4.3. Problem prioritisation

During the national stakeholder consultation workshop, sub-groups will review the evidence linked to their assigned focus area, identify problems/ gaps within that area and assign a priority to those problems. The assessment is based on the data consolidation and analysis, expert opinion, and personal experience of participants.

Problem prioritization involves assessing the magnitude and scope of problems in the country’s epidemiology, patient behaviour, and health and social systems and identification of the main priorities.

How to prioritise problems

• Step 1: Identify programmatic gaps (e.g. gaps between estimated disease burden and case notification, loss of patient between care continuum steps, etc.), problems, and challenges within the focus area assigned to the sub-group. Problems should be oriented along the care continuum and be based on (validated & quantified) the data evidence provided on Day 1.
• Step 2: For each problem, consider which groups are affected, cost implications (of the problem itself – considering both cost to the affected populations and the health sector-, not of interventions to address the problem), ethical imperatives, and any other aspects
• Step 3: Evaluate progress in addressing each problem using the current mix of interventions and investments
• Step 4: Score the problem according to standardized domains and reach a consensus on priority issues that the national TB response should focus on
• Step 5: Comment on critical information gaps in each of the above steps that can inform future data needs and operational research agenda during the NSP period.

Identified problems should be scored on a range from 1-5, and notes and scores from each sub-group should be presented to the workshop by the rapporteurs of each group.

At the end of the session on problem prioritization, facilitators should aggregate and categorize the findings of all subgroups according to the continuum of care. This will allow a streamlined analysis of the views and opinions of participants to be presented back to stakeholders. Refer to the PCF templates in the toolkit section to download available templates. An example is shown below.

A generic tool in PowerPoint format is included in the PCF templates in the toolkit section to explain how sub-groups can prioritize problems along the care continuum.

KeyTakeaways:

• The first planning step of the consultative meeting is to assess the magnitude and scope of problems based on evidence
• Priority focus areas are identified by systematically reviewing existing data and evidence along the continuum of care
• Assessing the available evidence from the perspectives of epidemiology, people and systems along the care continuum can help to identify key gaps that limit progress in accessing, diagnosing, and treating all people with TB or at risk of developing TB
• Priorities are ideally set at both national and sub-national levels, as the distribution of TB disease, the populations at risk, TB services, and socioeconomic factors are heterogeneous, with substantial subnational differences.