Is the cost of the screening and timely intervention operation warranted,given all the considerations covered in items 1-6 above, in comparison with alternative uses of the resources

Will the operation divert resources from other measures that are likely to be more effective? What other ways are there of addressing the problem that do not involve screening ? are these better? Will the screening operation divert health workers attention from more crucial efforts addressing the principal health problems of the population ? will it accomplish little but create the impression among the public that their problems are being dealt with and divert their attention from issues of higher priority ?

In order to answer these questions , the costs and benefits of the proposed screening and intervention activities must be weighed against those of alternative strategies, taking into account both direct and indirect, as well as immediate and future , benefits .

When planned thoughtfully and implemented in a population-based fashion, screening can provide a rational bases for resource allocation. it can be used to ensure that preventive measures are applied where they will have the most effect. However, the costs of screening and subsequent follow-up need to be weighed against the savings to be derived from other potentially more effective and efficient uses of resources.

In general, primary prevention is better than a strategy that depends on screening . especially where an important risk factor can be significantly reduced without medical intervention as , for example , in the case of smoking it might be desirable to concentrate the available resources on mass public education and policy initiatives such as legislation to ban advertising of tobacco products. Even resources spent on ensuring an adequate food supply at the community level, on community-wide promotional efforts to encourage families to give priority to the nutritional needs of pregnant and lactating women, and children, or on promotion of family planning . in such cases, there might be little to be gained by diverting resources towards a screening operation to identify and treat individuals with the risk factor.

In some situations it may be preferable to mount a mass public education campaign to encourage those with a given risk factor , symptom, or sign to consult the health services, rather than having health workers go out to find them. The self-referral of symptomatic persons would be followed by appropriate diagnostic tests and accompanied by case-finding activities covering persons consulting the health services for other reasons. This approach depends on the health services being readily accessible to those at risk, and on a successful mass education effort.