  • Young population usually afflicted by communicable diseases
  • Old population afflicted by non-communicable diseases
• Importance of analysing age structure

  • Gives idea of size of specific population groups to be covered by special programs (e.g. elderly, toddlers, adolescents)
• Factors to consider in geographical distribution analysis

  • Access to health service
  • Programmes to improve transport and communication
  • Urban growth and slums and their implications
  • Out-migration of able-bodied work force from rural areas
• Undeserved population


  Population that is not adequately served
• Important considerations in geographical distribution analysis

  • Size of undeserved population
  • Size of indigenous, usually marginalized population
  • Percentage population at the lowest level of economic status
• Health status indicators to compare to national targets

  • Crude birth rate
  • Infant mortality rate
  • Child mortality rate (1-4 yrs.)
  • Maternal mortality rate
• Observations on the level of socioeconomic status, environmental state, health resources distribution and program performance in the least healthy areas (usually low levels) would firmly establish them as priority
• Areas of inquiry for health resources

  • Inter sectoral relationships
  • Intra sectoral relationship
  • Health facilities
  • Health manpower
  • Health financing
  • Status of health projects
• The essence of planning is in setting priorities
• Priority setting occurs throughout the various phases of the planning process and is made at the different levels of decision making
• Prioritization requires good judgement, an ability to "synthesize the numerous relevant details and to balance variables which often have very different quantitative relationships or lie in different dimensional scales"
• Priority setting is perhaps the most intuitive or subjective part of the planning process
• Criteria for ranking identified disease/condition problems

  • Vulnerability of problems to technology
  • Magnitude of the problem
  • Social concern
  • Existing health policies
• Factors to consider in vulnerability of problems to technology

  • Existence of an effective technology to reduce or control each identified disease/condition problem
  • Feasibility of implementing the technology
  • The degree to which the technology can be geographically applied
  • The multiplicity of effects of the technology
• Factors to consider in magnitude of the problem

  • Projected number of deaths
  • Projected number of cases
  • Mortality/morbidity index
  • Rapidly worsening trend
• Social concern


  The value attached by the community to a particular disease or condition
• Questions to assess social concern

  • Is the disease/condition or problem explicitly expressed as important to the community?
  • Does the problem affect certain age groups, geographical areas, social strata, occupational groups, etc. which are considered important by the community?
• Criteria for determining priority among programmes

  • Instrumental to achievement of high priority policy objective
  • Expected potential impact
  • Expected or potential scope
  • Feasibility (technical/operational)
  • Community acceptance
  • Social need
  • Accepted obligations of the agency, including special mandate
• Cost-effect and cost-benefit analysis should be employed in association with other criteria, not singly
• Other criteria for prioritization of community health issues

  • Need among vulnerable populations
  • Community's capacity and willingness to act
  • Ability to have measurable impact
  • Availability of resources
  • Whether the issue is a root cause of other problems
  • Trending health concerns
  • Importance to community members
  • Evidence that an intervention can change the problem
  • Alignment with existing priorities
  • Hospital's ability to contribute
  • Potential challenges or barriers
  • Opportunity to intervene at prevention level
• Process for selecting community health priorities

  1. Select a prioritization committee

  2. Discuss the data

  3. Review community assets

  4. Build consensus around priority needs

  5. Validate selected priorities

  6. Present priorities to senior leadership and board for approval
• Techniques for prioritization


  • Multi-voting technique
  • Strategy lists
  • Nominal group technique
  • Hanlon method
  • Prioritization matrix