Concept ONE

HEALTHY
COMMUNITY
INTRODUCTION
A Community is usually regarded as a
population in a given territory, which is
linked together by certain bonds. These bonds
may come from a government, language or general
COURSE
culture. Following this concept, one can say that a barrio, OBJECTIVE
municipality, city, province or nation is a community since
all these groupings possess the described characteristics. Developed an overview of the
course.
Community is considered as the second most important group. Recall the description of a
Community is the extension of the family which I viewed as the healthy community.
group of first importance. The community ompletes a persons
Identify the elements of a
social training, which started in the family.
healthy community
Explain the factors that affects
the health of a community
This chapter highlights the concept not only a
community but an ideal healthy community. It
emphasizes the characteristics , element
function, component, community
organizing and the function of a
midwife towards attaining a
healthy community

LEARNING CONTENT
Definition of community, characteristics and classification
Components of a community
Concepts of a healthy community
Elements of a healthy community
Factors that affect community health
Effects of a healthy community1
 DISCUSSION PROPER

COMMUNITY
A. Definition of Community -
 a social group determined by geographic boundaries with common values and interests. It functions
within a particular   social structure  and exhibits and creates norms, values, and   social institutions

B. Classification of Communities:
1. Urban - is characterized by high density, a socially homogenous population and a complex
structure, non-agricultural occupations.
2. Rural – is usually small and the occupation of the people is usually  farming, fishing, and food
gathering.
3. Rurban – a combination of rural and urban community.

C. Characteristics of a Community:
1. Environment
2. Population behavior
3. Human biology
4. System of Care

D. Elements of Community:
1. Promotion of healthful living
2. Prevention of health problems
3. Remedial care for health problems
4. Rehabilitation
5. Evaluation
6. Research
E. Characteristics of a Healthy Community
1. Prompts its members to have a high degree of awareness that, “we are community.”
2. Uses its natural resources while taking steps to conserve them for future generations.
3. Openly recognizes the existence of sub-groups and welcomes their participation in community
affairs.
4. Prepared to meet crises.
5. Has open channels of communication that allows information to flow among all sub-groups
of its citizens and in all directions.
6. Seeks to make each of its system’s resources available to all members of the community.
7. Has legitimate and effective ways to settle disputes and meet needs that arise within the
community.
8. Encourages maximum citizen participation in decision-making.

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 9. Promotes high level wellness among its members.

F. Functions of the Community:

1. Production, distribution, and consumption of goods and services.
2. Socialization
3. Social control
4. Social Participation
5. Mutual support

G. Components of a Community:
1. The People. – This represents the “core“ that makes up the community.
2. Eight (8) subsystems of the community:

a. Housing – includes the type and characteristics of housing   facilities in the

community.

b. Education – include laws, regulations, facilities, activities    affecting education.

c. Fire and Safety - Availability and accessibility of fire protection and safety services
and facilities.

d. Politics and Government - these include the existing   political structure, decision-
making process, pattern, leadership styles.

e. Health – includes health facilities and services.

f. Communication – these include systems, types and forms of communication

existing.

g. Economics – occupation, types of economic activities    engaged by the people.

h. Recreation - recreational activities and facilities including types of consumers.

H. Factors Affecting Community Health:

1. Physical Factors
2. Socio-Cultural Factors
3. economy

4. Individual behaviour

I. Community Health Care

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  Organized effort to promote health, prevent disease, and prolong life.
 Determinants of Health
1) Poverty
 Living in urban
 With elementary education
 No access to safe water
 No sanitary toilet
2) Food Security
3) Basic Literacy Rate
4) Gender & Women
5) Violence
6) Natural Hazards and Climate Change
7) Pollution, Water Supply and Sanitation

J. Community Organization.
 Collaboration of all health services and other services to learn about the people’s problems and plan
for action.

K. Benefits of Community Organizing:

1. Able to utilize problem solving method
2. Utilizes community resources
3. United and cohesive
4. Participation in decision making

L. Roles of the Midwife in Community Work

1. Guide- helps to achieve goals
2. Enabler- facilitates in community organization process
3. Therapist- clarifies issues, brings diverse groups together
4. Expert- gives technical advice

M. Benefits of Community Organizing:

1. Able to utilize problem solving method
2. Utilizes community resources
3. United and cohesive
4. Participation in decision making

N. Functions of the Rural Health Midwife (DOH)

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 1. Management
o Prepare annual health plan
o Identify training needs
o Recording, accounting of equipment, supplies

2. Health Care
o Provide quality service
o Assessment of health needs of clients, families
o MCH services
o Consultation and referral services
o Conduct clinic within catchment are
o Recording, filing

3. Epidemiology and Statistics

o Report disease incidence
o Monitor disease occurrence
o Alert MHO of any unusual incidence
o Report births and deaths
o Report performance using FHSIS

4. Community Health and Organization

o Identify community leaders, volunteers, GO, NGO
o Implement Community Health Plan
o Organize and monitor PHC activity
o Participate in community health organizations
o Follow-up/give technical support to BHWs, hilots, and other health workers
o Assessment of Community Health Needs
o Community Diagnosis

Activity # 1. Interview a Rural health midwife in your community on programs instituted to bring about
reforms towards achieving healthy community. How are these programs initiated, planned, implemented
and monitored. How the program affect the people

1. Identify the 3 function of midwife in DOH under

management
a. Prepare annual health plan

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 b. Identify training needs
c. Recording, accounting of supplies and
equipment

Concept TWO
Health Statistics and
Epidemiology

COURSE
OBJECTIVE
1. Define related terms
2. Identify health indicators of
INTRODUCTION a community
3. Explain the implications of

Health statistics is critical in identifying health statistics to community

and quantifying information on the health- health and development
related issues from vital records because it
measures the progress towards attainment of
improved and achieved public health goals. For example LEARNING CONTENT
maternal and infant mortality serves as important
indicators of the country's health, it influences policy II. Health Statistics and Epidemiology
development, funding of programs and research, and a. Health Statistics
measures of health care quality. Moreover, accurate
b. Health indicators,
implications
and timely documentation of births and deaths is
c. Epidemiology
essential to high-quality vital statistics. 

By identifying statistical trends and trails, midwives

can monitor local conditions and compare
them to state, national, and international
trends, to improve its services in the
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community..
 DISCUSSION PROPER

HEALTH STATISTICS
A. DEFINITION OF TERMS:
1. Statistics – refers to a systematic approach of obtaining, organizing, and analyzing numerical
facts that the conclusion may be drawn from them.
2. Vital Statistics - is the study of vital events such as births, deaths, illness, marriages, divorces,
separation
3. Health Indicators- a list of information which would determine the health of a    particular
community like population, crude birth rate, crude death rate, infant and maternal death rates,
neonatal death rate.
 statistical data which related the total number of various kinds of biologic or vital events
(like births, marriages, illnesses, and deaths) to the size and characteristics of the affected
population.
 Common health Indicator
a. Birth
b. Death
c. Marriages
d. Migration
 Common vital statistical indicator
a. Fertility rate
b. Mortality rate
c. Morbidity rate
4. Statistics of Disease (morbidity) and death (mortality) – indicates the    state of health of a
community and the success and failure of   health  workers
5. Rate- shows the relationship between a vital event and those person exposed to the occurrence
of said event, within a given area and during a specified unit of time.
6. Ratio- is used to describe the relationship between two numerical quantities or measures of
events without taking particular considerations to the time or place.
7. Crude or General Rates- refers to the total living population. It must be presumed that the total
population was exposed to the risk of the occurrence of the event.
8. Crude Rate-have for its denominator the total population of a specific geographic unit.
9. Specific rate- the event occurring to a specific group are related only to the affected segment of
the population: specific rate should be considered more valuable when comparing population
because one could be Zero in one group possessing particular characteristic like age,

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 educational attainment sex, marital status, occupation, race and even exposure to doiseases or
risk factors of disease.

10. Midyear population- estimated population as of july 1, of a specified year.

11. Live birth- condition wherein infants at or sometime after birth breaths spontaneously of shown
any other sign of life. Whether or not then placenta has been cut or not
12. Specific Rate – the relationship is for a specific population class or group
13. Crude Birth Rate – is the measure of one characteristic of the natural growth or increase in
population
CBR=No. of Registered Live Births x 1000
Population
14. Crude Death Rate- is the measure of one mortality from all causes which may result in a
decrease of population.
CDR= No. of Deaths Registered x 1000
Population
15. Infant Mortality in Rate- measures the risk of dying during the 1st year of live. It is good index of
the general health condition of a community since it reflects the changes in the environment
and health condition of the community.
IMR= No. of Deaths Under One Year of Age x 1000
Registered live Births
16. Maternal Mortality Rate- Measure the risk of dying from causes related to pregnancy,
childbirth, and puerperium. It is an index of the obstetrical care needed and received by
women in a community.
MMR= No. of Deaths from Maternal Causes x 1000
No. of registered Live Births
17. Fetal Death Rate- measure pregnancy wastage. Death of the product of conception occurs
prior to its complete expulsion, irrespective of duration of pregnancy.

FDR- No. of Fetal Deaths x 1000

No. of Live Births
18. Neonatal Death Rate- measure the risk of dying 1st month of life. It serves as an index of the
effects of prenatal care and obstetrical management of the newborn.

NDR= No. of Deaths Under 28 Days of Age x 1000

No. of Live Births

B. Implications of Health Statistics to Individual, Family,      and Community

1. An indispensable tool in planning, implementation, and evaluation of any health program.
2. Serve as indices of the health conditions obtained in a community or population group.
3. Provide valuable clues as to the nature of health services and actions needed.
4. Serve as bases for determining success or failure of such services/action.

C. Sources of Data:
1. Population census

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2. Registration of vital data
3. Health survey
4. Studies and researches

EPIDEMIOLOGY

A. Definition
Is the study of occurrences and distribution of diseases as well  as the distribution and
determinants of health states or events in specified population, and the application of this study to
the  control of health problems.

B. Uses of Epidemiology
According to Morris, Epidemiology is used to;

1. Study the history of health population and the rise and fall of diseases and changes in their
character.
2. Diagnose the health of the community and the condition of people to measure the distribution
and dimension of illness in terms of incidence, prevalence, disability, and mortality, to set health
problems in perspective and to define their relative importance and to identify groups needing
special attention.
3. Study the work of health services with a view of improving them.
4. Estimate the risk of diseases, accidents, defect, and the chances of avoiding them.
5. Identify syndromes by describing the distribution and association of clinical phenomena in the
population.
6. Complete the clinical picture of chronic diseases and describe their natural history.
7. Search for causes of health and disease by comparing the experience of groups that are clearly
defined by their composition, inheritance, experience, behavior and environments.

C. The Epidemiologic Triangle

1. Host – is any organism that harbors and provides nourishment for another organism
2. Agent – is the intrinsic property of microorganism to survive and multiply in the
environment to produce disease.
3. Environment – is the sum total of all external condition and influences that affects the
development of an organism which can be biological, social and physical.

D. 3 Components of the Environment

1. a. Physical environment - is composed of the inanimate surroundings such as the
geophysical conditions of the climate.
2. b. Biological Environment – makes up the living things around us such as plants and
animal life.
3. c. Socio-Economic environment – which may be in the form of level of economic
development of the community, presence of social disruptions, and the like.

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E. FACTORS AFFECTING DISEASE DISTRIBUTION

1. Person - refers to the characteristics of the individual who were   exposed

and contacted the infection or the disease in    question.
a. Age
b. Sex and Occupation
2. Place - refers to the features, factor or conditions which existed   in or
described the environment in which the disease   occurred.
a. Urban-rural differences
b. Socio-economic areas
3. Time – refers both to the period during which the cases of the   disease
being studied were exposed to the source of the  infection and the period during
which the illness  occurred.

F. Patterns of Disease Occurrence and Distribution

1. Sporadic Occurrence - is the intermittent occurrence of a few isolated and unrelated
cases given in a given locality.
2. Endemic Occurrence – is the continuous occurrence throughout a period of time, of the
usual number of cases in a given locality.
3. Epidemic Occurrence – is of unusually large number of cases in a relatively short period of
time.
4. Pandemic Occurrence – is the simultaneous occurrence of epidemic of the same disease
in several countries.

G. Steps in Epidemiological Investigation

1. Confirm diagnosis
2. Establish time and space relationship
3. Establish relationship to groups
4. Correlate data

H. Functions of the Midwife in Epidemiology

1. Surveillance of notifiable diseases
2. Coordinates with members of health team during disease outbreak
3. Case finding and collection of specimen
4. Isolate CD cases
5. Home care
6. Teach concurrent and terminal disinfection
7. Health Education to prevent spread
8. Follow-up cases and contacts
9. Conduct community Health Education

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 10. Refer cases
11. Coordinates with concerned community agencies
12. Records and reports

Concept THREE
 Community Health Care
Development Process
INTRODUCTION
A community health & well being may
be affected by many factors & everyone in COURSE
the community should play its role and react
OBJECTIVE
to community health needs.
 Describe the community as a client
This chapter labels a community health improvement
 Explain the approaches to community
process that provides a framework that maintains
development.
and improves health. A community can take a
 Discuss COPAR as a strategy for community
comprehensive approach by evaluating its health
development
needs, defining its resources and assets for health
promotion, develop and implement a strategy for
action.
Perilous to this procedure is insuring that suitable
steps are being taken by accountable parties &
that those activities are having the planned
LEARNING CONTENT
impact on health in the community. III. Community Health Care Development Process
a. Approaches to community development
This chapter also includes a
b. HRDP-COPAR Model as a strategy
discussion of the capacities for community development
needed to support performance c. Phases of COPAR
monitoring & health d. Critical Activities
improvement
activities.
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 DISCUSSION PROPER

COMMUNITY HEALTH CAREDEVELOPMENT

PROCESS

A. Approaches to Development:
1. Welfare Approach
 Is the immediate and/or spontaneous response to ameliorate the manifestation of poverty,
especially on the personal level?
 Assumes that poverty is God-given
 Believes that poverty is caused by bad luck

2. Modernization Approach
 Also referred to as “Project Development Approach
 Introduces whatever resources are lacking in a given community.
 Assumes that development consists of abandoning the traditional methods of doing this.
 Believes that poverty is due to lack of education and lack of resources .

3. .Transformatory/Participatory Approach
 The process of empowering the poor and the oppressed sectors of the society so that they
can pursue a more just and humane society.
 Believes that poverty is caused by the prevalence of exploitation, oppression, domination,
and other unjust structures.
B. HEALTH RESOURCE DEVELOPMENT PROGRAM (HRDP)
 Philippine Center for Population and Development (PCPD)
1. Initially known as Population Center Foundation (PCF), the Foundation started operations in
1973.
2. Major concern then was “managing the growth of the country’s population through fertility
reduction or family planning”.
3. February 15, 1991

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  PCF was renamed the Philippine Center for Population and Development (PCPD)
 To make health services available and accessible to depressed and underserved
communities in the Philippines.
 As an operating foundation, it expanded its scope beyond traditional population
concerns. Still in the context of population management, its programs addressed the
social and human development of rural and urban communities in the Philippines.
 PCPD operations is fully covered by earned income from trust funds and lease rentals
of the building that it owns and manages.
4. HEALTH RESOURCE DEVELOPMENT PROGRAM (HRDP PCPD)
 Cycles of HRDP:
 HRDP I
 HRDP II
5. HRDP II
 uses the same strategy but the program could not be sustained by the schools or
hospitals and the income generating projects eventually became a hindrance to the
goal of achieving the health program because the people tended to be more
interested in the income generated by the projects.

6. HRDP III
 Both HRDP I and II have brought about some changes in the community life of the
people. There was an established basic health infrastructures; basic health services
were increased, there were trained health workers and organized health groups to
take care of the healthy needs of the community. The PCPD refined the program and
resulted to what is now called HRDP III

7. Unique Features of HRDP III:

1. Comprehensive training of the staff and faculty.
2. Periodic training program and regular assistance.
3. PHC as the approach
4. Community organizing is the main strategy.
5. Participatory Action Research as facilitating strategy.
6. Available funds to finance community initiated projects.
 The HRDP III describes Community Organizing as a continuous and sustained process
of educating the people to let the m understand and develop their critical awareness
of the existing conditions; it is working with the people collectively and efficiently
discover their immediate and long-term problems and mobilizing the people to
develop their immediate needs toward the solution of their long-term projects.

8. DESCRIPTION
 The Health Resource Development Program (HRDP) was a model for the capability-
building of NGOs, such as medical and nursing schools, in community-based health.
Using the HRDP model, the project developed effective primary health care systems
in 28 depressed and underserved communities. This was achieved through the

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 improvement of the capabilities of four health NGOs to provide community outreach
services and to train and organize community residents in the management of their
health concerns. The project covered the targeted 28 communities, with each of the
four NGOs working in seven communities.

 These barangays were: (1) In Cagayan - Namabbalan, Sisim, Bugatay, Cabasan, Iriga
II, Iriga III and Iriga Turod under St. Paul's University. (2) In Quezon - Dalahican,
Ransohan, Talao-Talao I, Talao-Talao II, Talao-Talao III, Barra Island and Talipan
under Sacred Heart College. (3) In Cavite - Alingaro, Hukay, Pasong Kawayan, Biluso,
Ilang-Ilang, Asyungan and Buwisan under De La Salle University Emilio Aguinaldo
College of Medicine. (4) In Misamis

 Oriental - Bulao-Bulaos, Baikingon A, Baikingon B, Kamarahan and Sili-Sili under the

Liceo de Cagayan. Community health organizations(CHOs) were formed in these
communities.

 The CHOs mobilized the residents to participate in planning and implementing

community health projects and enabled them to undertake their own self-
improvement projects. Trainings on leadership, project development and
management, and participatory action research were provided by the project.
Community health workers were selected and trained to provide basic health
services. All four NGOs revised their curricula to make these more community
health-oriented.

C. COMMUNITY ORGANIZING AND PARTICIPATORY ACTION RESEARCH

(CO-PAR)
1. Definitions of COPAR:
 Community Organizing-Participatory Action Research has been the strategy used by
the HRDP III in implementing the Primary Health Care delivery in depressed
underserved communities to become self-reliant.
 COPAR is a social development approach that aims to transform the apathetic, poor
into dynamic, participatory and politically responsive community.
 a collective, participatory, transformative, liberative, sustained and systematic
process of building people's organizations by mobilizing and enhancing the
capabilities and resources of the people for the resolution of their exploitative
conditions
 A process by which a community identifies its needs and objectives, develops
confidence to take action in respect to them and in doing so, extends and develops
cooperative and collaborative attitudes and practices in the community
 A continuous and sustained process of educating the people to understand and
develop their critical awareness of their existing conditions, working with the
 People collectively and efficiently on their immediate needs toward solving their
long-term problems.

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2. Importance of COPAR
 An important tool for community development and people empowerment
 Prepares people/clients to eventually take over the management of a development
programs in the future.
 Maximizes community participation and involvement;

3. Principles of COPAR
 People especially the most oppressed, exploited and deprived sectors are open to
change, have the capacity to change, and are to bring about change.
 COPAR should be based on the interest of the poorest of sectors of society.
 COPAR should lead to a self-reliant community and society

4. CRITICAL STEPS (ACTIVITIES) in Building People’s Organization

 Integration
 Social Investigation
 Tentative Program Planning
 Groundwork
 The meeting
 Roleplay
 Mobilization or Action
 Evaluation
 Reflection
 Organization

5. COPAR Process
 A progressive cycle of action – reflection action
 Consciousness learning
 Participatory and mass-based
 Group-centered and not leader-oriented
6. Community Organizing- Community organizing is a continuous and sustained

process of:
 Guiding people to understand the existing condition of their own community
 Organizing people to work collectively and efficiently on their immediate and long-
term problems
 Mobilizing people to develop their capacity and readiness to respond and take action
on their immediate and long-term needs

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  A middle ground where the health care worker and the people need to attain
community organization.
 A liberal freedom of the community where the people are allowed to participate in
the overall health care status of their community
 A transformation force, that enables the individuals, families and communities to be
responsible for their own health.
 A phenomenon of interest goals and objectives and the people in their way to health
citizenry.
1. As applied to Primary Health Care, Community Organizing is defined as the
process and structures through which members of the community are tapped
to become organized for participation in health care and community
development activities.
2. As a process, Community Organizing is the sequence of steps whereby the
members of the community work together to critically assess and evaluate
community conditions to improve thee conditions.
3. As a structure, it refers to the particular group of community members that
work together for common health and health-related problems.
4. It can be culled from this definition that it is the people who organized
themselves into a working team who can effectively solve their own health
problems.

7. Importance of Community Organizing

 It provides the people with an opportunity to get involved and identify the common
health problems of their community.
 It guides the community in decision- making towards self-reliance.
 It guides people in analyzing the strengths and weaknesses of every possible solution

offered by them.

8. Objectives of Community Organizing:

 To make people aware of social realities toward the development of local initiative,
optimal use of human, technical, and material resources, and strengthening of
people’s capacities.
 To form structures that hold the people’s basic interests as oppressed and deprived
sectors of the community and as people bound by the interest to serve the people.
 To initiate the responsible actions intended to address holistically the various
community health and social problems.
9. Emphases Of Community Organizing In Primary Health Care
 The community works to solve their own problems.

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  The direction is internal rather than external.
 The development of the capacity to establish a project is more important than the
project

 There is consciousness-raising to perceive health and medical care within the total
structure of society.
10. Participatory Action Research
 As a process, Participatory Action Research (PAR) is an investigation on problems and
issues concerning life and environment of the underprivileged by way of research
collaboration with the underprivileged whose representatives participate in the
actual research as researchers themselves, doing research of their own problem.
 As a structure, the beneficiaries of the research are the main actors in the research
process. It enables the community to experience a collaborative consciousness of
their own situations. PAR involves research, education and actions to empower
people determine the cause of their problems, analysed these problems and act by
themselves in responding to their own problems. The essential element of PAR is
participation.
 PAR is a community-directed process of gathering and analyzing information for the
process of taking actions and making changes.
 In PAR, there is an outside researcher, a professional one who through immersion and
integration on the community becomes a committed participant and learner in the
community.

11. Objectives of PAR

 To encourage consciousness of the suffering and develop competence for changing
their own situation.
 To help in the organization building by harnessing both human and natural resources
in responding to community needs.
 To enhance the knowledge of the researcher in the community on the social reality
before them.

12. Participants in PAR

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  Outside Researcher. The outside researcher is a professional researcher, who is
committed and a learner; active learner rather than detached. He goes into an
immersion and integration in the community. He shares his research knowledge to
encourage genuine participation but would never assume a paternalistic
authoritarian attitude but leaves the application of that knowledge to the people of
the community.

 Local Researcher. The local researchers are trained in the process of research and
are made aware of the needs of their people and committed to do something about
them. The local researchers elicit active participation from community members for
collective data gathering, data analysis and action. They are the link between the

community and the outside resources.

D. PHASES OF COPAR PROCESS:

1. Pre-Entry Phase
 Is the initial phase of the organizing process where the community organizer looks
for communities to serve and help.
 It is considered the simplest phase in terms of actual outputs, activities and
strategies and time spent for it.
 Activities:
1. Site Selection:
 Do initial networking/consultation with local government units,
NGO’s
 Conduct Preliminary Social Investigation (PSI)
 Make long/short list of potential communities
 Do ocular survey of short listed communities
 General Secondary Data
 Develop community profile from secondary data
 Develop survey tools
 nterview barangay officials, leaders, key informants
 Coordinate with LGU, NGO’s for assistance
 Orientation on baseline survey
 Courtesy call to community leaders
 Conduct community assembly
 Conduct baseline survey
 Develop materials for information dissemination
 Conduct staff planning/strategizing for entry phase
2. Criteria for Initial Site Selection
 Must have a population of 100-200 families
 Economically depressed and underserved

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  No strong resistance from the community
 No serious peace and order problem
 No similar group or organization holding the same program
3. Identifying Potential Municipalities
 Make short/long list
4. Identifying Potential Barangay
 Same process as in selecting municipality
 Consult key informants and residents
 Coordinate with local government and NGO’s for future activities
5. Choosing Final Barangay

 Conduct informal interviews with community residents and

key informants.
 Determine the need of the program in the community
 Take note of political development
 Develop community profiles for secondary data
 Develop survey tools
 Pay courtesy call to community leaders
 Choose foster families based on guidelines
6. Identifying/Selecting of Host family
 House is strategically locted in the community
 Should not belong to the rich segment
 Respected by both formal and informal leaders
 Neighbors are not hesitant to enter the house
 No member of the host family should be moving out in the
community
2. ENTRY PHASE
 Sometimes called the “Social Preparation Phase.” Is crucial in determining which
strategies for organizing would suit the chosen community.
 This phase signals the actual entry of the community worker/organizer into the
community.
1. Guidelines for Entry:
 Recognizes the role of local authorities
 The appearance, speech, behavior, and lifestyle should be in keeping
with those of the community residents.
 Avoid raising the consciousness of the community residents
2. Activities:
 Integrate with community residents
 Deepening social investigation
 Disseminate information/sensitize community residents on the
program and PHC
 Formulate criteria selection of core group member
 Define roles and functions of the core group members

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 i. social preparation
ii. organizing research team
iii. set up community health organization
iv. identify potential community workers
 Mobilizing community to act on their health needs
 Continue social investigation
 Conduct team building activities
 Present baseline survey results to the community
 Conduct Self-Awareness Leadership Training (SALT) among core group
members
 Train community researchers
 Consult community to organize:
i. community Health Organization
ii. Community Research Team
 Core Group Formation
i. Core Group Formation
ii. Leader spotting through sociogram
1. Key persons- approached by most people
2. Opinion Leader- approached by key person
3. Isolates- never or hardly consulted
3. Criteria Used for Spotting Potential Leaders:
 Belongs to the poor sectors and classes and is directly engaged in
production.
 well-respected by the members of the community and has relatively
wide influence
 desirous of change and is willing to work for change
 have time, conscientious and resourceful in work
 able to communicate effectively
4. Criteria in the Selection of Core Group Member
 Must be respected member of the community.
 Must belong to the poor sectors or classes in the community.
 Must be responsible, committed individuals, willing to work for social
change and transformation.
 Must be willing to learn.
 Must possess good communication skills.
5. Tasks of the Research Team
 Clarify research issues and its interrelationships with other problem
 Identify data needed for the research
 Identify the sources of the information
 Identify the type of research that is appropriate
 Formulate the research tool
 Pretest the research too and revise as necessary

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  Plan the conduct of the research
 Collect data
 Tabulate the data
 Analyze the primary data
 Prepare for the research validation/consultation
 Conduct the research validation/consultation

3. COMMUNITY ACTION AND ORGANIZATION – BUILDING PHASE

 It signals the start of community self-management because it entails the formation
of more formal structure and the inclusion of more formal procedure of planning,
implementing, and evaluating community-wise activities.
 It is at this phase where the organized leaders or groups are being given training to
develop their style in managing their own concerns/programs.
1. Key Activities:
 Community self-management
 Election of CHO Officers - Community Health Organization (CHO)
 Preparation of legal requirements
 Guidelines in the organization of the CHO by the Core group
 Organize/train CHW’s and second liners
 Participatory Action Research (PAR) > Development plan of project
proposal
 Research Team Committee
 Planning Committee
 Organize working committees
 Consolidate community diagnosis and PAR results
 Formulate community health plan
 Link with other LGU’s INGO’s for financial and technical assistance

4. SUSTENANCE AND STRENGTHENING PHASE

 This is the last phase when the community can already stand on their own, thus the
people can sustain the program even without the help from the project
implementers.
 Occurs when the community organization has already been established and the
community members are already actively participating in community-wide
undertakings.
 At this point, the different committee’s set-up in the organization-building phase are
already expected to be functioning by way of planning, implementing, and
evaluating their own programs, with the overall guidance from the community-wide
organization.
1. Key Activities
 Training of CHO for monitoring and implementing of community
health program

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  Develop financial and management systems
 Assess /re-plan community health programs
 Institutionalize linkages, referral points
 Formulation/ratification of constitution and by-laws
 Apply for SEC registration /LGU Accreditation
 Linkaging and networking
 Conduct of mobilization on health and development concerns
 Implementation of livelihood projects
 Negotiate absorption of CHW’s by LGU
 Affiliate with other groups

Concept FOUR
CARE ENHANCEMENT QUALITIES OF
HEALTH WORKERS
IN COMMUNITY
SETTING
INTRODUCTION

One of the trusted health provider in the

community is the midwife because they empower
the community. Health workers are widely known COURSE
to improve the health of the communities by linking
OBJECTIVE
them to health care and social services, educating them
 Describe a community health
about disease and injury prevention, working to make health worker
services more accessible, and by mobilizing the communities to  Enumerate qualities of a
create positive change. They also serve as counsellors, helping community health worker 22
 Identify functions of a
 LEARNING CONTENT
IV. Care Enhancement Qualities of health workers in
community setting
a. The community health worker
b. Qualities of a health worker
c. Functions of a health worker
d. The community health worker as a health
educator
e. Conflict Management

DISCUSSION PROPER

Community Health Worker

A. Definition
 A community health worker is one who provides basic community health care services for
promotion of health, prevention of illness, simple treatment and rehabilitation.

B. Qualities of a Health worker

1. Open - accepts need for joint planning and decision relative to health care in a particular
situation not resistant to change.
2. Tactful – does not embarrass people but give constructive criticisms; presides meeting or
discussions in a subtle manner
3. Objective – unbiased and fair
4. Good listener – always available and attentive to the client’s communication and needs.
5. Efficient - produces the expected output with considerations to cost and time
6. Flexible – adapts easily and makes necessary adjustment appropriately

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 7. Critical thinker - decides on what has been analyzed

C. Functions of a Health Worker

1. Community Health Service Provider- Carries out health services contributing to the
promotion of health,   prevention of illness, early treatment of illnesses and rehabilitation.
Appraises health needs and concerns of clients (existing or potential)
2. Facilitator -Helps plan a comprehensive program with the people. Provides continuing
guidance and supervisory assistance.
3. Health Counselor- Provides health counseling including emotional support to individuals,
family, group and community.
4. Health Educator- Improves the health of the people by employing various methods or
scientific procedures to stimulate, arouse, and guide people to healthful ways of living. She
takes into considerations the 3 aspects of health education.
 Information – provision of knowledge
 Education – change in knowledge, attitude and skills
 Communication – exchange of information
D. Traits and Qualities of a Health Educator
1. Efficient – plans with the people, organizes, conducts, and directs health education activities
according to the needs of the community.
2. Good communication – provides participants/clients with clear and relevant   information.
3. Keen observer – keeps an eye on the proceedings, processes, and client’s behavior
4. Systematic – knows how to put in sequence or logical order the parts of the  session
5. Creative and resourceful – makes use of available resources; innovative.
6. Knowledgeable – able to impart relevant, updated, and sufficient input needed by the
client.
7. Open – invites ideas, suggestions and criticisms; involves people indecision making
8. With sense of humor – knows how to place a touch of humor to keep clients alive during
the session.

E. Conflict Management
1. CONFLICT- Conflict means to come into opposition whether weapons as in battle, or
physically as in children’s round and tumble, or verbally as in quarrel between friends.
2. Conflict within an organization may be:
 Intrapersonal conflict – occurs within the person
 Interpersonal conflict - is a conflict between people, groups, or team members on
issues which are of personal nature.
 Organizational conflict – occurs within the organization, specifically the
disagreement between 2 or more parties or between 2 or more positions as to how
to best achieve the organization’s goals
3. Common conflict resolution methods
 Avoiding. Someone who uses a strategy of "avoiding" mostly tries to ignore or
sidestep the conflict, hoping it will resolve itself or dissipate.

24
 i. also known as a “lose-lose situation” through unassertive or uncooperative
means of settling conflict because it does not address the conflict but just let
it go away.
 Accommodating. Using the strategy of "accommodating" to resolve conflict
essentially involves taking steps to satisfy the other party's concerns or demands at
the expense of your own needs or desires.
 Compromising. The strategy of "compromising" involves finding an acceptable
resolution that will partly, but not entirely, satisfy the concerns of all parties
involved.
 Competing. Someone who uses the conflict resolution strategy of "competing" tries
to satisfy their own desires at the expense of the other parties involved.
 Collaborating. Using "collaborating" involves finding a solution that entirely satisfies
the concerns of all involved parties.
4. Outcomes of Conflict:
 Win/lose - is the predominant form in our culture where we tend to define
situations.

i. Ex. In sports, education, business, personal relations – as competition for

scarce resources, the trophy, scholarship, the job.
 Lose/lose – this approach leads easily into a lose/lose situation, since anger and
resentment of the loser does not disappear, but simply goes   underground to
emerge later as backlash.
i. Ex. In a quarrel between two siblings regarding a toy, when
parents intervenes and establish ownership for the younger child, the
resentment of the older child may express itself by breaking the toy
so that neither one can play with it.
 Win/win- competition for scarce goods. Here, the achievement of one may include
the achievement of the other.

i. When 2 groups have identified a common goal which will both benefit them.
Like when members of a consumer cooperative pool their efforts to improve
the quality and reduce the cost of food to each member.

5. Causes of Conflict:
 Difference in needs, values and wants
 Differences in perceptions
 Differing Anticipation of possible Losses and Gains
 Inability to integrate differences and the inability to give and take

6. Three Basic Ways of Handling Conflict

 Moving away from it either by total denial, or by suppressing or
minimizing the differences or by distracting ourselves and the other by changing the
subject, or by giving in, surrendering.

25
 Partial or total suppression of conflict leads to physical and/or psychological sickness for the
weaker party or the manipulation and emotional blackmail which interferes with the
relationship on the part of the powerful party.

 Moving against the other, fighting back in an attempt to overpower the other.
This mode produces escalation in feelings of anger and hostility and in violence of actions
and reactions

 Moving toward the conflict in an open confrontation.

i. Confrontation is a way of using opposition constructively, trying to move
from a win/lose toward a win/win situation.

 For the effective functioning of the group, the aim of the person should not be the
elimination of conflict.
 His concern should be on the “How” of handling conflict. If handled properly, conflict
can be the source of organization of growth and development.
 If handled wrongly, it can be the source of psychological decline and decay

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 Concept Five

APPLICATION OF
COPAR IN
COMMUNITY HEALTH
INTRODUCTION CARE PROCESS

This chapter focuses primarily on the

processes that we can use to effectively apply
COPAR in the community.

COPAR or Community Organizing
Participatory Action Research is a vital part
of public health. COPAR aims to transform
the apathetic, individualistic and voiceless poor
into dynamic, participatory and politically COURSE
responsive community
OBJECTIVE
1. Enumerate ways on how to become an
LEARNING effective health educator
2. Recall the steps of the health care27
 DISCUSSION PROPER

A. Health Care Process

 a scientific and systematized approach to health care for individuals, families and
community for health promotion and illness prevention.

B. Steps in the community Health Care Process

1. COMMUNITY Assessment- getting to know the community clients which include:
 Decide what data to be gathered
i. Demographic data- population size, structures/composition, distribution,
density.
ii. Socio-economic data- occupation, income level, land ownership, production
quality
iii. Politics- leadership structure and style, decision-making process and pattern
iv. Culture- values, benefits people uphold, norms, culture group, etc.
v. Environment- topographical/geographical characteristics, sanitary condition
vi. Health care delivery system
 Plan the process of data gathering
i. Determining data gathering methods
ii. Interview- a face to face conversation between 2 individuals in which one
seeks information and data provides it.
iii. Observation- process of obtaining data through visual means
iv. Review the secondary data

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 v. Community survey
 Plan the data gathering activity
i. Determining participants to the data gathering process
ii. Actual data
iii. Preparation of the assessment report, including the list prioritized
needs/concerns

2. PLANNING FOR A PROGRAM OF ACTION/PROJECT

 Determining the objectives for care/action
i. Identify what is to be done and what outcomes might be expected from the
program
ii. Criteria for setting objectives
o Realistically achievable within the competence of the implement or
Specifically stated
o Flexible enough to allow for change
o Closely related to the problems/ needs/concerns identified and felt by
the patient
o Closely coordinated with those of the health care team
 Select activities and methods/strategies for achieving the objectives
i. these are a variety of activities that may be employed to meet the objectives
and this includes the ff:
1. Home visits
2. Conference/ demonstration
3. Health service delivery
4. Group discussion/education
5. Information dissemination
 The following activities are considered in selecting activities
i. Consider need/capabilities of client
ii. Identify target clientele
iii. Review traditional activities and select those not detrimental to health, life
and limb
iv. Bear in mind that a balanced program is far more effective than those which
are unbalanced or biased
v. Estimate the time needed
vi. Identify the person responsible
vii. Develop monitoring and evaluation scheme methods, tools, strategies for
evaluation
1. Self-evaluation
2. Peer evaluation
3. Evaluation by superiors
4. Analysis of statistical reports
5. Use of standards Records review
6. Use of tests

29
 7. Case discussion
8. Action reflection action session (ARAS)

3. PROGRAM IMPLEMENTATION.
 In this phase, plans are actually carried out, resources are actually mobilized to meet
objectives set. Very critical is the active participation of the people.

4. PROGRAM MONITORING AND EVALUATION

 Evaluation
i. Is an essential component of planning and should be built- in as the plan of
services is constructed or development.
ii. Is a process that is designed to show the relationship between services
rendered and the objectives or purposes of the service/unit/care provider.
iii. Not a record or account of what was done but of what DIFFERENCE the
“doing” made.
iv. Is mainly used to help in the selection and designed in the future
plans/programs/projects.
v. Is assessment of whether or not the planned strategy or plan of care actually
worked for the client or not.
vi. Types of Evaluation
1. Impact evaluation- estimate the impact of care or of a program on a
client by comparing the conditions of the effected groups after it has
taken place with what they would have been.
2. Cost effective analysis- is done to compare alternative care
intervention in terms of the cost of producing a given output.
 Monitoring
i. Is an internal program, care activity concerned to assess whether recourses
are being used as intended and whether they are producing the intended
outputs.
ii. Both monitoring and evaluation are vital elements of care. Both are
interrelated processes and require baseline information and documentation
during implementation

30
 References
REFERENCES:
1. https://www.slideshare.net/mamirich12/community-health-care-development-process
2. Community Health Nursing services in the Philippines, Community health Nursing Section, 10 th Edition,
copyright 2019
3. Health Care Practice in the community, Erlinda Castro- Palaganas, 1 st Edition, copyright 2017
4. A Learning Guide for Allied Health Students Towards Community Health Development, Arnold F.D Arcania,
1st Edition, 2017

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