Perspectives on preference-based heuristics in primary health care decision-making

Abstract

Improving the delivery of primary health care (PHC) services in developing countries requires the solution of a variety of complicated decision problems. Heuristic decision models are well suited for generating solutions to such problems in many developing countries where formidable financial, logistical, and personnel limitations make it difficult to satisfy the data and computational requirements of classical operations research (OR) models. Moreover, many PHC service delivery problems may substantially violate the assumptions underlying these OR models. This paper reviews the use of a particular form of heuristic—the preference-based heuristic—in three PRICOR studies reported on earlier in this volume. In each study, the objective was to select the most promising strategy for mobilizing community resources to finance some or all of the costs of PHC. The paper argues that the use of preferences in the solution of such PHC decision problems is essential. Reasons for this include the increasing number of choices available to users of PHC services, the competition inherent in such a situation, and the critical importance of client acceptance of PHC interventions, if those interventions are to be effective. Limitations of preference-based heuristics are recognized. Nevertheless, by giving explicit attention to the values of clients and other relevant groups, such decision models can be a relatively simple, cost-effective way of helping to ensure a program design which is both technically feasible and personally acceptable to those most directly concerned.