Whose Priorities Count? Comparison of Community-identified Health Problems and Burden-of-Disease-assessed Health Priorities in a District in Uganda

Objectives: The aim of the study was to compare health problems as defined quantitatively by the Burden of Disease study to those defined by the community. The secondary aim was to explore the potential for using qualitative participatory methodologies as tools for planing and priority setting.

Design: Interviews and group discussions with a purposely sampled set of community members (n = 51) and community leaders(n = 6). The Nominal group technique, as well as in-depth interviews, were used to identify major health problems - as perceived by the community. Epidemiological data on the major health problems were derived from the national Burden of Disease study.

Results: Community perceived health problems were similar to those identified by the burden of disease study. Reasons given for the ranking included prevalence, fatality, social and cultural stigma. Social stigma and cultural values were not considered in the burden of disease studies. However, socially stigmatized diseases were considered to be more serious compared to non-stigmatised conditions, in spite of their low prevalence. Poverty and lack of knowledge were the perceived major causes of ill-health in the community.

Conclusions: Qualitative approaches like the nominal group technique may be useful in eliciting community values that could supplement quantitative information like that elicited by the Burden of Disease study. Such a mixed approach would capture both epidemiologicaly assessed and community felt needs in the priority setting process.