Explore the Health Issue and Set Priorities

STEPS
  1. Decide the objectives for this phase
  2. Explore the health issue with the core group
  3. Together with the core group, explore the health issues with the broader community
  4. Analyze the information
  5. Set priorities for action
    6.

STEP 5: Set priorities for action.

For the whole community mobilization process, many choices have to be made about content, process and sequence of action, and all of these will have to be prioritized. Although some program teams prefer to include priority setting in the Plan Together phase (phase five), we have chosen to include this step in the exploration phase because our approach is to work with a core group of those most affected by and interested in the health issue. When this group is largely composed of individuals and groups that have little power in the broader community, such as poor people, women, adolescents, children or others, the risk of moving this step to the Plan Together phase is that priorities will be set by those who have more power but may not be directly affected by the issue and so do not reflect this group’s concerns.

Setting priorities

If the community mobilization health issue is defined broadly, there is likely to be a large universe of potential priorities to choose from. For example, if the CM goal is to reduce child mortality in children under five years old, the community could prioritize from such problems as: diarrheal diseases (dehydration), malaria, acute respiratory infections, infectious diseases (such as measles or tetanus), malnutrition, too many children in too little time, neonatal complications from delivery and post-partum period.

To decide which priorities the community will focus on immediately in the upcoming planning phase, participants will need to look again at the health issue in light of the information they have just gathered and analyzed and establish criteria for setting their priorities. Some suggested criteria to consider include:

  • Severity. Is this condition/problem life-threatening? Does it lead to chronic life complications?

  • Frequency. How many people experience the problem or condition? How often?

  • Risk. How many people could experience it in the future?

  • Impact on the community. What is the impact that this problem/condition has on our community now? What kind of impact could it have in the future if we don't address it?

  • Feasibility of a response. Have any effective responses to the problem/condition been identified? Is financial, material and resource support available? Do people possess now or could they develop the necessary skills and abilities to make a difference?

  • Commitment. Is there local political support for this problem/condition/goal? Is there external interest in addressing the issue? Are community members motivated to do something about the problem?

The team and core group should review the information gathered to rank the possible priorities until there is general agreement. It is best to try to limit the number of priorities to two or three in order to focus the group’s effort.

One Method of Setting Priorities

When the group has identified the full range of potential priorities related to the project goal, a set of picture cards representing each of these problems, conditions or issues can be developed for ranking and pile sorting. To encourage full discussion and greater participation of each group member, you may want to divide the core group into smaller groups of three to five people each. Copies of each card set can be given to these smaller subgroups to help participants organize priorities. Individuals can rank their priorities using the cards and then share their priorities with other subgroup members. Pile sorts can help the group organize the cards. Those cards that are not deemed priority by all group members can be set aside, while others can be sorted and discussed using the criteria determined above to arrive at a consensus in the group on the top priorities. When the subgroups have arrived at their priorities, they can then discuss and debate and negotiate their priorities with the other subgroups to arrive at general, core group priorities. In addition to facilitating greater participation of all group members, this process also helps members build skills. such as being able to present opinions and information in a public forum, defend their decisions and negotiate with other groups. Building and strengthening these skills is important preparation for the upcoming "Plan Together" phase.

Strategies for dealing with conflict and disagreement

Priority setting in groups is not an easy task, particularly when participants have not done this before or when the group has only recently been formed. Group leaders may be emerging, and roles and relationships may be shifting as the group establishes its working style. Diverse groups are likely to have differences of opinion. In these circumstances, it is not unusual to see disagreement or conflict. Each culture has its own accepted practices and systems for dealing with conflict, and you should be aware of what is normally done in your setting. Additionally, there are many resources that describe various approaches to conflict prevention and resolution. Some strategies which help prevent/resolve conflict include: articulating issues on all sides, setting goals that all agree on, establishing culturally appropriate communication mechanisms for decision-making, mediating, negotiating, and determining whether there is a need to agree to disagree. Different decision-making strategies include: voting, consensus-building, letting the leaders decide, rotating priorities one time to the next, and/or adding on additional priorities. The Conflict Research Consortium at the University of Colorado has developed an excellent guide to conflict management. For further information, see resources at the end of this phase and further discussion in phase five, step 4.