Prevention toolkit

Tool 9 – Prioritisation Frameworks

The tool

• A prioritisation framework, such as multi-criteria decision analysis (MCDA), provides a robust method for comparing and prioritising different policy or intervention options.

Use this to

• Compare and prioritise policy or investment options where multiple objectives (e.g. cost, impact, equity) matter.
• Structure complex decisions and make trade-offs between prevention outcomes explicit.

You end up with

• A consistently scored and weighted comparison of options, typically resulting in a ranked or prioritised list.
• A transparent record of criteria, assumptions, and trade-offs to support decision-making and scrutiny.

Who can use this?

• Policymakers, analysts, planners and commissioners who need to assess multiple options for action and make a decision.

How does this tool support prevention thinking?

• Prioritisation frameworks are being actively used in the prevention space to help prioritise key drivers of demand, outcomes or interventions. In particular, multi-criteria decision analysis approaches are being used to incorporate levels of prevention as criteria in decision making, potentially increasing the focus on preventative investment with longer term outcomes.
• There are examples of MCDA frameworks actively being used in the Scottish Government Health and Social Care Portfolio and for healthcare delivery-focused prioritisation decisions in Public Services Delivery Scotland.

Using the tool

We use the term “prioritisation framework” to reflect a tool that has a structure for using a set of selection criteria to rank and score different options.

These tools can be used in lighter touch ways, to provide a quick and transparent way of illustrating the factors involved in a decision, to more analytically robust and extensive models, such as Multi Criteria Decision Analysis (as set out in the UK Multi-Criteria analysis manual).

Regardless of the complexity of the prioritisation framework, these tools typically follow a similar structure, which are described as a set of steps below.

For this Toolkit, we assume that the prioritisation approach will be working with options that have already been developed elsewhere (rather than focussing on determining the options). The approach should also be working with existing evidence the options or interventions being proposed, rather than focussing on generating new evidence.

Step 1 - Define the decision context and objectives

The first step is to clearly articulate the decision problem and its scope.

This involves specifying what choices need to be made (e.g. selecting between intervention options, ranking different options), the decision makers involved, and the objectives the analysis is intended to support.

An example of an objective could be to prioritise preventative interventions that maximise long-term health outcomes and reduce system costs over a 5-year horizon. This could be ranking criteria for interventions such as a smoking cessation programme, workplace mental health support, or a community physical activity initiative.

Step 2 - Decision criteria

The next step is to define the criteria against which options will be assessed. These criteria should capture all relevant dimensions, such as impact, effectiveness, equity, cost, feasibility, and risk. Each criterion should be clearly defined and measurable, either quantitatively or qualitatively. Importantly, criteria should be non-overlapping to avoid double counting.

For the health interventions used in the example in Step 1, criteria could cover for example:

• Impact – the extent to which the measure leads to expected physical or mental wellbeing
• Equity - could assess whether the intervention reaches disadvantaged groups (e.g. higher smoking rates in deprived areas)
• Cost - could compare delivery costs per participant
• Feasibility - could consider how easily each intervention can be rolled out locally

You should also consider how decision criteria should be weighted differently to one another. This reflects the relative importance of each criteria in the decision-making process. For example, impact may be given a higher weight than cost, or vice versa, depending on the context and priorities of the decision maker. This is often done through stakeholder engagement, expert elicitation, or formal weighting techniques such as point allocation.

It is important that those deciding the weights are independent from those developing the scores for each of the criteria to avoid any bias in outcomes.

Step 3 - Scoring options against criteria

Once the criteria, and their relative importance, are confirmed, each intervention option is then assessed against every criterion.

This is typically done by scoring each intervention against the set of criteria. This may be derived from quantitative data (e.g. ranking estimated impact on outcomes or costs) or qualitative judgements (e.g. self-reported ranking of the implementation feasibility). For the hypothetical example used, the smoking cessation programme may score highly on impact (strong evidence base and large health gains) but moderately on feasibility if it requires specialist staff, whereas workplace mental health support may score highly on feasibility but more moderately on measurable health impact.

To make sure scores can be compared, the scoring scales are typically standardised, often ranging from 0 to 5 or 0 to 100. This step produces a performance matrix that shows how each option performs across all criteria. This is the one of the main outputs of a multi-criteria analysis.

Step 4 – Results and interpretation

Once the scoring has been completed, the scores across all the criteria are combined into one overall score for each intervention. As part of this, the relative weighting of each criteria are considered. This provides a single, comparable metric that reflects both performance and priorities. These scores are used to compare and rank the intervention options.

Sensitivity analysis could also be undertaken to understand how ranking and priorities may change if you weight one criteria more heavily than another. This could include weighting the impact of different options depending on how successfully they address the underlying factors that causes problems to happen in the first place (I.e. primary prevention). For example, the smoking cessation, workplace mental health support and physical activity initiatives could rank differently based on which criteria is weighted as being particularly important to the decision-maker.

These findings should be presented in a clear and accessible way for decision makers. The decision making process should be transparent, with clear documentation of assumptions, scoring methods, and weightings. The aim is to support informed, evidence-based decision-making, while making trade-offs explicit.

Where to find more information/ support

More information on prioritisation frameworks, in particular multi-criteria decision analysis (MCDA), can be found through the UK Multi-Criteria analysis manual.

Resources

• For further detailed guidance on MCDA see An Introductory Guide to Multi-Criteria Decision Analysis (MCDA) – Government Analysis Function
• Prioritisation and MCDA is also covered in the HM Treasury Green Book supplementary guidance