Prioritization Tools for Diseases and Interventions Targeting Populations in Africa and Canada Vulnerable to Water-Related Health Issues

The effects of climate change on changing water dynamics is an important global health concern, including the direct effect these changes are likely to have on a number of infectious diseases, particularly vector-borne diseases.

Given the realities of scarcity of funds in low and middle income settings, where sustainable funding remains a constant challenge, or restricted budgets in high income countries, due to multiple cost demands, these changing conditions will require decisions to be made concerning the allocation of resources.

Economic tools have been used previously to assist with this type of decision-making. However, results may differ when prioritization is achieved using broader considerations identified by local stakeholders. Multicriteria analyses should therefore also be assessed.

Photo : V. Hongoh

• Examine, assemble and discuss existing scientific information on climate sensitive infectious diseases and health impacts related to vector-borne and zoonotic diseases under changing water dynamics in Quebec and in Burkina Faso;

• Describe and compare perceived concerns and capacities of the public to adapt to, and cope with changes to the risks posed by vector-borne and zoonotic diseases in a context of climate change;

• Assess and validate a specific set of indicators of vulnerability to diseases studied through the development of a multi-criteria / multi-actor process (MCDA tool and process).

• A literature review was conducted to identify diseases of concern and relevant information pertaining to prioritization and management of these diseases in Quebec and Burkina Faso, as well as in Manitoba;

• A cross-sectional study was conducted via focus group discussions to assess concerns relating to climate sensitive disease prioritization and management of a vector-borne disease endemic to each research study area;

• A multicriteria-decision analysis approach was adopted to prioritize both diseases and interventions for the management of climate sensitive infectious diseases in two main regions: Quebec and Burkina Faso;

• An additional validation study was also carried out in Manitoba. Pilot prioritization work was done in Quebec and Burkina Faso to examine effects on disease rankings and intervention rankings.

Criteria were identified and prioritized through a multicriteria decision analysis (MCDA) approach. Focus group discussions held in Quebec (Canada), Burkina Faso and Manitoba (Canada) helped to assess multi-stakeholder expressed concerns around disease prioritization as well as vector-borne disease specific intervention models.

Figure 1 shows that several criteria were the same in both settings with additional considerations for Burkina Faso associated with the country's specific context. The effect of context specific criteria and weights resulted in similar yet distinct prioritizations of diseases and interventions in the various regions and contexts studied.

Figure 1. Criteria retained by local stakeholders for the prioritization of infectious diseases

The presence of consistent criteria between sites suggests that common concerns exist for prioritization of both diseases and interventions across regions and contexts. However, context-specific adjustments and discussions reveal important concerns regarding resource availability and capacity that should be considered prior to adaptation of decision-making.

For all models, stakeholders weighted criteria thereby allowing a measure of local priorities and values to be incorporated into the models. Comparisons were made across study sites (Quebec and Burkina Faso) and pilot prioritizations were done to examine effects on disease rankings and intervention rankings (Figure 2). The weighted REC and ECC criteria were the ones that presented the most significant differences between the two study areas.

Figure 2. Trial disease prioritization ranking and scores for Burkina Faso and Quebec

Participatory approaches, such as those compatible with a MCDA, facilitate rich knowledge exchange and problem structuring. Moreover, given the diversity of concerned stakeholders, both in low and middle-income country settings as well as in vector-borne disease management settings in high-income countries, multi-actor collaborations across different sectors including NGOs, local government and community are of critical importance to optimize interventions for these health-related issues.

Formal mechanisms such as MCDA provide means to foster consensus, early conflict detection prior to roll-out of interventions, shared awareness as well as improved collaboration around important and complex health issues such as those posed by climate sensitive infectious diseases. Additionally, the use of multi-criteria decision aid approaches with scenarios allows for the exploration of key perspectives under changing conditions contributing to adaptive management and climate change adaptation planning.

• Public Health Agency of Canada