HEALTHY COMMUNITY I. COMMON ELEMENTS OF A COMMUNITY >(these are critical attributes that define a group of people as a community) 1.

Group Orientation - the goals of the group take priority over those of individual members to take collective action with regard to common concern 2. Bond between individuals - may take this forms: >Lifestyle held in common >shared ethnicity or culture >fact of living in a specific geographic location >similar interest, goals or occupations 3. Human interaction - there must be significant social interaction between individuals in order for a community to exist II. Working definition of a Community: A. Community a group of people who share some type of bond and commonalities; who engage in interaction with each other and which functions collectively regarding common concerns. -It is a socialized group determined by geographic boundaries and or common values or interest, its members know and interact with each other. It functions with a particular structure and exhibits and creates norms, values and social institutions. -Composed of people, place, identity, common culture and socialized system (Arcaina, A Learning...CHD) 1. It is a social group determined by geographic boundaries and/or common values and interest. -Members know and interact with each other -It functions within a particular social structure and exhibits and creates norms, values and social institution. 2. It is a system of formal and informal of group members. groups characterized by interdependence and whose functions is to meet the collective needs

Ex. Need for education, shelter, leadership and etc.

3. It is a collection of people who share some important features of their lives.

Ex. Gay community, Filipino expat community

4. It is a social unit in which there is transaction of a common life among the people making up the unit B. Aggregates a group of presence of the defining attributes people with some characteristics in common; may or may not be communities depending on the

Ex. A research group who have been selected for having the common experience of being diagnosed with cancer.
III. CHARACTERISTICS 1. Environment >physical, socio-cultural, educational and employment milieu >living and working conditions; development of adequate coping skills and the ability to environmental changes without diminishing health >consist of: b.physical - geographic locale, weather, soil composition, housing conditions, educational milieu c.social accepted modes of behavior, social norms, family structure prevailing social attitudes

psychological self-image, stressors 2. Population behavior/lifestyle -self-responsibility, self-care competency -consumption patterns -employment/occupation -incorporate adequate rest, exercise and nutrition, leisure activities -consistent use of safety devices such as seatbelts, hearing protection and smoke detectors 3. Human biology -genetic characteristics of population, maturation and aging includes anatomical (height and weight), physiological (BP), chemical (blood cholesterol levels) and immunologic (immunity to certain disease) 4. Systems of health care (includes the availability, accessibility, adequacy & use of health care services at levels of prevention) a. Promotion (Promotive) -involves activities designed improve or maintain health status Ex. Individuals: ensuring adequate rest for the toddler, designing exercise program for the mother. -Family : Education on parenting for parents -Community : Provision of well-child and family planning services and educational programs related to basic nutrition or physical fitness. b. Prevention(Preventive)

-Specific measures aimed at disease prevention. Ex. Indiv: immunizing a child. -Family : Support group for teenage parents to prevent child abuse Community : Chlorination of community water supply c. Diagnosis and treatment/cure(Curative)

-Early recognition and therapy for health problems that have occurred. Ex. Indiv: treatment of STDs -Family: Provide counseling for existing marital problems -Community: Mental health programs that require institutionalizing mentally ill patients d. Rehabilitation(Rehabilitative) attempts to limit the incapacitation caused by health problems and prevent recurrence. Ex. Indiv: Physical and Occupational therapy for a stroke patient -Family: Family counseling for families of alcoholics (Al-Anon) -Community: Opening schools for special children IV. CLASSIFICATION A. GENERAL CLASSIFICATION 1. Urban high density community >Socially heterogeneous population >Complex structure, non-agricultural occupation

>Something different from an area characterized by complex interpersonal social relations 2. Rural usually small >occupation of the people is usually farming, fishing and food gathering >peopled by simple folks characterized by primary group relations, well-knit and having a high-degree of group feeling; 3. Rurban / Suburban an outlying part of a city or town > A smaller place adjacent to or sometimes within commuting distance of a city >Blending or characterized by the blending of urban and rural communities B. CLASSIFICATION ACCORDING TO BONDS 1. Communities with territorial bond -those with specifically defined boundaries that may either be separated or temporal or both -reflect the where and when dimension a. Geopolitical Communities

=with defined geographic and jurisdictional boundaries such as towns, cities, countries and so on. b. Communities with problem ecology -the locale within which a particular problem exist -ecology is defined in terms of the interrelated factors that contribute to a health problem rather than its usual meaning related to natural environment. -the area that encompasses any type of health problem and its contributing factors (ex. Polluted river starts in Brgy. A but runs its course in Brgy. B, so Brgy. A and B are considered communities of problem ecology. c. Communities of solution the area in which the resources necessary to solve a problem are found. 2. Communities with relational bonds -includes groups in which the bonds between individuals exists in the form of a common relationship rather than specific boundaries. a. Communities of interest orientation -the relational bond is one shared of shared interest / goals e.g. professional organizations -share a common interest / concern and they use the group as a means of advancing that interest b. Feeling communities one in which the relational bond is an emotional feeling of belonging or camaraderie (e.g. class).

V. COMPONENTS OF A COMMUNITY 1. The CORE (Community Core) -represents the people that make up the community. -included are the demographics of the population as well as the values, beliefs and history of the people. 2. Eight subsystems A. housing =shelter, lodging, dwellings provided for number of people or for a community

-type of housing facilities, housing materials that are present. -adequacy and availability of the housing facilities to the whole population -housing laws / regulations governing the people B. Education =laws, regulations, facilities and activities affecting education -ratio of educators to learners -distribution of education facilities -recipients of education -informal education facilities and activities existing in the community

C. Fire and safety =Fire protection facilities and fire prevention activities and their distribution of the community -Police protection ex. Tanods, roving community patrols D. Politics and government political structures present in the community =decision-making process/pattern of leadership style observed E. Health =health facilities and activities in the community -distribution of health facilities -utilization of health services -ratio of provider to clientele served -1 BHW : 10 households -1 BHM : 5,000 pop. -1 BHN : 10,000 pop. -1 MHO : 20,000 pop. F. Communication systems -types of communication existing in the community (e.g. telephones, mail, telegrams, internet, pagers, cellphones, radio, television and print media) -forms of communication (verbal, written, and nonverbal) -formal and informal communication G. Economics -general occupation of the population -types of economic activities (production, distribution, marketing, and buying of goods) -income; poverty line : 6,400 pesos H. Recreation -recreational activities / facilities present consumers of these recreations and their appropriateness VI. COMMUNITY HEALTH -community health can be defined as the attainment of the greatest possible biological, psychological and social well-being of the community as an entity and its individual members. -displays evidence of biological, psychological and social well-being in itself (e.g. a healthy community is economically stable, unpolluted and is able to provide for the needs of its members at adequate levels.)

ex. Democratic, republic, decentralized

VII. CHARACTERISTICS OF A HEALTHY COMMUNITY

1. prompts its members to have a high degree of awareness that we are community heightened sense of belongingness and affiliation. ex.

Pilipino Ako shirts, proud to be Cebuano.

2. uses its natural resources while taking steps to conserve them for future generations ex. Logging, water conservation measures 3. openly recognizes the existence of sub-groups and welcomes their participation in community affairs

ex. Participation in fiesta preparation activities by homeowners association, youth groups 4. is prepared to meet crises ex. Bagyo Ruping
5. is a problem-solving community; it identifies, analyzes and organizes to meet its own needs 6. has open channels of communication that allows information to flow among all subgroups of its citizen in all directions 7. seeks to make each of its systems resources available to all members of the community 8. has legitimate and effective ways to settle disputes and meet needs that arises within the community 9. encourages maximum citizen participation in decision-making 10. promotes a high level wellness among all its members. VIII. ELEMENTS OF ALL HEALTHY COMMUNITY 1,People are partners in health care community managed approach 2.People work together to attain goals participation and cooperation 3.Physical environment promotes health, safety, order and cleanliness. 4.Safe water and nutritious food. 5.Families provide members with basic needs. 6.Available, affordable health care.

IX. FACTORS THAT AFFECT COMMUNITY HEALTH (MULITFACTORIAL PHENOMENON) 1. Political Factors early community health workers were adept in influencing health-related policies.

=health policy formulation is done by top politicians with little consultation from health care providers =health policy decisions at community level reflected in budget allocations on health care programs, disaster preparation; creation of new health programs or expansion or discontinuing of current ones =legislation and ordinances that regulate health-related behavior (e.g. anti-smoking in public utility vehicles) 2. Socio-economic affect the ability to provide necessities like food and shelter, ability to obtain health care =General economic climate also affects health =Example: declining economy contributes to high levels of unemployment, which leads to reduced income, which is also accompanied by loss of

employer-provided insurance benefits thus reducing health care access. Reduced tax based results in reduced health and welfare programs: Declining economy also raises prices of goods and services.
=Rising health care costs also due to advanced medical technology which have contributed to growing numbers of elderly and chronically ill who require ongoing health care services at high costs. =Diminishing access to care escalating costs result in cutbacks in health services, ex. Immunization, decreased access to medicare benefits 3. Heredity with the growing population, the number of people with heredofamilial diseases like cancer and diabetes is increasing; genetic transmission of traits from parents to offspring 4. Environment =Sum total of all the conditions and surroundings and influence of the indvidual A. Social Environment Prevalence of mental health support system. B. Physical Environment Increased pollution

problems, more broken families with decreased

overcrowding

5. Behavior Lifestyle factors contribute to illness or health diet, exercise, smoking etc. =Increased incidence of substance abuse (alcohol, drugs) which in turn influence care expenditures =Sexual promiscuity leading to more STDs 6. Cultural n on physical traits (values, customs, beliefs, attitudes) -Practices: customary action usually done to maintain or promote health (ex. Habak, anting2) Beliefs : state/habit of the mind wherein a group of people place trust into something/someone 7. Health Care Delivery System accessibility, affordability of health facilities and services =Referring to the services and programs relating to health promotion and prevention of illness =Promotive =Preventive =Curative =Rehabilitative

Philippine HCDS The totality of all policies, infrastructures, facilities, equipments, products, human resources and services that addresses the health needs, problems and concerns of the people. Primary Function: Promotion, protection, preservation or restoration of health thru the provision and delivery of health services and thru the regulation and encouragement of the providers of health goods and services. Vision: Health as a right; health for all Filipinos by year 2000 and Health in the Hands of the people by year 2020. Mission: In partnership with the people, DOH will try to show equity, quality and access to health care thru: 1.By making services available 2.By arousing community awareness 3.Mobilizing resources 4.Promoting the means to better health HC Facilities Levels of care HC workers Primary RHU, BHU, Clinics Preventive Promotive Midwife BHW

Secondary District Hospitals

Curative CHN/PHN RSI

Tertiary VSMMC, CHH, CDHU Rehabilitative (Long term care Nursing home) MHO

National Health Plan and Devolution NHP -Blue print of all health plans/programs followed by DOH -Defines countrys problems, policies, thrust, strategies and targets (2000-2020) -Provides long term direction of the health care services -Dynamic, effective, efficient response to devolution -decentralization Devolution RA 7160 (Local Government Code of 1991) -Aims to transform the LGU into a self-reliant communities and active partners in the attainment of National goals thru a more responsive and accountable government structure Impact Programs of the DOH 1.National Tuberculosis program 2;Leprosy control program 3.Malaria control program 4.Reproductive health program 5.Maternal and Child Health program 6.Expanded Program on Immunization 7.National Diabetes and Control program 8.Breastfeeding and Lactation Program 9.Health Care program for older persons 10.Womens health and safe motherhood program Community Health Nursing =a special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, improvement of the conditions in the social and physical environment, rehabilitation of illness and disability (WHO Expert Committee on Nursing) A. Philosophy

CHN is based on the worth and dignity of man

Concept =Primary focus of CHN practice is on health promotion. The nurse has responsibility for evaluating health status of people and groups and relating them to practice =CHN are generalist in terms of their practice benefit not only individuals but the whole family and community =Dynamic process of assessing, planning, diagnosing, implementing and evaluation until the termination of nursing is implicit in the practice of CHN Goal

=Raise the level of health of the citizenry =Principles of CHN (Gardner, Leahy, Cobb and Jones) =Based on recognized needs of communities, families, groups and individuals =CH nurse must understand fully the objectives and policies of the agency =Family is the unit of care =Available regardless to race, creed and socio-economic status =Health teaching is the primary responsibility of the CH nurse B. Qualities of a Health Worker Open Tactful Good coordinator Objective Good listener Efficient Flexible Critical thinker Creative Patient Visionary Genuine love for the people Knowledgeable C. Roles of a Health worker

CH Service Provider Facilitator Health Counselor Co-researcher Manager/supervisor Community organizer Coordinator of services Health monitor Role model Change agent Reporter/recorder/ statistician Team member Health educator Planner

Recipients of Home Visits =Those who are undergoing continuous treatment =Those who do not take part in group activities =Those whose health needs are to be watched and followed up more closely =Those who do not come to the health center Health Education =A process whereby knowledge, attitude and practice of people are changed to improve an individual, a family, and the community health =A basic health service and every member of the health team shares responsibility in providing health education =One of the most important aspects of the functions of the CHN Principles of HE Considers the health status of the people

Is learning Should be recognized as a basic function of all health workers Takes place at home, school and in the community A cooperative effort Involves motivation, experience, and change in conduct and thinking Meets the needs, interests and problem of the people affected Achieved by doing Slow continuing process Makes use of supplementary aids and devices Utilizes community resources Creative process Helps people attain health thru their own efforts HE Teaching Methods and Strategies Interview Counseling Open forum Workshop Case study Role play Symposium Community assembly Use of IEC (information, education, communication) Use of publication Use of audiovisual aids Use of other IEC support Guidelines on how to be an effective health educator Teaching methodologies and strategies Preparation of IEC materials Use of teaching plan

Conflict Management =conflict is an escapable part of human life wherein 2 or more sets of needs/values/opinions/ideas pull in different directions =Conflict within in a team/community/family are inevitable and sometimes necessary =As a general rule, conflict is neither to be avoided nor stimulated but managed

=Conflict management a technique /method that deals with conflict; a way to settle conflict
Advantages -Stimulates creativity -Provides opportunity to improve interpersonal & leadership skills of other people -Develop deeper understanding of people Disadvantages -Raises tension -Disrupts team functioning to some degree -Reduces teams effectiveness -Immobilizes the team -Suppressed conflict can grow and becomes difficult to resolve -Sources of Conflict -Incompatible differences -Dispute over allocating resources -Perceived threat to an individual Conflict Resolution =preventive measures first to decrease the number of conflicts facing the team =Proceeds thru accepting the existence of a conflict, identifying the source, seeking agreements and generate solution Encourage open communication 3 Ways of Handling a Conflict Flight Fight Confront Outcome of Conflict Win - Lose situation Lose - Lose situation Win - Win situation Primary Health Care =key in achieving an acceptable level of health through out the world in the foreseeable future as part of social development and the spirit of social justice (Alma Ata, Russia; WHO 1979) =Health for All by the year 2000; Health in the Hands of the people by year 2020 =WHO: PHC is characterized by partnership and empowerment of the people shall permeate as the core strategy in the effective provision of essential health services that are community based, accessible, acceptable, available/sustainable at a cost, which the community can afford.

Mission: To strengthen the HCDS by increasing opportunities and supporting conditions wherein people will manage their own health care. Vision: Health for All Filipinos Goals: 1. Self-reliance (empowerment) 2. Self-determination 3. Health for All by the year 2000; Health in the Hands

of the people by year 2020

3 Ways of viewing PHC 1. as an approach (strategy) 2. as a service 3. as a structure

4 cornerstone of PHC 1. active community participation and involvement 2. intra and inter sectoral linkages 3. development of appropriate strategy 4. support mechanism made available Concepts -Cooperation of the community -Capability of people to determine and analyze their own problems -Voluntary community involvement -Basic minimum needs of the society should be spelled out -Villagers work to ensure better living of the community -Achieve better quality of life -Self-reliance -Activities must be in harmony with existing institutions -Appropriate strategy -Public health service ELEMENTS E L E M E N T S

- education for health (partnership of family and HW) - locally epidemic disease control - EPI - Maternal Child care program - essential drugs (proper utilization and acquiring of drugs) - nutrition (proper cooking and storing of food) - treatment of communicable diseases - safe water and sanitation

APPROACHES TO COMMUNITY DEVELOPMENT Welfare Approach / Dole-out System -the immediate and/or spontaneous response to ameliorate the manifestation of the poverty, especially on the personal level -assumes that poverty is God-given; destined, hence the poor should accept their condition since they will receive their just reward in heaven -believes that poverty is caused by bad luck, natural disasters and certain circumstances which are beyond their control 2. Modernization Approach / Project Development Approach -introduces whatever resources are lacking in a given community -considered a national strategy which adopts the western mode of technological development -consists of abandoning traditional methods of doing things and must adopt the technology of industrial countries.

3. Liberalization / Transformatory / Participatory Approach -Process of empowering/transforming the poor and the oppressed sectors of society so that they can pursue a more just and humane society -Assumes that poverty is not God-given; rather it is rooted in the historical past and is maintained by oppressive structures of society -Believes that poverty is caused by prevalence of exploitation, oppression, domination and other unjust structures -believes that poverty is due to lack of education; lack of resources such as capital and technology. Community Organizing Participatory Action Research (COPAR) I. Background and Framework Rationale: The Philippine Center of Population and Development in its effort to support the Department of Health in its implementation of PHC designed the Health Resource Development Program (HRDP) to enable health training institutions to effectively implement their community-based health programs. HRDP sees community organizing (CO) as a tool for peoples empowerment in health. It is used to generate community participation and involvement in health activities and to prepare communities to set up their own health programs. II. Definitions: =social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community =a collective, participatory, transformative, liberative, sustained and systematic process of building peoples organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative conditions

III. Processes/Methods Used: -A Progressive cycle of Action-Reflection-Action which begins with small, local and concrete issues identified by the people and the evaluation and reflection of and on the action taken them. -Consciousness-raising thru experimental learning is central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. -COPAR is participatory and mass based -COPAR is group centered and not leader oriented IV. Participatory Action Research (PAR) =an investigation on problems and issues concerning the life and environment of the underprivileged whose representatives participate in the research process as equal partners =the community as researchers rather than outsiders doing research upon them or upon their problems =central element in PAR : Participation =an active process whereby the expected beneficiaries of research are the main actors in the entire research process; research is based on a system of discussion, investigation and analysis. V. Objectives of PAR: aims to encourage consciousness of their sufferings and develop competence of changing their situation an attempt towards organizational building, harnessing both the human and material resources of the community in responding to the needs evoked in the PAR research as an educational aspect, it enhances the knowledge of both the researcher and the researched on the social reality before them VI. Importance of COPAR to PHC CO maximizes community participation and involvement. CO could an alternative in situations wherein health interventions in PHC do not require direct involvement of modern medical practitioners. CO gets people actively involved in selection and support of community health workers. Through CO, community resources are mobilized for selected health services. CO improves both projects effectiveness during planning, implementation and ultimate impact. CO is critical in achieving the PHC goal of self- reliance and social awareness

Principles of COPAR General: People, esp. the oppressed and exploited sectors are most open to change, have the capacity to change and are able to bring about change, Thus, CO should be based on the following: -Power must reside in the people -Development is from the people to the people -Peoples participation should always be present CO should be for the interest of the poorest sectors of the society; must be focused on collective organizations, planning and action. CO should lead to self-reliant communities WHEN THE PEOPLE LEAD, THE LEADERS FOLLOW Specific: Community participation = the active involvement of community members in decisions about how to improve the existing conditions or the mobilization of community people to take active part in the delivery of health services Reasons for CP: -to develop the capability of the people in solving problems -to let the people acquire a sense of commitment and ownership in the programs/projects implemented Phases of COPAR PRE-ENTRY PHASE Initial phase of the organizing process where the community organizer looks for communities to serve/help Simplest phase in terms of output, activities, strategies and time spent for it Criteria needed before going into the barangay = clear and simple Activities: 1. Site selection a. Depressed community with majority of the population belonging to the poor sector Household income below the national poverty threshold Lack of income opportunities b. Inaccessible / Inadequate health services Absence of barangay health station Lack of primary and secondary hospitals c. Poor health status high incidence of communicable diseases high malnutrition rate high infant mortality rate lack of sanitary toilets d. Area must not have a serious peace and order problem e. No strong resistance from the community f. Area must be free from similar agencies or program to avoid competition and duplication of services 2. Preliminary Social Investigation (PSI)\ Gathering of information about the different areas focusing on the data necessary to determine the site that best conforms with the criteria Methods / Techniques: a. Use of secondary data from various government offices, - City Health Dept., National Statistics Office, PHO or the RHU b. Use of secondary data from other community based programs

c. Coordination with extension workers from both GOs and NGOs d. Conduct ocular observation = make use of the five senses -Accessibility of the community Geography Terrain -Settlement pattern Available physical resources II. ENTRY PHASE -Social preparatory phase sensitization of the people on the critical events in their life Motivating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing hem to take collective action -Crucial in determining which strategies for organizing is a stranger to the community Success of the activities in the later parts of CO greatly depend on how much the community organizer/worker has integrated with the community, his understanding of the place, the people, the events and his commitment to serve and to be identified with the community he plans to work with Guidelines for entry into the community -Recognize the role of local authorities by paying them visits to inform them of your presence and to orient them on the project objectives -Ones appearance, speech, behavior and lifestyle should be in keeping with those of the -community residents (role models) -Avoid raising the expectations of the community residents low key profile and approach

A. Integration with the community Process of establishing rapport with the people in a continuing effort to imbibe community life by living with them, undergoing the same experiences, sharing their hopes, aspirations and hardships toward building mutual trust and cooperation. Methods of integration: 1. participation in direct production activities of the people like planting, harvesting, fishing crafts making, etc. 2. conduct house to house visits 3. participation in social activities such as baptism, birthday parties, weddings, wakes, etc. 4. conversing with the people where they usually gather (stores, waterwells, washing streams, etc.) 5. doing household chores like cooking, dishwashing, cleaning the house, etc. B. Conduct information campaign on organizing (HRDP) Health Resource Development Plan About HRDPs rationale, objectives, main strategies and activities This could become a strategy for the community organizer to provide the people with initial health education based on initially assessed needs

C. Conduct of community study and deepening social investigation (scientific process of collecting, collating, synthesizing and analyzing data to draw a clear picture of the community) activities of organizer are always guided by his own perception and analysis of the prevailing community situation -done to have a sound basis for determining the interventions, whether for social action, project mobilization, delivery of health services, training or planning his daily activities. D. Provision of basic health services -Primary purpose is to respond to the acute health problems of the residents and by doing so, stress the preventive aspects of care

More importantly, CO wise, to enable to draw out the peoples interest in the project and at the same time, enhance their integration into the community E. Identification of potential leaders Techniques: conduct informal discussion with the community members observing the people who are active in small mobilization activities (cleanliness and beautification drives, road repairs, mini-medical missions, etc.) observing who in the community readily responds to community problems and emergencies and those whose concern for other people are very well manifested in their actions observing the people in their natural environment (informal group discussions). Usually, it is the person who have leadership potential who would stand out. sociogram systematic process of identifying indigenous leaders in the community who can help facilitate the change process should be subtly done, results not divulged, since it may offend the people and raise negative feelings of rejection or denial do the same with other groups list potential leaders Persons identified (sociogram) ;Key person = the star in the sociogram, the person who is approached by most people, an obvious leader ;Opinion leader = the person who is approach by the key person and is therefore, the person behind key persons opinion and ideas ;Isolate = the person who is never or hardly approached band is therefore not vital to mobilization of the community Characteristics of a potential leader: belongs to the poor sectors of classes in the community a respected member of the community responsive and willing to work for change must have potential management skills had leadership training must possess good communication skills

F. Core group formation = end product of entry phase -taken from the list of potential leaders -process of laying down the foundation of a strong peoples organization done by bringing together several of the most advanced indigenous leaders to exchange knowledge and insights towards deeper understanding of the dynamics of the community Functions of the Core group: 1. Serves as training ground for democratic and collective leadership 2. Builds peoples potentials and self-confidence 3. 4. 5. 6. Social preparation of a community for health and development work Organizing a community research team for the conduct of a community diagnosis Setting up Community Health Organization (CHO) and facilitate the identification of potential CHWs Sensitizing and mobilizing the community to act on their immediate health needs and participate in delivery of health services

III. Organization-building Phase A. COMMUNITY DIAGNOSIS / RESEARCH PHASE = done by the Core group Research team = responsible for determining needs, monitoring problems, issues and finding ways to resolve problems/meet needs AA. Research training phase I 1. Problem identification 2. Problem analysis: A. Structural analysis analyzes the roots of the existing problems and may be done through the why web

B. Cause and effect analysis analyzes both the causes and effects of the problems and may be done through the use of a problem tree 3. Classification of problems: Primary (directly health related, e.g. malnutrition) Secondary (indirectly health related, e.g. economic, political and social) 4. Gathering of data to be gathered based on problem analysis 5. Identification of possible informants / respondents 6. Selection of research methodologies: A. Survey systematic collection of people self-reported information at a particular point in time B. Systematic observation recording of an object, event or behavior as it is seen or occurs C. Interview face to face meeting between 2 or more people, where the interviewer asks questions to obtain information D. Records review consists of reading through existing records of an agency or person E. Community meetings public meetings that allow the community to participate G. Focus group discussions qualitative technique for gathering information on a topic or number of topics for small group of informants who share homogenous characteristics and who are capable of shedding light on the subject for discussion 7. Selection of research instrument: A. Resource / social map provides a clear picture of the barangay in once glance -Gives the research team a common orientation of the resources within the barangay, thus, community organizer and the people are able to plan together on the kinds of projects or activities that the people will engage in (e.g. construction of health center the resource map can help determine potential location B. Seasonal diagramming provides information about the trends and patterns of income, production, expenditures illnesses and other things throughout the year in the barangay -Allows the research team to recognize the periods when the CO can synchronize activities that need cooperation and participation of the people C. Time allocation diagram informs community organizer and research team of the ways in which a certain household allocates time to their different tasks D. Census mapping gives the CO and researcher a chance to take a closer look a individual household esp. with regards to issues that interest them -Serves to identify indicators that can help in planning programs for the community -e.g. household with 0 ~ 6 years old children / with pregnant mothers / older people E. Venn diagramming ranking of institutions according to their contribution to community development -Helps to identify the role of institutions in the community e.g. 1. School 2. Church 3. Cooperative F. Service mapping determines the availability of services in the community -Increases the awareness of community members of their situation, to assess the available services and plan actions to improve the kind of services to be introduced into the community

G. Wealth ranking determines the economic attributes of the households in a barangay -Produces information of relative wealth and well being of a household H. Pairwise ranking determines the considered priority problems by the community members Priority problems identification I. Health data board provides information about health status of the community J. Questionnaire helps to obtain the profile and / or demographic data of the households K. Historical mapping or time line provides information about the important events that have happen in their community, both the success and failures 8. Planning for the actual data gathering may use the Gantt Chart BB. Research training phase II 1. Organization of data -data tabulation -data analysis 2. Presentation of community diagnosis:(DAP) Methods: -community assemblies (meetings, plays, etc.) -mothers class -CHWS Assemblies -Use of posters, publications, other media 3. Points to consider in priority setting for community needs/problems -Technology to be used in solving problems -Magnitude/severity of the problem -Social concern; referring to the significance of the specific population groups affected by the problem -Health policies/programs implemented by the government in the area. B. COMMUNITY ORGANIZATION AND CAPABILITY BUILDING PHASE -Core group can be expanded to include other members of the community once they manifest cohesiveness -CHOnal structure may take various forms and shape & would depend on the conditions prevailing in the community as well as level of awareness of the people -Whatever its structure = it should give rise to communitys participation and involvement in decision making -Where core group are given training (formal, informal, OJT) to develop their KSA in managing their own concerns/problems Committees are created facilitated by COs Functions: -Charged with the management of relevant and appropriate health programs -Ensure collective participation indecision making, planning, implementation and evaluation of community projects -Establish network of linkage / networks for mobilizing external support and referrals -Generate resources for maintaining and sustaining health programs or activities -Raising community consciousness on health and other broader issues -Mobilizing the people of act on their health problems and issues affecting them Capability building = promotes self-awareness and management training

Activities: -Community meetings to draw up guidelines for the organization -Election of officers -Management system and procedures -Team building -Action Reflection in Faith Action (ARFA) -Working out legal requirements -Organization of working committees and task groups -Training of working committees C. COMMUNITY ACTION PHASE C.1 PIME of health services 1.Planning Community health and development plans should be Poor planning = poor outcome/result 2. Implementation S M A R T; that is: specific, measurable, attainable, realistic and time-bound

Project management a significant component in the implementation / action phase Guidelines for managing community projects: a. CP is a series of activities that are designed to achieve a result that is beneficial to the group of people b. CP demands that a certain performance be achieved for a fixed number of pesos and within a fixed period of time c. CP must be divided into a number or activities which must be managed d. Managing a CP means using men, money, man-hour, material and machines efficiently to achieve goals and objectives (5Ms of project management) e. CP goals and objectives must explain what will be accomplished and when it will be completed f. CP cannot be a success unless the goals and objectives are clear to the people who will implement it g. CP, to become successful, must be started, its resources organized, its work done and its progress checked h. CP must have a good control system or monitoring and evaluation scheme 3. Monitoring an internal project activity designed to provide constant feedback on the progress of a project, the problems it is facing and the efficiency with which it is being implemented -Assess whether resources are being used as intended and whether they are producing the intended outputs 4. Evaluation an assessment of whether or not the planned projectstrategy actually works in the field and is therefore mainly used in the selection and design of future projects Uses of Monitoring and Evaluation: a. Decision-making -M & E results may help determine whether to continue a program or to add or drop a component b. Assessment / improvement of performance -Info from M & E may be used to identify weak points within a program c. Allocation of resources -An analysis of the program may reveal that one part of its strategy is successful while another is not d. Personal development -Regular assessment of accomplishment / failures may determine the kind of training the staff needs

-Also enables the management to measure the relative efficiency and effectiveness of the staff e. New knowledge and understanding -Learning / lessons are gathered from every success and failures that the program encountered

IV. SUSTENANCE AND STRENGTHENING PHASE Refers to the capacity of the programs / projects to continuously provide or deliver its positive impacts to the beneficiaries Activities: 1. Initial identification and implementation of resource mobilization 2. Setting up and institutionalization of financial scheme 3. Formulation and ratification of constitution and by-laws 4. Continuing education, upgrading community leaders, CHWs and CHOs -To unify the members/residents on the goals, objectives, activities and methods of HRDP -Done through regular planning and evaluation sessions, consultations, committee meetings and general assemblies, small group discussions and formal training sessions 5. Development of medium / long term community health and development plan 5. Formalizing and institutionalizing linkages, networks and referral system -Permanent structures in lieu of the NGO should take on the lead role of assisting the community organization once it phases out of the area -Basic services could continue even without the NGO 6. Development and implementation of viable management system -Financial sustainability through the implementation of income generating projects -Envisions to generate funds for the community organization to use in implementing various health activities 8. Identification and development of secondary leaders -These are the people who could take on the role of the officers in the event that some become inactive CRITICAL STEPS (ACTIVITIES) IN BUILDING PEOPLES ORGANIZATION 1. Integration a CO becoming one with the people in order to : a. immerse himself in the poor community b. understand deeply the culture, economy, leaders, history, rhythms and life style in the community 2. Social Investigation a systematic process of collecting,collating, analyzing data to draw a clear picture of the community. also known as the community study 3. Tentative program planning - CO to choose one issue to work on in order to begin organizing the people 4. Groundwork - going around and motivating the people on a one on one basis to do something on the issue that has been chosen 5. The meeting - people collectively ratifying what they have already decided individually. The meeting gives the people the collective power and confidence. Problems and issues are discussed 6. Role play - means to act out the meeting that will take place between the leaders of the people and the government representatives. It is a way of training the people to anticipate what will happen and prepare themselves for such eventuality 7. Mobilization or action - actual experience of the people in confronting the powerful and the actual exercise of people power 8. Evaluation - the people reviewing the steps 1~7 so as to determine whether they were successful or not in their objectives 9. Reflection - dealing with deeper, on-going concerns to look at the positive values CO is trying to build in the organization. It gives the people time to reflect on the stark reality of life compared to the ideal.

10. Organization - the peoples organization is the result of many successive and similar actions of the people. A final organizational structure is set up with elected officers and supporting members Roles and Activities in Community Health Care Developmen 1. Recorder / documentor -Keeps written account or services rendered, observations, conditions, needs, problems and attitudes of the clientele in community development activities and accomplishments made Develops the peoples capabilities to keep / maintain their own recording and reporting system 2. Reporter -Takes responsibility to disseminate pertinent information to appropriate authorities, agencies and most especially to client / community -Records refers to the forms in which information pertaining the client / community is noted -Health records written information about the health of the people. Includes records of birth, death, illnesses and injuries and other health activities -Reports refers top periodic summaries of the services / activities of an organization / unit or the analysis of certain phases of its work Purposes of records and reports 1. Measure service / program directed to the clients / community -tells the CHW the number of persons seen and those who needed to be followed up, what services were given to them 2. Provide basis for future planning 3. Interpret the work to the public and other agencies and communities tells others what you, as CHW, have done 4. Aide in studying the conditions of the community -helps health team I identifying problems, illnesses, etc. 5. Contribute to client care -helps in preparing / ordering drugs and supplies needed in providing health services Basic Principles for Effective and Useful Reports 1. All items must be carefully selected in order to give significant information 2. Reports are of the most interest value when they are arranged so that comparison may be made between successive periods of time 3. Reports are of value only when the items included carry a common meaning to all who make use of them 4. Reports are more readily received when presented in an interesting manner