# Health Project Prioritization in Meta, Colombia, Using Anp-Dematel
## 3 Materials and Methods
### Construction of the Influence Matrix Between Network Elements
\begin{table}
\begin{tabular}{c c} \hline \hline
**Objective** & **First-Level Criterion** & **Second-Level Criterion** \\ \hline C.2 Healthy Living and & C.2.1 Reduce circulatory system diseases \\ Non-Communicable Conditions & (ischemic heart disease). cerebrospinal \\ disease and hypertension & C.2.2 Reduce oral health conditions (oral \\ varices, fissured tongue. cold sores, \\ periodontitis, cavities, oral infections, etc.) \\ \hline C.3 Social Cohesion and Mental Health & C.3.1 Reduce the mortality rate due to \\ intentional self-inflicted injuries (suicide) & C.3.2 Decrease the incidence rate of \\ domestic violence \\ \hline C.4 Food and Nutritional Security & C.4.1 Reduce percentage of departmental \\ population with Unsatisfied Basic \\ Needs (UBN) & Needs (UBN) \\ C.4.2 Decrease the prevalence of acute \\ malnutrition in children under five years old \\ \hline C.5 Sexuality. Sexual and & C.5.1 Lower the mortality rate from HIV/AIDS \\ Reproductive Rights & C.5.2 Reduce the fatality rate of congenital \\ syphilis among live births \\ \hline C.6 Public Health in Emergencies & C.6.1 Expand hospital capacity to respond to \\ and Disasters & emergencies and disasters \\  & C.6.2 Increase availability of basic and \\ advanced (medicalized) patient transport in \\ emergencies or disasters \\ \hline C.7 Healthy Living and & C.7.1 Decrease mortality rate from acute \\ Communicable Diseases & respiratory infections (pneumonia. influenza. \\ rhinitis. pharyngitis. tonsillitis. sinusitis. etc.) \\  & C.7.2 Reduce mortality rate from acute \\ diarrheal disease (ADD) in children under five \\ years old \\ \hline C.8 Differential Management of & C.8.1 Improve access to healthcare services for \\ Vulnerable Populations & rural and Indigenous populations \\  & C.8.2 Develop a culturally appropriate \\ healthcare model for ethnic populations \\ \hline C.9 Strengthening of Health & C.9.1 Implement the healthcare model based \\ Authority Management & on the Primary Health Care (PHC) strategy \\  & C.9.2 Improve service quality and installed \\ capacity for both departmental and \\ regional demand \\ \hline \hline \end{tabular}
\end{table} 
Table 1: _Cont._version of the instrument), all 29 participating specialists evaluated directional influences between elements. Their responses enabled the creation of a relational map that captured four dimensions of interaction: (i) mutual influences among criteria, (ii) impacts of criteria on alternatives, (iii) feedback effects from alternatives to criteria, and (iv) interdependencies among alternatives. This approach is consistent with DEMATEL protocols for complex system analysis, where each matrix entry quantifies the directed influence from one element to another. After two Delphi rounds, the expert panel achieved substantial agreement ([PERSON] \(\kappa\) = 0.78) on a six-point scale ranging from \"None\" (0) to \"Very High\" (5), with clear operational definitions. The scale is summarized in Table 3. The use of a 0-5 scale aligns with standard DEMATEL practice to reduce cognitive burden [31]; although debates continue regarding optimal granularity, evidence suggests that five-point scales enhance response quality without sacrificing discriminative power [18]. Complete documentation of individual expert judgments (E1 to E29) was maintained throughout the process. Appendix Table 2 presents the influence matrix from Expert E1, selected for its high consistency (CR = 0.92). Table 4 provides an illustrative submatrix that captures nuanced relationships--such as the moderate influence of water access (C.1.1) on cardiovascular health (C.2.1) and the absence of direct influence on suicide rates (C.3.1). These examples highlight the method's ability to detect specific directional relationships often missed by traditional ranking techniques. The resulting matrices enabled a comprehensive mapping of both direct and indirect relationships across the health system. This phase converted qualitative expert input into structured, quantifiable data, bridging theory and practical application.