FACILITATOR GUIDE

Prioritizing Public Health

Problem
Created: 2013
Prioritizing Public Health Problems. Atlanta, GA: Centers for Disease Control and
Prevention (CDC), 2013.
PRIORITIZING PUBLIC HEALTH PROBLEMS

Table of Contents

Prioritizing Public Health Problems ............................................ 3

LEARNING OBJECTIVES ................................................................................. 3
ESTIMATED COMPLETION TIME ....................................................................... 3
TRAINING TECHNIQUES ................................................................................. 3
PREREQUISITES ............................................................................................ 3
MATERIALS AND EQUIPMENT .......................................................................... 3
REFERENCES AND RESOURCES........................................................................ 3
PREPARATION CHECKLIST .............................................................................. 4
FONT GLOSSARY .......................................................................................... 4
ICON GLOSSARY ........................................................................................... 4
MODULE CONTENT ........................................................................................ 6
SKILL ASSESSMENT (FROM PARTICIPANT GUIDE) ............................................. 28

FACILITATOR GUIDE |2
 PRIORITIZING PUBLIC HEALTH PROBLEMS

Prioritizing Public Health Problems

LEARNING OBJECTIVES

At the end of the training, participants will be able to:

• Identify the key stakeholders and partners with whom to prioritize public
health problems
• Identify the criteria for prioritizing public health problems
• Reach consensus on the two highest priority NCDs on which to focus
prevention and control efforts

ESTIMATED COMPLETION TIME

• 2 hours (90 minutes interactive presentation, 30 minutes Skill

Assessment)

TRAINING TECHNIQUES

• Content and examples will be presented using lecture and group

discussion. Skill assessment will be in small groups.

PREREQUISITES

• Introduction to NCD Epidemiology and NCD Burden of Disease

MATERIALS AND EQUIPMENT

Facilitator:
• PowerPoint file for presentation
• Two flipcharts with markers
Participant:
• Participant Guide

REFERENCES AND RESOURCES

• Gregg, M.B. (Ed.). 2008. Field Epidemiology (3rd ed.). New York: Oxford
University Press.
• Porta, M and Last, J.M. (Ed.). 2008. A Dictionary of Epidemiology (5th
ed.). New York: Oxford University Press.

FACILITATOR GUIDE |3
PRIORITIZING PUBLIC HEALTH PROBLEMS

• Office of Workforce and Career Development. 2006. Principles of

Epidemiology in Public Health Practice (3rd ed.). Atlanta: CDC.
• McKenna et al. 1998. Current Issues and Challenges in Chronic Disease
Control. In: Chronic Disease Epidemiology and Control. Washington:
American Public Health Association

PREPARATION CHECKLIST

The following are action items to be completed by the facilitator prior to training:

___ Review slides

___ Obtain country-specific data on incidence, prevalence, disease-specific mortality,
and/or DALYs (disability-adjusted life years) for four priority NCDs and/or risk factors.
___Participants will use this information in the Skill Assessment.

FONT GLOSSARY

The following fonts are used in this guide:

Font Type Font Meaning

Plain Script
Bold Instructions

Italics Answers

ICON GLOSSARY

The following icons are used in this guide:

Image Type Image Meaning

Small group exercise.

Activity Icon

Write responses during facilitator-led discussions or

debriefs.
Flip Chart Icon

FACILITATOR GUIDE |4
 PRIORITIZING PUBLIC HEALTH PROBLEMS

Image Type Image Meaning

Question for facilitator to ask participants.

Question Icon

Supplemental information discussion.

Tip Icon

FACILITATOR GUIDE |5
PRIORITIZING PUBLIC HEALTH PROBLEMS

MODULE CONTENT

Duration/
What To Do/What To Say
Slide Number

2 minutes

Slide 1

• Introduce yourself to participants if you are a new

facilitator.
• Remind participants of what they have learned so far and
relate it to what they will learn in this lesson.
• Explain that during this lesson they will learn how to
work collaboratively with others to prioritize public
health problems.
• Explain that having this skill will provide them with a
systematic way to identify top priority health problems
when time and resources are limited.
• Explain that after learning the lesson content they will
complete a skill assessment with a small group.
• Tell participants that this lesson will take approximately
two hours to complete.

FACILITATOR GUIDE |6
 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

2 minutes

Slide 2

• Direct participants to Slide 1 in their Participant Guide.

Read the learning objectives from the slide.

Questions • Ask participants if they have any questions about the

objectives.

1 minutes

Slide 3

• Tell participants what they will learn during this lesson.

FACILITATOR GUIDE |7
PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

3 minutes

Slide 4

• Ask: Why do we need to prioritize public health problems?

Questions • Record responses on flipchart.

• Reveal possible answers on slide.
• Explain that resources are not only about money.
Flip Chart
• Explain that prioritizing also helps to identify which
health problems/issues you will deal with first. Just
because a health issue doesn’t make it to the “top of the
list” does not mean that it will never be considered in
later years.
• Explain that they can prioritize chronic diseases AND
risk factors, for example, breast cancer, hypertension,
obesity, and smoking.
1 minute

Slide 5

• Explain that you will now discuss two concepts that they
will use when prioritizing: participatory planning and
consensus building.

FACILITATOR GUIDE |8
 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

4 minutes

Slide 6

• Explain that because we each have different experiences

and perspectives, we will all see some things a bit
differently.
• Say: If our plans are to be effective, decisions need to involve
all concerned and affected parties. This is called
participatory planning.
• Click slide until you see the graphic. Read the slide.
• Ask the group to define “stakeholder”.
• Click and reveal definition on slide.
• Ask participants to give examples of stakeholders for a
current project/intervention.
• Possible answers: MOH, regional/district medical officers,
community leaders, organizational leaders, target population.
• Ask the group to define “partner” and to give examples.
• Possible answers: Can be the same as stakeholders, for
example MOH, but they are supportive of what you are doing
and not all stakeholders are supporters.
• Click and reveal definition on slide.
• Ask: How would you involve stakeholders and partners in
prioritizing diseases?
• Possible answers: invite them to a meeting in which you all
discuss and prioritize diseases; send out questionnaire; have
informal discussion groups; explain the benefits to them of
working with you.

FACILITATOR GUIDE |9
PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

3 minutes

Slide 7

• Read the slide.

• Discuss these additional points:
o Use consensus building to ensure that everyone involved
participates in making decisions that affect them.
o The objective is to have everyone agree and be a part of
the process, but you may not always be able to reach
consensus.
o Keep in mind that not all stakeholders will be present or
have buy-in.
o Consensus building often involves understanding the
minority objections.
o Deal with minority objections in a way that all participants
are comfortable with the overall decision of the group.

3 minutes

Slide 8

• Ask: What are some important criteria for establishing a

consensus in a group?
Question
FACILITATOR GUIDE |10
 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
• Reveal the points on the slide and discuss.
• Add these points:
o Avoid “one best way” attitude.
o Avoid “either/or” thinking.
o Combine points of view rather than “majority rule”.
o Do not end healthy conflict prematurely.
o Consensus is closely related to the term “agreement” and
is different than the concept of “alignment”, which is
finding a common underlying set of beliefs or purposes.
20 minutes

(5 minutes to
introduce; 15
minutes for
exercise)

Slide 9-11

• Tell participants that they will now practice reaching

consensus.
Activity
• Read the exercise instructions to the class.
• Explain that this exercise is an abbreviated version of a
“survival exercise” that is used in different training
courses. Tell them that because of time limitations, the
class will only complete parts of this exercise as you will
now describe.

FACILITATOR GUIDE |11

PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

• Read the following situation to the class:

It is approximately 10:00 in the morning and you and your
companions have just crash-landed in the desert. Both the
pilot and copilot perished in the plane, which completely
burned shortly after impact. No one else was hurt.
The pilot was not able to notify anyone of the position of the
plane before the crash; however, before the crash he had
indicated that the plane was south-southwest of a small
town, and that the plane had veered several kilometers off
the course of the flight plan.
The area of the crash is flat with little vegetation. The last
weather report that the pilot had announced indicated that
the temperature would reach 43 degrees centigrade. You all
have comfortable clothes and shoes and a handkerchief.
Collectively, you have some paper money and a few coins.
Before the plane caught on fire, your group was able to take
5 items off the plane:
• One parachute (red and white)
• One flashlight with batteries
• Water (one quart per person)
• Top coat (one per person)
• Small mirror
Your task is to work in a group and rank these items
according to their importance to your survival, starting with
number one - the most important – to number five - the least
important.
• Divide the class into groups of five to six participants.
Or, if they are currently set up at round tables, they can

FACILITATOR GUIDE |12

 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
remain with their group.
• Tell participants to refer to the activity on the appropriate
page in their Participant Guide and to spend
approximately 15 minutes ranking the items as a group.
Tell them to try to reach consensus.
• Tell participants to assign a spokesperson who will
discuss the group’s rankings with the class.
• Tell participants to begin.
• Walk around to make sure participants are working
together in their groups.
• Provide participants a five-minute warning.
Reconvene the class and use the next slide to recap the
activity.

• Reconvene the class after 15 minutes and ask each

group representative to present its rankings. Ask for
their rationale in the rankings. If you choose, you may
discuss the following “expert” top rankings to help
facilitate the discussion:
1. Mirror: Because all pilots file a flight plan, the survivors
can presume that someone will begin looking for them.
The mirror will help them signal to rescuers who are
Question looking for them.
2. Top coat: As the weather will become dangerously hot,
the top coat will protect them from the sun and from the
cold of the desert at night.
3. Water: Water is needed to prevent dehydration.
4. Flashlight: To signal the rescuers who are searching at
night; it will also make the survivors feel more
FACILITATOR GUIDE |13
PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
comfortable at night.
5. Parachute: Could be used to spread on the ground as a
signal and it could also offer protection.
• Ask participants how they felt about the consensus
building process. Was it difficult? Why?
• If a group could not reach consensus, ask them why.
• Ask: Why didn’t each group come up with the same list?
• Possible answer: People have different backgrounds and
opinions, which can lead to different rankings.
• Ensure the discussion stays on track and does not
exceed the time limit.
• Read the points on the slide and discuss the following
points:
o Consensus building can be difficult because of varying
opinions and experiences.
o In this exercise, we tried to imagine that our lives
depended on reaching a consensus. In reality, the
survival of our programs might depend on this ability.
o The first thing you must try to do is to reach a consensus
on the big issues. Often, once you have done this and
understand the differences of opinion, the smaller issues
fall into place.
• For example, in this exercise, if you take a closer look at why
one person selects a mirror as the most important item and
another selects the water, you will uncover information that
will help with other decisions. The person who selects the
mirror may want to stay put and use the mirror to signal
rescuers. The person who selects the water may prefer to go
for help rather than wait. Knowing the reasons behind these
differences will make it easier to reach consensus on related
issues.

FACILITATOR GUIDE |14

 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

1 minute

Slide 12

• Explain that to help reach a consensus in establishing

priorities you should identify criteria or standards.

5 minutes

Slide 13

• Explain that to help reach a consensus in establishing

priorities you should identify criteria or standards.
• Ask: What criteria would you use (or have used) to prioritize
health problems?
Question
• Encourage participants to use work-related examples
(related to NCDs or IDs).
• Record responses on flipchart. Discuss responses.
Flipchart • Click on the bullets one at a time and discuss as needed.
Include these points for last two bullets:
o Disease of international interest can be a global target or
WHO priority.
o Equity refers to poor groups that suffer excess burden
from simple problems.
FACILITATOR GUIDE |15
PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
• Tell participants that you recommend selecting no more
than five criteria when prioritizing health problems.
Question
• Ask: Out of this list of criteria, which five would you use to
prioritize health problems?
• Tell participants that you are going to spend some time
going over the first four criteria in greater detail.
3 minutes

Slide 14

• Read the definition of size of problem.

• Ask: What source would you use to learn about the size
of the problem?
Question
• Click to reveal answer.

3 minutes

Slide 15

• Explain that scoring each health problem using values

can make it easier to compare and rank.
• Explain that this slide is an example of values they can
Question use.
• Read the slide.

FACILITATOR GUIDE |16

 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
• Ask participants to provide an example of a health
problem in the community that they would rate a 1? 3?
5?

3 minutes

Slide 16

• Say: This table can be used to rate the problems, one

criterion at a time.
• Explain that in this example they would consider the size
of the problem for EACH health problem. Then they
would move on to the next criterion, in this case,
seriousness.
• Stress that they can select any criterion; you are just
showing them examples of four criteria.
• Remind participants of other criteria they have listed on
the flip chart (e.g., availability of local expertise
regarding the health issue.

3 minutes

Slide 17

FACILITATOR GUIDE |17

PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
• Explain that the next criterion for prioritizing problems
that you will discuss is seriousness of the health
problem.
• Read the first two bullets.
• Ask: What type of data provides information about the
seriousness of a health problem?
• Ask: What data sources would you use to find the
Question seriousness of diabetes? Hypertension? Breast cancer?
• Read the third bullet.
• Point out that health threats such as rare fatal diseases
may have a small burden but may have a horrible
outcome and lead to public hysteria.

3 minutes

Slide 18

• Read the slide.

• Ask participants to provide an example of a health
Question problem in the community that they would rate a 1? 3?
5?

FACILITATOR GUIDE |18

 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

1 minute

Slide 19

• Show the sample ratings for seriousness.

1 minute

Slide 20

• Read the slide. Include these points:

o Consider whether there are currently evidence-based
interventions (widely accepted as effective).
o Consider whether there are promising practices to
address health problem (evidence base is growing, but
intervention is not yet widely accepted as effective).
o Consider if interventions can be easily implemented.
Question • Ask: How would you obtain information about availability of
current interventions?
• Possible answers: community leaders, stakeholders,
community survey/focus groups, peer-reviewed journals,
scientific reports
• Say: Information about current interventions may take more
time and energy to compile than other criteria like size and
FACILITATOR GUIDE |19
PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
seriousness. You might want to assign the data-gathering
task of this component to a person with expertise in this.

3 minutes

Slide 21

• Read the slide.

• Ask participants to provide an example of a health
Question problem in the community that they would rate a 1? 3?
5?

3 minutes

Slide 22

• Show the example of rating availability of interventions.

FACILITATOR GUIDE |20

 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

3 minutes

Slide 23

• Explain that they should consider the increased

monetary and societal costs of the health problem.
Question • Ask: What monetary costs can be associated with a health
issue?
• Answers should include medical expenses, social services,
public services, employers, productivity
• Ask: What societal costs can be associated with a health
Question
issue?
• Possible answers: effects on the individual and family if the
person is unable to work, cannot support his or family, cannot
contribute to the community
Question
• Ask: How would you find information about economic and
social impact?
• Possible answers: community leaders, stakeholders,
community survey/focus groups.

3 minutes

Slide 24

FACILITATOR GUIDE |21

PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
• Read the slide.
• Ask participants to provide an example of a health
Question problem in the community that they would rate a 1? 3?
5?

3 minutes

Slide 25

• Show the example of rating impact.

3 minutes

Slide 26

• Say: One way to determine a resulting rating is to multiply

the values from each column (e.g., 5 x 4 x 4 x 4 = 320).
• Explain that multiplying rather than adding the numbers
shows a greater difference, making it easier to rank. (If
you added the numbers, the results would be 17, 16, 18,
15, and 14, making it more difficult to persuade people
that breast cancer should be a priority over diabetes.)

Tip • Note: Some people assign weights to each criterion; for

FACILITATOR GUIDE |22
 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
example, “seriousness” might be given a weight of “2”,
which would give it twice the importance of the other
criteria. If participants ask about weights, explain that it
is out of scope for this training; direct them to the
appropriate resource to learn more.
• Explain that this slide shows an example of how you
would determine the resulting ratings and that they
would most likely have a different result based on the
situation in their country.
• Ask: In this example, if your country only had the resources
Question to focus on two health problems, what would be the two
highest priority problems?
• Answer: Breast cancer and diabetes.
• Show the example of rating impact.

1 minute

Slides 27-35

• Tell participants that they will now participate in the

Review Game.
• Note: Adjust number of questions depending on number
of tables and teams. If participants are already at small
tables, you may keep them together as a team.
Otherwise, divide the class into teams of four or five
participants.
• After participants are in their teams, ask each team to
(quickly) give you a team name. Record team names on
a flip chart.
• Tell participants to discuss answers in their teams
before providing them out loud. Correct answers will
receive 2 points. You may give 1 point for partially
correct answers.
FACILITATOR GUIDE |23
PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
• Begin by clicking on the following slides, one question at
a time.
• To reveal the answers, click on the slide after the
question appears (and participants answer the question).
• Record points on flip chart.
• (Optional) Provide a prize to winning team.

FACILITATOR GUIDE |24

 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number

3 minutes

Slide 36

FACILITATOR GUIDE |25

PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
• Read the misunderstanding and then click and read the
‘reality’.
• Explain that because there is a rapid upsurge in chronic
disease risk factors due to epidemiologic and
demographic transitions, countries will need to deal with
both infectious diseases AND chronic disease problems.
• Ask: What factors in [local country] affect NCDs?

Question • Say: That is why learning how to prioritizing health problems

is so important!

3 minutes

Slides 37

• Tell participants that they will now practice prioritizing

health problems for NCDs and risk factors of importance
in their country.
• Read the slide.
• Tell participants that they should spend no more than 15
minutes on this assessment.
• Direct participants to the appropriate Slide in their
Activity Participant Guide for instructions and blank worksheets
they can use.
• Tell participants that in a real situation, they may select
four or five criteria, but because of time limitations, they
will practice using only three criteria.
• If applicable, hand out or show on the screen the
country-specific data you collected on incidence,
prevalence, and mortality of NCDs that are of importance
to your country.
• If you do not have country-specific data, spend a few
minutes with the entire class to identify a list of four
important health issues or problems that they can then
FACILITATOR GUIDE |26
 PRIORITIZING PUBLIC HEALTH PROBLEMS

Duration/
What To Do/What To Say
Slide Number
prioritize in their small groups. Depending on the
available resources, it may be realistic for the class to
identify communicable diseases as well as NCDs. (If this
is the case, encourage participants to identify at least
one high priority NCD so they can use it in subsequent
lesson assessments.)
• Explain that because they might not have the correct
quantitative and/or qualitative data with them they may
have to use their best judgment or guess.
• While participants are working in their groups, walk
around and assist if needed. Give them a five-minute
warning, as needed.
• Use the next slide to debrief.

3 minutes

Slide 15

• Debrief the skill assessment by asking each group the

questions on the slide.
• Additional questions you may ask:
o What was easier to build consensus: the survival exercise
or this assessment? Why?
o What lessons did you learn from this assessment about
consensus building and prioritizing health problems?

FACILITATOR GUIDE |27

PRIORITIZING PUBLIC HEALTH PROBLEMS

SKILL ASSESSMENT (FROM PARTICIPANT GUIDE)

Activity

Instructions:
1. Work with your facilitator to identify four NCDs and risk factors of importance in
your country and record on the worksheet on the following Slide.
2. Use the space below to record the key stakeholders and partners to involve in
prioritizing those health problems.

3. As a group, determine three criteria to use for prioritizing and record on the
worksheet on the following Slide.
4. Prioritize the problems and reach consensus on the two highest priority health
problems to focus prevention and control efforts. (Use the worksheet on the next
Slide to rank and prioritize each health problem.)

FACILITATOR GUIDE |28

 PRIORITIZING PUBLIC HEALTH PROBLEMS

Prioritizing Health Problems Worksheet

Determine criteria for each health problem.

Health Problem Criteria Criteria Criteria Criteria Resulting

1 2 3 4 Rating

FACILITATOR GUIDE |29