Community Health Community Health NursingNursing

Community:Community:

Group of people with common Group of people with common characteristic or interests living characteristic or interests living together with in a territory or together with in a territory or geographical boundary geographical boundary

A social organization that is A social organization that is territorially localized and territorially localized and through which its members through which its members satisfy most of their daily needs satisfy most of their daily needs and deal with most of their and deal with most of their common problemscommon problems

Elements of a community:Elements of a community:

1.A population or groups of people1.A population or groups of people2. An area or territory2. An area or territory3. A sense of interrelatedness or social interaction3. A sense of interrelatedness or social interaction4. Sharing of common ties or a bond4. Sharing of common ties or a bond

- the essence of a community lies in the - the essence of a community lies in the relationships within itrelationships within it- as a social organization, it has a dynamic - as a social organization, it has a dynamic phenomenon within different statuses and rolesphenomenon within different statuses and roles- roles in the community are patterned for the - roles in the community are patterned for the performance of functionsperformance of functions- members of the community carry on their - members of the community carry on their respective roles to enhance common goalsrespective roles to enhance common goals

Health– Health– state of complete physical, mental, and social well-being, state of complete physical, mental, and social well-being, not merely the absence of disease or infirmitynot merely the absence of disease or infirmity

Community Health-Community Health- part of paramedical or medical intervention/ part of paramedical or medical intervention/ approach which is concerned on the health of the whole or approach which is concerned on the health of the whole or populationpopulation

Public Health-the science and art of preventing disease, prolonging Public Health-the science and art of preventing disease, prolonging the efficiency thru organized community effort to:the efficiency thru organized community effort to:

sanitation of the environmentsanitation of the environment control of communicable diseasescontrol of communicable diseases the education of the individual in personal hygienethe education of the individual in personal hygiene the organization of medical and nursing service for the early the organization of medical and nursing service for the early

diagnosis and preventive treatment of diseasediagnosis and preventive treatment of disease the development of social machinery to ensure every one a the development of social machinery to ensure every one a

standard of living, adequate for the maintenance of health to standard of living, adequate for the maintenance of health to enable every citizen to enable every citizen to realize his birth right of health andrealize his birth right of health and longevitylongevity..

- Dr. C. - Dr. C. WinslowWinslow

Priorities in public health:Priorities in public health:1.the survival of human species1.the survival of human species

2. the prevention of conditions which lead 2. the prevention of conditions which lead to the destruction of retardation of to the destruction of retardation of human function and potential in the human function and potential in the early years of lifeearly years of life

3. the achievement of the human 3. the achievement of the human potential potential

4. prevention of the loss of productivity 4. prevention of the loss of productivity of young adults and those in the middle of young adults and those in the middle period of life period of life

5. improvement of quality of life, 5. improvement of quality of life, especially in later yearsespecially in later years

ECO-SYSTEM influences the ECO-SYSTEM influences the OLOFOLOF

FACTORS:FACTORS: PoliticalPolitical BehavioralBehavioral HeredityHeredity Health care delivery systemHealth care delivery system EnvironmentEnvironment Socioeconomic influenceSocioeconomic influence

Community Health NursingCommunity Health Nursing- learned practice discipline with the ultimate learned practice discipline with the ultimate

goal of contributing, as individual and in goal of contributing, as individual and in collaborative with others, to the promotion collaborative with others, to the promotion of the clients optimum level of functioning of the clients optimum level of functioning through teaching and delivery of carethrough teaching and delivery of care

Public Health NursingPublic Health Nursing --a special field of nursing that combines the a special field of nursing that combines the

skills of nursing, public health and some skills of nursing, public health and some phases of social assistance for the phases of social assistance for the promotion o health, the improvement of promotion o health, the improvement of conditions in the social and physical conditions in the social and physical environment, rehabilitation, prevention of environment, rehabilitation, prevention of illness and disability.illness and disability.

- The WHO Expert Committee of Nursing- The WHO Expert Committee of Nursing

Concepts in Public Health Concepts in Public Health NursingNursing

population-basedpopulation-based community focusedcommunity focused multi-disciplinary approachmulti-disciplinary approach man as an open systemman as an open system

Philosophy Philosophy The family is the smallest unit in a The family is the smallest unit in a

democratic societydemocratic society Values and changes in the society it Values and changes in the society it

serves as well as the advances in serves as well as the advances in medicines, philosophy, sociology must be medicines, philosophy, sociology must be consideredconsidered

Family and community are the patient of Family and community are the patient of public health nursepublic health nurse

Community Health Nurse has a unique Community Health Nurse has a unique identity within the professions is dealing identity within the professions is dealing with the individual, family and communitywith the individual, family and community

Concepts of Community Health NursingConcepts of Community Health Nursing

The primary focus of community health nursing practice is on The primary focus of community health nursing practice is on health health promotionpromotion. The community health nurse, by the nature of her work, has . The community health nurse, by the nature of her work, has the opportunity and responsibility for evaluating the health status of the opportunity and responsibility for evaluating the health status of people and groups and relating them to practice.people and groups and relating them to practice.

Community health nursing practice is extended to benefit not only the Community health nursing practice is extended to benefit not only the individual but the family and communityindividual but the family and community

Community health nurses are Community health nurses are generalistsgeneralists in terms of their practice in terms of their practice throughout life’s continuum – its full range of health problems and needs.throughout life’s continuum – its full range of health problems and needs.

Contact with the client and/or family may continue over a long period of Contact with the client and/or family may continue over a long period of time which includes all ages and all types of health care.time which includes all ages and all types of health care.

The nature of community health nursing practice require that current The nature of community health nursing practice require that current knowledge derive from the biological and social sciences, ecology, clinical knowledge derive from the biological and social sciences, ecology, clinical nursing and community health organization be utilized.nursing and community health organization be utilized.

The dynamic process of assessing, planning, implementing and The dynamic process of assessing, planning, implementing and intervening, provide periodic measurements of progress, evaluation and a intervening, provide periodic measurements of progress, evaluation and a continuum of the cycle until the termination of nursing is implicit in the continuum of the cycle until the termination of nursing is implicit in the practice of community health nursing.practice of community health nursing.

PrinciplesPrinciples CHN services is based on recognized CHN services is based on recognized

needs and problems of communities, needs and problems of communities, families, groups and individuals.families, groups and individuals.

The Community Health Nurse must The Community Health Nurse must understood fully the objectives and understood fully the objectives and policies of the agency he/she representspolicies of the agency he/she represents

In CHN, the family is the unit of service.In CHN, the family is the unit of service. CHN must be available to all regardless of CHN must be available to all regardless of

race, creed, and socio-economic statusrace, creed, and socio-economic status Health teaching is a primary responsibility Health teaching is a primary responsibility

of the Community Health Nurse.of the Community Health Nurse. The community health nurse works as a The community health nurse works as a

member of the health team.member of the health team. There must be a provision for periodic There must be a provision for periodic

evaluation of community health nursing evaluation of community health nursing servicesservices

Opportunities for continuation staff execution Opportunities for continuation staff execution program nurses must be provided by the program nurses must be provided by the community health nursing agency. The community health nursing agency. The community health nurse also has responsibility community health nurse also has responsibility for his/her own professional growth.for his/her own professional growth.

The community health nurse utilizes already The community health nurse utilizes already existing active organized groups in the existing active organized groups in the community.community.

There must be provision for educative There must be provision for educative supervision in CHN.supervision in CHN.

The community health nurse make use of The community health nurse make use of available community health resourcesavailable community health resources

There should be accurate recording and reporting There should be accurate recording and reporting in CHNin CHN

The CHN does not provide material relief but The CHN does not provide material relief but refers the patient and family to appropriate refers the patient and family to appropriate community resources for necessary financial, community resources for necessary financial, social assistance.social assistance.

Qualifications of a Public Health Nurse:Qualifications of a Public Health Nurse:

Professional Qualifications: BSN, RNProfessional Qualifications: BSN, RN Personal QualificationsPersonal Qualifications Good physical and mental healthGood physical and mental health Interest and willingness to work in the communityInterest and willingness to work in the community Capacity and ability to:Capacity and ability to: - relate practice with ongoing community health activities- relate practice with ongoing community health activities -work cooperatively with other disciplines and community members-work cooperatively with other disciplines and community members -take actions needed to improve self and service-take actions needed to improve self and service -analyze combination of factors that influence health -analyze combination of factors that influence health -apply nursing process in meeting health and nursing needs of the -apply nursing process in meeting health and nursing needs of the

communitycommunity -mobilize resources in the community-mobilize resources in the community Leadership potentialLeadership potential Resourcefulness and creativityResourcefulness and creativity Honesty and integrityHonesty and integrity Active membership to professional working organizationsActive membership to professional working organizations

Functions of the Public Health Nurse:Functions of the Public Health Nurse:Management FunctionManagement Function nurse organizes the nursing services of the local health nurse organizes the nursing services of the local health

agencyagency involves preparation of the nursing service plan as well as involves preparation of the nursing service plan as well as

the overall municipal health planthe overall municipal health plan involves program management: the delivery of package involves program management: the delivery of package

services provided by the program to the target clientelservices provided by the program to the target clientel

Supervisory FunctionSupervisory Function generally supervises midwives and auxiliary health workersgenerally supervises midwives and auxiliary health workers formulates supervisory plan and conducts supervisory formulates supervisory plan and conducts supervisory

visits for implementationvisits for implementation

Nursing Care FunctionNursing Care Function the inherent function of a nursethe inherent function of a nurse makes use of knowledge and skills in nursing processmakes use of knowledge and skills in nursing process home visits are visible manifestations of her caring home visits are visible manifestations of her caring

functionfunction involves referrals to appropriate levels of care when involves referrals to appropriate levels of care when

indicatedindicated

Collaborating and Coordinating FunctionCollaborating and Coordinating Function bringing activities and group of activities systematically bringing activities and group of activities systematically

into into proper relation or harmony with each otherproper relation or harmony with each other establish linkages and collaborative relationships with establish linkages and collaborative relationships with

other agencies and health professionalsother agencies and health professionalsHealth Promotion and Education FunctionHealth Promotion and Education Function health teachings and health information campaignshealth teachings and health information campaigns involves understanding of the multidimensional level of involves understanding of the multidimensional level of

health essential in planning and promoting interventions health essential in planning and promoting interventions for communitiesfor communities

educator:educator: involves providing clients with information that involves providing clients with information that allows them to make healthier choices and practicesallows them to make healthier choices and practices

Training FunctionTraining Function initiates formulation of staff development and training initiates formulation of staff development and training

program for midwives and other auxiliary health workerprogram for midwives and other auxiliary health worker community organizingcommunity organizingResearch FunctionResearch Function - participates in conducting research and utilization of - participates in conducting research and utilization of

research findings in practiceresearch findings in practice - disease surveillance: continuous collection and analysis of - disease surveillance: continuous collection and analysis of

data cases and deathsdata cases and deaths

Primary Health CarePrimary Health Care

Essential Health made universally Essential Health made universally accessible to individuals and families accessible to individuals and families in the community by means in the community by means acceptable to them thru their full acceptable to them thru their full participation and at cost that the participation and at cost that the community and country can afford at community and country can afford at every stage of development.every stage of development.

Strategies to promote equity in health Strategies to promote equity in health priorities:priorities:

vulnerable groupvulnerable group marginalizedmarginalized

MissionMission

To strengthen the health care system by To strengthen the health care system by increase opportunities and supporting the increase opportunities and supporting the conditions wherein people will manage conditions wherein people will manage their own healththeir own health

Alma Ata ConferenceAlma Ata Conference First conference on Primary Health Care was First conference on Primary Health Care was

held in Alma Ata, USSRheld in Alma Ata, USSR Legal Basis:Legal Basis: Letter of Instruction 949 signed Letter of Instruction 949 signed

on October 19, 1979 by Pres. Marcos a year on October 19, 1979 by Pres. Marcos a year after Alma Ata Conferenceafter Alma Ata Conference

PHC was declared in the ALMA ATA CONFERECE PHC was declared in the ALMA ATA CONFERECE in September 6-12, 1978 as a strategy to in September 6-12, 1978 as a strategy to community health development. community health development.

It is a strategy aimed to provide It is a strategy aimed to provide essential health care that is essential health care that is (concept):(concept):

CCommunity-basedommunity-based AAccessibleccessible PPart and parcel of the total socio-art and parcel of the total socio-

economic development effort of the economic development effort of the nationnation

AAcceptablecceptable SSustainable at an affordable costustainable at an affordable cost

Accessibility, acceptability, availability Accessibility, acceptability, availability and affordability of health servicesand affordability of health services

Strategies:Strategies: Health services are delivered where people Health services are delivered where people

live and worklive and work Development of indigenous/ resident Development of indigenous/ resident

volunteer health workers to provide health volunteer health workers to provide health carecare

Use of socially acceptable, appropriate and Use of socially acceptable, appropriate and affordable low cost technology sustainable affordable low cost technology sustainable by the communityby the community

Combined utilization of traditional Combined utilization of traditional medicinesmedicines

Partnership between the community Partnership between the community and health agencies in the provision and health agencies in the provision of quality, basic and essential health of quality, basic and essential health servicesservices

Strategies:Strategies: Community needs and priorities are bases Community needs and priorities are bases

for planning health services and activitiesfor planning health services and activities Inter/intra sectoral collaboration. Inter/intra sectoral collaboration.

Collaboration among all sectors Collaboration among all sectors (community, health , environment, social, (community, health , environment, social, political, economic, business, education, political, economic, business, education, religious, private and public religious, private and public organizations)organizations)

Community participationCommunity participationStrategies:Strategies: Awareness building and consciousness raising on health and Awareness building and consciousness raising on health and

development issuesdevelopment issues Community building and community organizingCommunity building and community organizing Planning, implementation, monitoring, and evaluation done Planning, implementation, monitoring, and evaluation done

by the peopleby the people Community discussions done through small group Community discussions done through small group

discussionsdiscussions Selection of community health workers by the communitySelection of community health workers by the community Formation of health committeeFormation of health committee Establishment of community health organizationEstablishment of community health organization Mass health campaigns and community mobilizationMass health campaigns and community mobilization Community health workers are given competency trainingCommunity health workers are given competency training Attitudes, knowledge and skills developed by CHW’s are on Attitudes, knowledge and skills developed by CHW’s are on

promotive, preventive, curative and rehabilitative health promotive, preventive, curative and rehabilitative health carecare

Regular supervision and periodic evaluation of CHW’s Regular supervision and periodic evaluation of CHW’s performance by the health staff and communityperformance by the health staff and community

Recognition of the rile of traditional healers in the delivery of Recognition of the rile of traditional healers in the delivery of carecare

Self relianceSelf relianceStrategies:Strategies: Income generating projects and activitiesIncome generating projects and activities Use of local indigenous resources available in the communityUse of local indigenous resources available in the community Training of community leaders on management skillsTraining of community leaders on management skills The community generates support for local health careThe community generates support for local health care5. Recognition of interrelationship between health 5. Recognition of interrelationship between health

and developmentand developmentStrategies:Strategies: Convergence of health, food, nutrition, water, Convergence of health, food, nutrition, water,

sanitation, and population servicessanitation, and population services Integration of PHC into national, provincial, municipal Integration of PHC into national, provincial, municipal

And barangay development plansAnd barangay development plans Coordination of activities with economic planning, Coordination of activities with economic planning,

education, agriculture, trade and industry, housing, education, agriculture, trade and industry, housing, public works, communication and social servicespublic works, communication and social services

MobilizationMobilization Strategies:Strategies: Establishment of an effective health referral Establishment of an effective health referral

systemsystem Multi sectoral and inter disciplinary linkagesMulti sectoral and inter disciplinary linkages IEC support using multi media channelsIEC support using multi media channels Collaboration among government agencies, Collaboration among government agencies,

NGO’s and community groupsNGO’s and community groups7. Decentralization 7. Decentralization Strategies:Strategies: Reallocation of budgetary resourcesReallocation of budgetary resources Advocacy for political will and support from the Advocacy for political will and support from the

national leadership to the barangay levelnational leadership to the barangay level RE orientation of health professional and other RE orientation of health professional and other

sectors regarding PHCsectors regarding PHC

Department of Health (DOH)Department of Health (DOH) Legal Framework:Legal Framework: R.A. 7160 (1991) Local Government R.A. 7160 (1991) Local Government

CodeCode -Provided for the decentralization of the -Provided for the decentralization of the

entire government. entire government. -All structures, personnel, and budgetary -All structures, personnel, and budgetary

allocations from the provincial health level allocations from the provincial health level down to the barangays were devolved to the down to the barangays were devolved to the local government units (LGUs) to facilitate local government units (LGUs) to facilitate health service deliveryhealth service delivery

-LGUs are now responsible for the delivery of -LGUs are now responsible for the delivery of basic health services (implementation basic health services (implementation function)function)

-DOH (governance function)-DOH (governance function)

E.O. 102 (1999)E.O. 102 (1999)The Department of HealthThe Department of Health is the national is the national

authority on health, providing technical authority on health, providing technical and other resource assistance to local and other resource assistance to local government units, people’s organization, government units, people’s organization, and other members of the civic society in and other members of the civic society in effectively implementing programs, effectively implementing programs, projects, and services that willprojects, and services that will

(a) promote the health and well-being of (a) promote the health and well-being of every Filipino, every Filipino,

(b) prevent and control diseases among (b) prevent and control diseases among population at risks, population at risks,

(c) protect individuals, families, and (c) protect individuals, families, and communities exposed to hazards and risks communities exposed to hazards and risks that could affect their health, and that could affect their health, and

(d)treat, manage, and rehabilitate (d)treat, manage, and rehabilitate individuals affected by diseases and individuals affected by diseases and disabilitydisability

Roles and Functions: DOHRoles and Functions: DOH 1. Leadership in Health1. Leadership in Health -national policy and regulatory institution where -national policy and regulatory institution where

LGUs and NGOs will base their direction for LGUs and NGOs will base their direction for healthhealth

2.Enabler and Capacity Builder2.Enabler and Capacity Builder -innovates new strategies in health to improve -innovates new strategies in health to improve

effectiveness of health programseffectiveness of health programs - ensures highest achievable standards of quality - ensures highest achievable standards of quality

health health carecare3. Administrator of Specific Services3. Administrator of Specific Services -manage selected national health facilities that -manage selected national health facilities that

shall serve as national referral centersshall serve as national referral centers -administers health emergency response services-administers health emergency response services

Vision: Vision: Health for all FilipinosHealth for all Filipinos DOH is the leader, staunch advocate, DOH is the leader, staunch advocate,

and model in promoting Health for and model in promoting Health for All in the PhilippinesAll in the Philippines

MissionMission: Ensure accessibility and quality : Ensure accessibility and quality health care to improve the quality of life health care to improve the quality of life of Filipinos, especially the poorof Filipinos, especially the poor

DOH shall guarantee equitable, DOH shall guarantee equitable, sustainable, and quality health for sustainable, and quality health for all Filipinos, especially the poor, and all Filipinos, especially the poor, and shall lead the quest in excellence for shall lead the quest in excellence for healthhealth

The Local Health SystemThe Local Health System RA 7160 (1991) - made local government RA 7160 (1991) - made local government

executives responsible to operate local executives responsible to operate local health care serviceshealth care services

Provincial GovernmentsProvincial Governments

- local government executive: governor- local government executive: governor

- operate provincial and district hospitals- operate provincial and district hospitals

City/ Municipal GovernmentsCity/ Municipal Governments

- local government executive: city or - local government executive: city or municipal mayormunicipal mayor

- operate Health Centers, Rural Health Units, - operate Health Centers, Rural Health Units, and Barangay Health Stations and Barangay Health Stations

International OrganizationsInternational Organizations

World Health Organization (WHO):World Health Organization (WHO):-the directing and coordinating authority for -the directing and coordinating authority for

health within the United Nations systemhealth within the United Nations systemWorld Health Assembly- the supreme World Health Assembly- the supreme

decision-making body for WHO. It meets decision-making body for WHO. It meets each year in May in Geneva, and is each year in May in Geneva, and is attended by delegations from all 193 attended by delegations from all 193 Member States.Member States.

Executive Board- composed of 34 members Executive Board- composed of 34 members technically qualified in the field of health. technically qualified in the field of health. Members are elected for three-year terms Members are elected for three-year terms

Objective:Objective: The attainment by all peoples The attainment by all peoples of the highest possible level of healthof the highest possible level of health

Core functions:Core functions: Providing leadership on matters critical to health and Providing leadership on matters critical to health and

engaging in partnerships where joint action is engaging in partnerships where joint action is neededneeded

Shaping the research agenda and stimulating the Shaping the research agenda and stimulating the generation, translation and dissemination of generation, translation and dissemination of valuable knowledgevaluable knowledge

Setting norms and standards and promoting and Setting norms and standards and promoting and monitoring their implementationmonitoring their implementation

Articulating ethical and evidence-based policy Articulating ethical and evidence-based policy options; options;

Providing technical support, catalysing change, and Providing technical support, catalysing change, and building sustainable institutional capacitybuilding sustainable institutional capacity

Monitoring the health situation and assessing health Monitoring the health situation and assessing health trendstrends

United Nations Children’s Fund United Nations Children’s Fund (UNICEF)(UNICEF)

-the United Nations (UN) body responsible -the United Nations (UN) body responsible for the rights of childrenfor the rights of children

Roles:Roles:

- required by the UN Convention to promote - required by the UN Convention to promote the effective implementation and to the effective implementation and to encourage international cooperation for the encourage international cooperation for the benefit of children. benefit of children.

-UNICEF is represented during UN -UNICEF is represented during UN Conventions and may be invited to provide Conventions and may be invited to provide expert advice on the implementation of the expert advice on the implementation of the conventionconvention

Global Structure of UNICEF:Global Structure of UNICEF:

-International offices:-International offices:

New York and GenevaNew York and Geneva

-Specialised offices: -Specialised offices:

Copenhagen- Supply Division which Copenhagen- Supply Division which manages the supply centres that are manages the supply centres that are essential in emergenciesessential in emergencies

Florence- Innocenti Research Centre well- Florence- Innocenti Research Centre well- known for its authoritative publications on known for its authoritative publications on childrenchildren

Funding:Funding:

-The UN does not fund UNICEF-The UN does not fund UNICEF

-Relies on voluntary donations to fund its -Relies on voluntary donations to fund its work for children worldwidework for children worldwide

-Raises funds for programs through -Raises funds for programs through donations, the sale of donations, the sale of cards and gifts, , partnerships with companies and and special events

DevelopmentDevelopment– – multi-dimensional process involving major multi-dimensional process involving major

changes in social structures, populations, changes in social structures, populations, attitudes, and national institutions, as well as the attitudes, and national institutions, as well as the acceleration of economic growth, reduction if acceleration of economic growth, reduction if inequality and eradication of absolute poverty. inequality and eradication of absolute poverty. The goal of development is to have a better life. The goal of development is to have a better life.

Community developmentCommunity development – organized effort of – organized effort of the people to improve the conditions of the people to improve the conditions of community life and the capacity of the people for community life and the capacity of the people for participation, self-direction and integrated efforts participation, self-direction and integrated efforts in community affairs. It advocates the principle of in community affairs. It advocates the principle of self-help and the voluntary participation and self-help and the voluntary participation and cooperation of people of the community, but cooperation of people of the community, but usually couples them with technical assistance for usually couples them with technical assistance for the government or voluntary organizations.the government or voluntary organizations.

Community OrganizationCommunity Organization– a process by which people, health services a process by which people, health services

and agencies of the community are brought and agencies of the community are brought together to:together to:

learn about the common problemslearn about the common problems identify these problems as their ownidentify these problems as their own plan the kind of action needed to solve plan the kind of action needed to solve

these problemsthese problems act on this basisact on this basis

Definitions of COPAR:Definitions of COPAR:

· A social development approach that aims to · A social development approach that aims to transform the apathetic, individualistic and transform the apathetic, individualistic and voiceless poor into dynamic, participatory voiceless poor into dynamic, participatory and politically responsive community.and politically responsive community.

· A collective, participatory, transformative, · A collective, participatory, transformative, liberative, sustained and systematic process liberative, sustained and systematic process of building people’s organizations by of building people’s organizations by mobilizing and enhancing the capabilities mobilizing and enhancing the capabilities and resources of the people for the and resources of the people for the resolution of their issues and concerns resolution of their issues and concerns towards effecting change in their existing towards effecting change in their existing oppressive and exploitative conditions (1994 oppressive and exploitative conditions (1994 National Rural Conference)National Rural Conference)

-A collective, participatory, transformative, -A collective, participatory, transformative, liberative, sustained and systematic liberative, sustained and systematic process of building people’s organizations process of building people’s organizations by mobilizing and enhancing the by mobilizing and enhancing the capabilities and resources of the people capabilities and resources of the people for the resolution of their issues and for the resolution of their issues and concerns towards effecting change in concerns towards effecting change in their existing oppressive and exploitative their existing oppressive and exploitative conditions (1994 National Rural conditions (1994 National Rural ConferenceConference

A process by which a community identifies A process by which a community identifies its needs and objectives, develops its needs and objectives, develops confidence to take action in respect to them confidence to take action in respect to them and in doing so, extends and develops and in doing so, extends and develops cooperative and collaborative attitudes and cooperative and collaborative attitudes and practices in the community (Ross 1967)practices in the community (Ross 1967)

· A continuous and sustained process of · A continuous and sustained process of educating the people to understand and educating the people to understand and develop their critical awareness of their develop their critical awareness of their existing condition, working with the people existing condition, working with the people collectively and efficiently on their collectively and efficiently on their immediate and long-term problems, and immediate and long-term problems, and mobilizing the people to develop their mobilizing the people to develop their capability and readiness to respond and take capability and readiness to respond and take action on their immediate needs towards action on their immediate needs towards solving their long-term problems (CO: A solving their long-term problems (CO: A manual of experience, PCPD)manual of experience, PCPD)

A continuous and sustained process of A continuous and sustained process of educating the people to understand and educating the people to understand and develop their critical awareness of their develop their critical awareness of their existing condition, working with the people existing condition, working with the people collectively and efficiently on their collectively and efficiently on their immediate and long-term problems, and immediate and long-term problems, and mobilizing the people to develop their mobilizing the people to develop their capability and readiness to respond and capability and readiness to respond and take action on their immediate needs take action on their immediate needs towards solving their long-term problems towards solving their long-term problems (CO: A manual of experience, PCPD)(CO: A manual of experience, PCPD)

The process and structure through The process and structure through which members of a community which members of a community are/or become organized for are/or become organized for participation in health care and participation in health care and community development activitiescommunity development activities

Importance of COPAR:Importance of COPAR: COPARCOPAR is an important tool for community is an important tool for community

development and people empowerment as development and people empowerment as this helps the community workers to this helps the community workers to generate community participation in generate community participation in development activities.development activities.

COPARCOPAR prepares people/clients to prepares people/clients to eventually take over the management of a eventually take over the management of a development programs in the future.development programs in the future.

COPARCOPAR maximizes community participation maximizes community participation and involvement; community resources are and involvement; community resources are mobilized for community services mobilized for community services

COPARCOPAR could be an alternative in could be an alternative in situations wherein health situations wherein health interventions in Public Health Care do interventions in Public Health Care do not require direct involvement of not require direct involvement of modern medical practitionersmodern medical practitioners

COPARCOPAR gets people actively involved gets people actively involved in selection and support of in selection and support of community health workerscommunity health workers

Through Through COPARCOPAR, community , community resources are mobilized for selected resources are mobilized for selected health serviceshealth services

COPARCOPAR improves both projects improves both projects effectiveness during implementationeffectiveness during implementation

Emphasis of COPAREmphasis of COPAR:: Community working to solve its own Community working to solve its own

problemproblem Direction is established internally and Direction is established internally and

externallyexternally Development and implementation of a Development and implementation of a

specific project less important than specific project less important than the development of the capacity of the development of the capacity of the community to establish the projectthe community to establish the project

Consciousness raising involves Consciousness raising involves perceiving health and medical care perceiving health and medical care within the total structure of societywithin the total structure of society

Principles of COPAR:Principles of COPAR: 1. People, especially the most 1. People, especially the most

oppressed, exploited and deprived oppressed, exploited and deprived sectors are open to change, have the sectors are open to change, have the capacity to change and are able to capacity to change and are able to bring about change.bring about change.

2. 2. COPARCOPAR should be based on the should be based on the interest of the poorest sectors of interest of the poorest sectors of societysociety

3. 3. COPARCOPAR should lead to a self- should lead to a self-reliant community and society.reliant community and society.

COPAR Process:COPAR Process:· A progressive cycle of · A progressive cycle of action-reflection actionaction-reflection action

which begins with small, local and concrete issues which begins with small, local and concrete issues identified by the people and the evaluation and the identified by the people and the evaluation and the reflection of and on the action taken by them.reflection of and on the action taken by them.

· Consciousness through experimental learning central · Consciousness through experimental learning central to the COPAR process because it places emphasis on to the COPAR process because it places emphasis on learning that emerges from concrete action and learning that emerges from concrete action and which enriches succeeding action.which enriches succeeding action.

· · COPARCOPAR is participatory and mass-based because it is is participatory and mass-based because it is primarily directed towards and biased in favor of the primarily directed towards and biased in favor of the poor, the powerless and oppressed.poor, the powerless and oppressed.

· · COPARCOPAR is group-centered and not leader-oriented. is group-centered and not leader-oriented. Leaders are identified, emerge and are tested Leaders are identified, emerge and are tested through action rather than appointed or selected by through action rather than appointed or selected by some external force or entity.some external force or entity.

Phases of COPARPhases of COPAR Pre-Entry PhasePre-Entry Phase The initial phase of the organizing process The initial phase of the organizing process

where the community / organizer looks for where the community / organizer looks for communities to serve / help.communities to serve / help.

It is considered to be the simplest phase in It is considered to be the simplest phase in terms of actual outputs, activities and terms of actual outputs, activities and strategies and time spent for it.strategies and time spent for it.

Designing a plan for community Designing a plan for community development including all its activities and development including all its activities and strategies for care / developmentstrategies for care / development

Designing criteria for the selection for the Designing criteria for the selection for the site.site.

Actual Selecting the site for community caresActual Selecting the site for community cares

Preparation of the InstitutionPreparation of the Institution – Train faculty and students in COPAR.Train faculty and students in COPAR.– Formulate plans for institutionalizing Formulate plans for institutionalizing

COPAR.COPAR.– Revise/enrich curriculum and immersion Revise/enrich curriculum and immersion

program.program.– Coordinate participants of other Coordinate participants of other

departments.departments.

Site Selection Site Selection – Initial networking with local government.Initial networking with local government.– Conduct preliminary special Conduct preliminary special

investigation.investigation.– Make long/short list of potential Make long/short list of potential

communities.communities.– Do ocular survey of listed communities.Do ocular survey of listed communities.

Criteria for Initial Site SelectionCriteria for Initial Site Selection – Must have a population of 100-200 families.Must have a population of 100-200 families.– Economically depressed.Economically depressed.– No strong resistance from the community.No strong resistance from the community.– No serious peace and order problem.No serious peace and order problem.– No similar group or organization holding the No similar group or organization holding the

same program. same program. Identifying Potential MunicipalitiesIdentifying Potential Municipalities

– Make long/short list.Make long/short list. Identifying Potential BarangayIdentifying Potential Barangay

– Do the same process as in selecting Do the same process as in selecting municipality.municipality.

– Consult key informants and residents.Consult key informants and residents.– Coordinate with local government and NGOs Coordinate with local government and NGOs

for future activities.for future activities.

Choosing Final Barangay Choosing Final Barangay – Conduct informal interviews with community Conduct informal interviews with community

residents and key informants.residents and key informants.– Determine the need of the program in the Determine the need of the program in the

community.community.– Take note of political development.Take note of political development.– Develop community profiles for secondary data.Develop community profiles for secondary data.– Develop survey tools.Develop survey tools.– Pay courtesy call to community leaders.Pay courtesy call to community leaders.– Choose foster families based on guidelines.Choose foster families based on guidelines.

Identifying Host FamilyIdentifying Host Family– House is strategically located in the House is strategically located in the

community.community.– Should not belong to the rich segment.Should not belong to the rich segment.– Respected by both formal and informal Respected by both formal and informal

leaders.leaders.– Neighbors are not hesitant to enter the Neighbors are not hesitant to enter the

house.house.– No member of the host family should be No member of the host family should be

moving out in the community.moving out in the community.

2. Entry Phase2. Entry Phase - sometimes called the social - sometimes called the social preparation phase. Is crucial in determining preparation phase. Is crucial in determining which strategies for organizing would suit the which strategies for organizing would suit the chosen community. Success of the activities chosen community. Success of the activities depend on how much the community depend on how much the community organizers has integrated with the organizers has integrated with the community.community.

Guidelines for EntryGuidelines for Entry– Recognize the role of local authorities by paying Recognize the role of local authorities by paying

them visits to inform their presence and activities.them visits to inform their presence and activities.– Her appearance, speech, behavior and lifestyle Her appearance, speech, behavior and lifestyle

should be in keeping with those of the community should be in keeping with those of the community residents without disregard of their being role residents without disregard of their being role model.model.

– Avoid raising the consciousness of the community Avoid raising the consciousness of the community residents; adopt a low-key profile.residents; adopt a low-key profile.

Activities in the Entry PhaseActivities in the Entry Phase– Integration - establishing rapport with the Integration - establishing rapport with the

people in continuing effort to imbibe people in continuing effort to imbibe community life.community life. living with the communityliving with the community seek out to converse with people where they seek out to converse with people where they

usually congregateusually congregate lend a hand in household choreslend a hand in household chores avoid gambling and drinkingavoid gambling and drinking

– Deepening social investigation/community Deepening social investigation/community study study verification and enrichment of data collected verification and enrichment of data collected

from initial surveyfrom initial survey conduct baseline survey by students, results conduct baseline survey by students, results

relayed through community assemblyrelayed through community assembly

3. Community Study/diagnosis Phase 3. Community Study/diagnosis Phase (Research Phase)(Research Phase)

Selection on the research teamSelection on the research team Training on Data Collection methods and Training on Data Collection methods and

techniques; capability-building (includes techniques; capability-building (includes development of data collection tools)development of data collection tools)

Planning for the actual gathering of dataPlanning for the actual gathering of data Data-gatheringData-gathering Training on data validation (includes tabulation Training on data validation (includes tabulation

and preliminary analysis of data)and preliminary analysis of data) Community validationCommunity validation Presentation of the community study / diagnosis Presentation of the community study / diagnosis

and recommendationsand recommendations Prioritization of community needs / problems for Prioritization of community needs / problems for

action action

4. Organization-building Phase (Community 4. Organization-building Phase (Community Organization and Capability Building Phase)Organization and Capability Building Phase) Entails the formation of more formal structure Entails the formation of more formal structure

and the inclusion of more formal procedure of and the inclusion of more formal procedure of planning, implementing, and evaluating planning, implementing, and evaluating community-wise activities. It is at this phase community-wise activities. It is at this phase where the organized leaders or groups are being where the organized leaders or groups are being given training (formal, informal, OJT) to develop given training (formal, informal, OJT) to develop their style in managing their own their style in managing their own concerns/programs.concerns/programs.

Key Activities Key Activities – Community Health Organization (CHO) Community Health Organization (CHO)

preparation of legal requirementspreparation of legal requirements guidelines in the organization of the CHO by the core groupguidelines in the organization of the CHO by the core group election of officerselection of officers

– Research Team CommitteeResearch Team Committee– Planning CommitteePlanning Committee– Health Committee OrganizationHealth Committee Organization– OthersOthers– Formation of by-laws by the CHO Formation of by-laws by the CHO

5. Community Action Phase5. Community Action Phase Organization and training of community Organization and training of community

health workershealth workers * development criteria for the selection of * development criteria for the selection of

CHWCHW * selection of CHW* selection of CHW * training of CHW* training of CHW Setting up of linkages/network referral Setting up of linkages/network referral

systemssystems PIME of health services/intervention schemes PIME of health services/intervention schemes

and community development projectsand community development projects Initial identification and implementation of Initial identification and implementation of

resource mobilization schemesresource mobilization schemes

6. Sustenance and Strengthening Phase6. Sustenance and Strengthening Phase Occurs when the community organization has Occurs when the community organization has

already been established and the community already been established and the community members are already actively participating in members are already actively participating in community-wide undertakings. At this point, the community-wide undertakings. At this point, the different committees setup in the organization-different committees setup in the organization-building phase are already expected to be building phase are already expected to be functioning by way of planning, implementing and functioning by way of planning, implementing and evaluating their own programs, with the overall evaluating their own programs, with the overall guidance from the community-wide organization.guidance from the community-wide organization.

Key Activities: Key Activities: – Training of CHO for monitoring and implementing of Training of CHO for monitoring and implementing of

community health program.community health program.– Identification of secondary leaders.Identification of secondary leaders.– Linkaging and networking.Linkaging and networking.– Conduct of mobilization on health and development Conduct of mobilization on health and development

concerns.concerns.– Implementation of livelihood projects.Implementation of livelihood projects.