Criteria are a set of measures that stakeholders use to weigh and determine which health problems, challenges, and solutions should be made a priority. These criteria should be defined before starting the priority setting process and be the basis for final priority setting decisions. In order to make high-quality PHC a priority, stakeholders need to define the principles that drive high-quality PHC (such as equity, efficiency, and sustainability) and set priorities for their health system based on these principles. 5 These principles will inform how stakeholders evaluate criteria relative to each other when considering what is politically feasible, affordable, and technically possible. 2 14 The WHO suggests a non-comprehensive list of five criteria that can be used to set priorities in the health sector. These include:
- The burden of disease: The burden of disease is a quantitative, time-based measure that combines years of life lost due to premature mortality and years of life lost due to time lived in states of sub-optimal health (i.e. injury, disease).
- The effectiveness of the intervention: This criteria evaluates how well the identified health issue can be addressed (clinically or practically) by the given intervention, including if the intervention is applicable and cost-effective for the local-context.
- Cost of the intervention: This criteria considers the cost of an intervention in terms of affordability and efficiency. It is important to consider the absolute and relative costs to the health sector, target community, and the individuals. The cost of an intervention must be both economically feasible and sustainable.
- Acceptability of the intervention: This criteria refers to whether the target community or population accepts the chosen health intervention, taking into account the social and cultural norms as well as the willingness of providers or other health authorities to carry out the intervention (i.e. risk aversion, resistance to change, perceived value). This criteria strongly relates to the applicability and feasibility elements of the effectiveness criteria; both require contextual knowledge to evaluate the intervention.
- Fairness: Fairness is a value judgment made collectively by governments and society based on the principles of equality and equity. The fairness criteria is essential to making well-informed judgements about tradeoffs on the importance of a health need and the effectiveness of an intervention. It also influences how much weight to give to the cost of a solution. For example, it might be important to prioritize the health problems of a specific at-risk or marginalized segment of the population, even if the intervention is not particularly cost-effective. An evaluation of fairness can help direct resources to marginalized populations, even when the intervention is not the most cost-effective solution.
Often, stakeholders will have to make trade-offs between different criteria; for example, stakeholders may consider both equity and cost-effectiveness in the evaluation of a given health intervention and find that the intervention that is the most equitable might not be the most cost-effective. The weight given to different criteria is ultimately a political decision shaped by the country-context, including values, principles, and economic and political environment. 2
While the above criteria are a strong starting point for priority setting conversations, new criteria may need to be added or adapted based on contextual factors, such as the epidemiological and demographic profile of the country, the health system structure, and political and financial capital. 2,15) Accordingly, local needs and norms will influence the relative weight attached to these different criteria. The analyses of these criteria will depend on both the quality of the data and information available - including information on the implementation of interventions.