Towards a multi-criteria approach for priority setting: An application to Ghana

Background: Many criteria have been proposed to guide priority setting in health, but their relative importance has not yet been determined in a way that allows a rank ordering of interventions. Methods: In an explorative study, a discrete choice experiment was carried out to determine the relative importance of different criteria in identifying priority interventions in Ghana. Thirty respondents chose between 12 pairs of scenarios that described interventions in terms of medical and non-medical criteria. Subsequently, a composite league table was constructed to rank order a set of interventions by mapping interventions on those criteria and considering the relative weights of different criteria. Results: Interventions that are cost-effective, reduce poverty, target severe diseases, or target the young had a higher probability of being chosen than others. The composite league table showed that high priority interventions in Ghana are prevention of mother to child transmission in HIV/AIDS control, and treatment of pneumonia and diarrhoea in childhood. Low priority interventions are certain interventions to control blood pressure, tobacco and alcohol abuse. The composite league table leads to a different and more differentiated rank ordering of interventions compared to pure efficiency ratings. Conclusion: This explorative study has introduced a multi-criteria approach to priority setting. It has shown the feasibility of accounting for efficiency, equity and other societal concerns in prioritization decisions, and its potentially large impact on priority setting.