# Health Project Prioritization in Meta, Colombia, Using Anp-Dematel
## 5 Discussion  
The prioritization analysis identified the replacement of the healthcare center in Puerto Gaitan (A05, 29.84%) as the highest-ranked project due to its strategic role in the hospital accessibility network. These findings underscore infrastructure improvement as a key driver of equity, aligning with approaches in Argentina, where multicriteria evaluation has guided the placement of new healthcare centers in underserved areas [40]. In contrast, Cuba and Uruguay prioritize primary healthcare, reflecting their advanced infrastructure and focus on preventive strategies [41]. This divergence highlights the need for prioritization frameworks to adapt to local contexts. The proposed prioritization reflects the needs identified in the ASIS 2021 [7] and is designed to generate tangible impacts. A05 not only addresses a historical infrastructure gap but could also reduce UBN by an estimated 25% within its coverage area. A03, related to emergency regulation, would prevent an estimated USD 2.5 million in annual losses due to avoidable incapacities, based on the regional burden of disease models presented in ASIS 2021 [7]. A02 and A01 prioritize territories with over 50% Indigenous population and elevated maternal mortality rates, directly contributing to the reduction of rural health disparities. \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline
**Comparisons** & **Kendall (r-b)** & **\(p\)-Value** & **Kendall Compatibility** & **S-S-Saty** & **S-Sauty Compatibility** & **G-Garuti** & **G-Garuti Compatibility** \\ \hline E1–E2 & 0.4 & 0.483 & Low & 0.037 & Null & 0.2247 & Null \\ E1–E3 & \(-0.2\) & 0.817 & Very Low & 0.035 & Null & 0.1903 & Null \\ E1–E4 & 0.0 & 1.000 & Null & 0.035 & Null & 0.2448 & Null \\ E2-E3 & 0.0 & 1.000 & Null & 0.037 & Null & 0.2043 & Null \\ E2-E4 & 0.6 & 0.233 & Moderate & 0.037 & Null & 0.2275 & Null \\ E3-E4 & 0.0 & 1.000 & Null & 0.035 & Null & 0.2189 & Null \\ E1-Group & 0.8 & 0.801 & High & 0.036 & Null & 0.2074 & Null \\ E2-Group & 0.2 & 0.817 & Very Low & 0.038 & Null & 0.1993 & Null \\ E3-Group & 0.0 & 1.000 & Null & 0.036 & Null & 0.1917 & Null \\ E4-Group & \(-0.2\) & 0.817 & Very Low & 0.037 & Null & 0.2204 & Null \\ \hline \hline \end{tabular}  
* The table includes selected stakeholder comparisons to illustrate the correlation metrics. Additional pairwise comparisons were conducted but are not shown here for readability purposes.  
\end{table} 
Table 11: Correlation metrics. Notably, decision-making criteria vary across regions and reflect not only technical and socioeconomic factors but also deeper political ideologies. In Brazil, efficiency and equity dominate healthcare planning, particularly in high-inequality settings, whereas Cuban policymakers prioritize equity over efficiency [42]. This contrast may be explained by ideological underpinnings: Brazil's decentralized and market-oriented governance tends to emphasize managerial efficiency, while Cuba's centralized socialist model places equity at the core of its public health strategies. Colombia has adopted integrated ANP-DEMATEL methodologies for health sector project prioritization, though these are typically applied at the national level. By focusing on the regional level (Meta department), this article demonstrates how prioritization frameworks must be sensitive not only to territorial specificities but also to the institutional and normative context in which decisions are made. Financial sustainability emerged as a critical consideration, raising questions about the long-term viability of proposed investments. A key debate centers on whether sustainability should focus solely on resource management or incorporate structural reforms to ensure equitable and efficient resource distribution. Sustainability must be evaluated not only economically but also through social and political lenses, necessitating broader discussions on healthcare equity and the State's role in service provision [43; 44].