Nursing Process in the Care of Population Groups and Community

Community Health Assessment Tool

Primary Data Collection

 the community is the primary source of data. Primary data are data that have not been
gathered before and are collected by the nurse through observation, survey, informant
interview, community forum, and focus group discussion.

Primary data collection:

Observation
 rapid observation of a community may be done through an ocular survey, either by riding
a vehicle or walking.

Survey
 made up of a series of questions for systematic collection of information from a sample
of individual or families

Informant interview
 purposeful talks with either key informants or ordinary members of the community.
o Structured interview- the nurse directs the talk based on an interview guide.
o Unstructured interview- the informant guides the talk

Community forum
 an open meeting of the members of the community (ex. Pulong pulong sa barangay)
 Besides data gathering, the community forum may also be used as a venue for informing
the people about secondary data, for data validation, and for getting feedback from the
people themselves about previously gathered data.

Focus group
 A focus group differs from a community forum in the sense that the focus group is made
up of a much smaller group , usually 6- 12 members only(Maurer and Smith, 2009).
Example: first- time pregnant woman

Secondary Data Collection

 taken from existing data sources. Going over secondary data first gives the nurse a
picture of what is already known about the population under study, which may facilitate
collection of primary data.

SECONDARY DATA SOURCES:

A. Registry of vital events
  Act 3753(Civil Registration Law, Philippine Legislature), enacted in 1930, established
the civil registry system in the Philippines and requires the registration of vital events
such as births, marriages and deaths.

 R.A 7160(Local Government Code) assigned the function of civil registration to local
governments and mandated the appointment of local (City/municipal) Civil Registrars.

 The PSA serves as the central repository of civil registries and the Civil Registrar General
of the Philippines.

B. Health Records and Reports

 As specified by Executive Order No. 352(Office of the President, Republic of the
Philippines, 1996), the Field Health Service Information System (FHSIS) is the official
recording and reporting system of the Department of Health and is used by the NSCB to
generate health statistics

The FHSIS Manual of operations lists and describes the following recording tools:

The individual Treatment Record (ITR)

 is the building block of the FHSIS. it contains the date, name, address of patient,
presenting symptoms or complaint of the patient on consultation, and the diagnosis,
treatment, and date of treatment.

Target Client Lists (TCLs)

 are the second building block of the FHSIS. It is used to plan and carry out patient care,
to facilitate monitoring and supervision of service delivery activities, and to report
services delivered.

Summary table
 is accomplished by the midwife. It is a 12-column table in which columns correspond to
the 12 months of the year. This record is kept at the BHS and has 2 components: Health
Program Accomplishment and Morbidity/ Diseases.

The monthly Consolidation table(MCT)

 is accomplished by the nurse based on the summary table.it serves as the source
document for the quarterly form and the output table of the RHU or health center.

The reporting forms, as enumerated in the FHSIS manual of Operations are the
following:

Monthly forms
 are regularly prepared by the midwife and submitted to the nurse, who then uses the data
to prepare the Quarterly forms.
o Program report (M1)- contains indicators categorized as maternal care, child care,
family planning, and disease control.
 o Morbidity report (M2)- contains a list of all cases of disease by age and sex.

Quarterly forms
 are usually prepared by the nurse. There should only be one quarterly form for the
municipality/ city.
o Program report(Q1)- contains the three month total of indicators categorized as
maternal care, family planning, child care, dental health, and disease control.
o Morbidity report(Q2)- is a 3- month consolidation of morbidity report(M2)

Annual forms

A- BHS
 is a report by the midwife that contains demographic, environmental, and
natality data.
o Annual form 1 (A-1) is prepared by the nurse and is the report of the RHU or
health center. It contains demographic and environmental data, and data on
natality and mortality for the entire year.
o Annual form 2 (A-2) prepared by the nurse, is the yearly morbidity report by age
and sex.
o Annual form 3 (A-3) also prepared by the nurse, is the yearly report of all deaths
(mortality) by age and sex.

C. Disease Registries
 A listing of persons diagnosed with a specific type of disease in the defined population.
Data collected through disease registries serve as basis for monitoring, decision- making,
and program management.

D. Census data
 a census is a periodic governmental enumeration of the population. During a census,
people may be assigned to a locality by de jure or de facto method. De jure assignment is
based on the legally established place of residence of people, whereas de facto is
according to the actual physical location of the people(NSCB, 2012).

METHODS TO PRESENT COMMUNITY DATA

Bar Graph
 to compare values across different categories of data.

Line graph
 to have a visual image of trends in data over time and age.

Pie Chart
 to show percentage distribution or composition of a variable, such as population or
households.
Scatter plot or diagram
 to show correlation between two variables. The values of both variables in subjects are
plotted in a graph with an x-axis and a y- axis.

Community Diagnosis

Community Diagnosis
 The process of determining the health status of the community and the factors responsible
for it. The term is applied both to the process of determination and to its findings(WHO,
2004)
 It is a quantitative and qualitative description of the health of citizens and the factors that
influence their health. Community diagnosis allows identification of problems and areas
of improvement, thereby stimulating action(WHO, 1994)

TYPES OF COMMUNITY DIAGNOSIS

 Traditional research approach
 Participatory action research (PAR)

Points of Traditional research approach COPAR

comparison

Decision Making Top- down Bottom- up

emphasis expert/ nurse- driven process community - driven process
Much premium is placed on the data Premium is placed on the
and output process

Roles Nurse as researcher: the community Community members as

member are subjects/ objects of the researchers: the nurse is a
research instrument facilitator and recorder
Data analysis is done by the nurse Data analysis is done
and then presented to the community. collectively by the community.

Methodology Research tools and methodologies Research tools and

are predetermined/ prepackaged by methodologies are made by
the nurse organizer. the community.

Output Upon completion, the study is Conclusions and

packaged, submitted to the agency, recommendations are made
and published. Recommendations are by the community.
made by the researcher based on the
findings of the study.

Schemes in Stating Community Diagnoses

SHUSTER AND GOEPPINGER

  Shuster and Goppinger (2004)proposed a practical adaptation of a format of nursing
diagnoses for population groups previously presented by Green and Slade (2001) The
three- part statement consist of:
o The health risk or specified problem to which the community is exposed.
o The specific aggregate or community with whom the nurse will be working to
deal with the risk or problem.
o Related factors that influence how the community will respond to the health risk
or problem.

OHAMA SYSTEM
 The Ohama System has been used as a framework for the care of individuals, families,
and communities by nurses, nursing educators, physicians, and other health care
providers.
 It is a comprehensive and research- based classification system for client problems that
exists in the public domain, meaning, it is not held under copyright.

The Ohama classification system has three components that are to be used
together:

A problem classification scheme(client assessment)

 serves as a guide in collecting , classifying, analyzing, documenting , and communicating
health and health- related needs and strengths.

Intervention Scheme (care plans and services)

 The Intervention Scheme is designed to describe and communicate multidisciplinary
practice, practice that is intended to prevent illness, improve or restore health, decrease
deterioration, and/or provide comfort before death.

Problem Rating Scale for Outcomes (client change/evaluation)

 The Problem Rating Scale for Outcomes is a method to evaluate client progress
throughout the period of service. It consists of three five-point, Likert-type scales to
measure the entire range of severity for the concepts of Knowledge, Behavior, and
Status.

Domains and Problems of the Problem Classification Scheme

Environmental Domain: Material resources and physical surroundings both inside and outside
the living area, neighborhood, and broader community.
 Income
 Sanitation
 Residence
 Neighborhood/workplace safety
Psychosocial Domain: Patterns of behavior, emotion, communication, relationships, and
development.
 Communication with community resources
 Social contact
 Role change
 Interpersonal relationship
 Spirituality
 Grief
 Mental health
 Sexuality
 Caretaking/parenting
 Neglect
 Abuse
 Growth and development

Physiological Domain: Functions and processes that maintain life

 Hearing
 Respiration
 Circulation
 Neuro-Musculo-skeletal function
 Vision
 Digestion
 Hydration
 Consciousness
 Bowel function
 Skin
 Urinary function
 Pain
 Reproductive function
 Oral health
 Pregnancy
 Cognition
 Postpartum
 Speech and language
 Communicable/infectious condition

Health-related Behaviors Domain: Patterns of activity that maintain or promote wellness,

promote recovery, and decrease the risk of disease.
 Nutrition
 Sleep and rest patterns
 Physical activity
 Personal care
 Substance use
 Family planning
  Health care supervision
 Medication regimen

PLANNING COMMUNITY HEALTH INTERVENTIONS

PRIORITY SETTING
 THIS STEP PROVIDES THE NURSE AND THE HEALTH TEAM WITH A
LOGICAL MEANS OF ESTABLISHING PRIORITY AMONG THE IDENTIFIED
HEALTH CONCERNS.
 WHO has suggested the following criteria to decide on a community health concern for
intervention:
o Significance of the problem- based on the number of people in the community
affected by the problem or condition.
o Community awareness- when people are aware of the risk arising from a
condition pervasive in the community, they are likely to have the motivation to
deal with the condition and give it a priority.
o Ability to reduce risk- it is related to the availability of expertise(Shuster and
Goeppinger, 2004) among the health team and the community itself.
o In determining cost of reducing risk, the nurse has to consider economic, social,
and ethical exquisites and consequences of planned action.
o Ability to identify the target population for the intervention is the matter of
availability of data sources such as FHSIS, census, survey reports, and/ or case-
finding or screening tools.
o Availability of resources to intervene in the reduction of risk entails technological,
financial, and other material resources of the community, the nurse, and the health
agency.

Formulating goals and objectives

Goals
 are the desired outcomes at the end of interventions, whereas objectives are the short-
term changes in the community that are observed as the health team and the community
work towards the attainment of goals.

Objectives
 serve as instructions, defining what should be detected in the community as interventions
are being implemented. Defines the desired step- by- step family responses as they work
toward a goal.

Specific, measurable, attainable, relevant, and time- bound (SMART) objectives provide a solid
basis for monitoring and evaluation.
 SPECIFIC- the objective clearly articulates who is expected to do what
 MEASURABLE- observable, measurable, and whenever possible, quantifiable
indications of the family’s achievement as a result of their efforts toward a goal provide a
complete basis for monitoring and evaluation.
  ATTAINABLE- the objective has to be realistic and in conformity with available
resources, existing constraints, and family traits, such as style and functioning.
 RELEVANT- the objective is appropriate for family need or problem that is intended to
be minimized , alleviated or resolved.
 TIME-BOUND- having a specified target time or date helps the family and the nurse in
focusing their attention and efforts toward the attainment of the objective(Doran, 1981)

Deciding on community interventions

 Because of their inherent differences, what may work for one community may not be
effective in another .
 The group analyzes the reasons for people’s health behavior and direct strategies to
respond to the underlying causes.
 In the process of developing the plan, the group takes into consideration the
demographic, psychological, social, cultural, and economic characteristics of the target
population on one hand and the available health resources on the other hand.

IMPLEMENTING THE COMMUNITY HEALTH INTERVENTIONS

 It is often referred to as the action phase, implementation is the most exciting phase for
most health workers.
 The entire process is intended to enhance the community’s capability in dealing with
common health conditions/ problems.
 The nurse’s role therefore is to facilitate the process rather than directly implement the
planned interventions.
 Collaboration with other sectors such as the local government and other agencies may
also be necessary.

EVALUATION OF COMMUNITY HEALTH INTERVENTIONS

 Evaluation approaches maybe directed towards structure, process, and/ or outcome.
o STRUCTURE EVALUATION- involves looking into the manpower and physical
resources of the agency responsible for community health interventions.
o PROCESS EVALUATION- is examining the manpower by which assessment,
diagnosis, planning, implementation, and evaluation were undertaken.
o OUTCOME EVALUATION- is determining the degree of attainment of goals
and objectives.

Standards of evaluation

The bases of good evaluation are:

 Utility- is the value of the evaluation in terms of results. This will provide the basis for
utilizing the community health process in dealing with other community concerns in the
future.
 Feasibility- answers the question of whether the plan for evaluation is doable or not,
considering available resources(time, facilities, and expertise).
  Propriety- involves ethical and legal matters. Respect for the worth and dignity of the
participants in the data collection should be given due consideration.
 Accuracy- refers to the validity and reliability of the results of evaluation. Accurate
evaluation begins with accurate documentation while the community health process is
ongoing.

Types of evaluation:

Formative evaluations
 are used primarily to provide information for initiative improvement by examining the
delivery of the initiative, its implementation, procedures, personnel, etc.

Summative evaluations
 in contrast, examine the initiative's outcomes and are used to provide information that
will assist in making decisions regarding the initiative's adoption, continuation or
expansion and can assist in judgments of the initiative's overall merit based on certain
criteria.

Comprehensive evaluations
 combine both process and outcome questions.

Steps of program evaluation:

Planning
 The relevant questions during evaluation planning and implementation involve
determining the feasibility of the evaluation, identifying stakeholders, and specifying
short- and long-term goals.

Implementation — Formative and Process Evaluation

 Evaluation during a program’s implementation may examine whether the program is
successfully recruiting and retaining its intended participants, using training materials
that meet standards for accuracy and clarity, maintaining its projected timelines,
coordinating efficiently with other ongoing programs and activities, and meeting
applicable legal standards

Completion — Summative, Outcome, and Impact Evaluation

 Following completion of the program, evaluation may examine its immediate outcomes
or long-term impact or summarize its overall performance, including, for example, its
efficiency and sustainability. A program’s outcome can be defined as “the state of the
target population or the social conditions that a program is expected to have changed,”
(Rossi et al., 2004, p. 204).

Dissemination and Reporting

 To ensure that the dissemination and reporting of results to all appropriate audiences is
accomplished in a comprehensive and systematic manner, one needs to develop a
 dissemination plan during the planning stage of the evaluation. This plan should include
guidelines on who will present results, which audiences will receive the results, and who
will be included as a coauthor on manuscripts and presentations.

COMMUNITY ORGANIZING

COMMUNITY ORGANIZING
 Community organizing as a process consists of steps or activities that instill and reinforce
the people’s self- confidence on their own collective strengths and capabilities(Manalili,
1990)

 Community organizing is the process of educating and mobilizing members of the

community to enable them to resolve community problems.

The emphases of community organizing in primary health care are:

 People from the community working together to solve their own problems
 Internal organizational consolidations a prerequisite to external expansion
 Social movement first before technical change
 Health reforms occurring within the context of broader social transformation

Community development
 is the end goal of community organizing and all other efforts towards uplifting the status
of the poor and marginalized.
 will have to be defined and visualized by the community members and their participation
is crucial in the attainment of this vision.

Core principles in Community Organizing

CO is people- centered
 the basic premise of any community organizing endeavor is that the people are the means
and ends of development, and community empowerment is the process and the outcome.
(Felix, 1998)

CO is participative
 the participation of the community in the entire process- assessment, planning,
implementation and evaluation- should be ensured.

CO is democratic
 it is a process that allows the majority of people to recognize and critically analyze their
difficulties and articulate their aspirations.

CO is developmental
 CO should be directed towards changing current undesirable conditions.
CO is process- oriented
 The CO goals of empowerment and development are achieved through a process of
change.

Goals of community organizing

People’s empowerment
 through the process of CO, people learn to overcome their powerlessness and develop
their capacity to maximize their control over the situation and start to place the future in
their own hands.

Building relatively permanent structures and people’s organizations

 CO aims to establish and sustain relatively permanent organizational structures that best
serve the needs and aspirations of the people.

Improve quality of life

 CO also seeks to secure short- and long- term improvements in the quality of life of the
people.

Community Development
 The United Nations defines community development as a “process where community
members come together to take collective action and generate solutions to common
problems.”
 A holistic approach grounded in principles of empowerment, human rights, inclusion,
social justice, self-determination and collective action (Kenny, 2007)
 CD programs are led by community members at every stage – from deciding on issues to
selecting and implementing actions, and evaluation.

Purpose of Community Development

 To bring people to motivate themselves through programs geared towards their overall
development as a unit of society.
 Encouraging togetherness and teamwork is another purpose of community development
and this brings about a sense of strength.
 It aims to bring social reforms through discouraging ancient social or cultural practices
that are outdated and possibly harmful.
 We also cannot underestimate the purpose of community development that is creating
awareness on various social concerns such as health, poverty, security, hunger among
others.
 It also aims to promote good governance as it ensures the community leaders are on their
toes. It makes them aware that they are being watched when it comes to issues related to
their people and how they make decisions that affect them.
Principles of Community Development

Self-determination
 people and communities have the right to make their own choices and decisions.

Empowerment
 people should be able to control and use their own assets and means to influence.

Collective action
 coming together in groups or organizations strengthens peoples’ voices.

Working and learning together

 collaboration and sharing experiences is vital to good community activity.

Characteristics of Community Development

 Focus on geographic communities; local definition is important
 Includes a broad range of people
 Also, can focus on population groups
 Promotes empowerment, cooperation and consensus
 Leadership shared with citizens and those with appointed power
 Relationship oriented

Philosophy of Community Development

 Seeks to strengthen the capacity of community members to act collectively to improve
their physical, social, economic, and political environment
 Builds sustainable places through participation and empowerment

Core Values of Community Development

Collaboration and inclusion

 A large part of community development revolves around two major values: group
inclusion and collaboration. Healthy teamwork is crucial in order for a community
development project to succeed.

Meaningful participation and change

 Speaking of teamwork, it’s essential to understand that your participation is needed for a
greater purpose. Your contributions have significant meaning and value as you move
your community towards change.

Respect
 Respect for your community and others is so important in this process. Without it, the
change that’s needed will not be possible. Focusing on solidarity and being respectful of
others is a large part of the process.
Strengths-based assets
 A goal of community development is to strengthen the overall strength of the community
and its residents.

Integrity
 No good work can be accomplished without integrity. We need honest, dutiful people
who value their community and actively seek out positive change for everyone.

Hope
 There’s no more important quality for community development than hope. Change starts
with individuals, then it grows as we work together with hope for a better, more fruitful
future.

Elements of Community Development

Community Development as a Process
 Community Development is a process form one condition to another. It is an evolutionary
state of change from lower point to the upper. It is the process of total development of
man in a community is the motivation of people towards change in their behavior and
mental growth. Thus it can be easily said that C.D is a process of emphasizing social as
well as psychological change in human social life.

Community Development as a Method

 Community development as a method of practical work in the community people is
involved in it to bring change and development in the community. It is a method of
improvement and progress in which the social organizer play an important role. Social
worker goes to the communities met with people and aware them about the socio
economic backwardness and its causes in the locality. So, C.D as a method uses by the
social organizers to bring people together and work collectively for the improvement and
progress of community.

Community Development as a Program

 It is a set of procedures and having its rules and regulation in the form of programs. There
programs are involved in the better improvement of the community people in various
sectors. Different programs are working to achieve a variety of specific change and
development in community. The community program tries to meet the basic needs and
requirements of the people. Basically, community development program activities are as
under:

 Physical improvements, such as roads, housing, sanitation, drainage, system and farming
etc. Functional activities are health, education, protection, recreation etc. Social activities
including group discussion cooperation, work together, self-reliance etc.

Community Development as a Movement

  It is the gradually change in behavior, belief, mental horizon and motivation towards
change in human life. As a movement, it is the persuasion of masses to become self
reliance and work for the betterment of community. This movement is imposable without
the help, cooperation and coordination and also active participation of the people in
community programs. When the people identify the need of program as their own, then
the process of development starts with full zeal and progress. In this way the process of
community development takes place as a movement from lower stages to the peak point.

Pillars of Community Development

Objectives/goals:
 deepen the decentralization process
 set the National and Local Community Development agendas and support the
communities to understand them

People:
 It’s the people of the community who generates solutions to common problems that
improve the economic, social, environmental and cultural wellbeing of the community
 The control of community people over the amount, quality and benefits of development
activities helps make the process sustainable.

Strategy:
 useful, in guiding daily actions and prioritizing and reviewing established goals, and for
measuring progress.
 aim to provide a focus on specific needs which have an impact across the whole
community.
 identifies long and short-term goals the community wants to achieve

Technology:
 a catalyst for social change
 gives power and a voice to people within the larger ecosystem

Approaches to Community Development

WELFARE APPROACH
 the immediate and/or spontaneous to ameliorate the manifestation of 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 the control of the people

MODERNIZATION APPROACH
 assumes that development consists of abandoning the traditional methods of doing things
and must adopt the technology of industrial countries
  believes that poverty is due to lack of education, lack of resources such as capital and
technology

PARTICIPATORY APPROACH
 this is the process of empowering/transforming the poor and the oppressed sectors of
society so that they can pursue a more just and humane society
 believes that poverty is caused by prevalence of exploitation, oppression, domination and
other unjust structure

THE HEALTH RESOURCE DEVELOPMENT PROGRAM

COMMUNITY HEALTH ORGANIZING UTILITY COPAR
HRDP
 A model for establishing and implementing effective, sustainable and participatory PHC
programs in DDU (deprived, depressed, underserved) communities
 It entails development and mobilization of students and faculty of paramedical
institutions, and enrichment of health oriented curriculum and reorienting the health
education of future health workers to be more responsive and relevant to the current
community health needs

Strategies of HRDP
 Strengthening the integration of PHC, COPAR, Adult teaching learning concepts,
strategies and methodologies in the health science curricula
 Systematization of the student’s exposure program
 Development of CHO which can sustain health development program
 Community – capability building through leadership and skills trainings.
 Provision of health services by the faculty, students and the trained Barangay Health
Workers

History of HRDP
 was developed and sponsored by the Philippine Center for Population and Development
(PCPD)
 PCPD is a non-stock, non – profit institution, which serve as a resource center assisting
institutions and agencies through programs and projects geared toward the social human
development of rural and urban communities
 to make health services available and accessible to depressed and underserved
communities in the Philippines.
 Community organizing as the main strategy to be employed in preparing the communities
to develop their community health care systems and the establishment of community
health organization to manage the community health programs.
 Organizing work in the communities were done in 3 phases
 Participatory Action Research as fascinating strategy for maximum community
involvement through collective identification and analysis of community health
problems and collective health action
 Available funds to finance community initiated projects
HRDP I
 Trained the faculty, medical/nursing students to provide health care services to the far
flung barrios because of lack of man power for health services at the same time that
similar activities fulfilled the curricular requirements of the students for public health
 The PCPD provides seed money for the income generating projects
 Short-term service

HRDP II
 The 2nd cycle uses the same strategy but the program could not be sustained by the
schools or hospitals and the income-generating projects eventually become the hindrance
to the goal of achieving the health program because the people tend to be more interested
in the income generated by the projects
 Both HRPD I and HRDP II have brought about some changes in the community life of
the people
 Established basic health infrastructure; basic health services were increased; there were
trained workers and organized health groups to take care of the need of the community

HRDP III
 PCPD refined the program and resulted to what is now called HRDP III, which has these
unique features:
 Comprehensive training of the staff and faculty of the participating agency in which the
community work was initiated
 Periodic training program and regular assistance to the participating agency were
provided to strengthen the health outreach program to become community oriented
 PHC as the approach with which all nursing / medical students, their CI’s and indigenous
health workers are trained for community health work and around which all other project
inputs will revolve

COMMUNITY ORGANIZING PARTICATORY ACTION

RESEARCH (COPAR)
Introduction
 COPAR or Community Organizing Participatory Action Research is a vital part of
public health nursing. COPAR aims to transform the apathetic, individualistic and
voiceless poor into dynamic, participatory and politically responsive community

Definition
 A 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 people’s 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 (1994 National Rural
Conference).
 A process by which a community identifies its needs and objectives, develops confidence
to take action in respect to them and in doing so, extends and develops cooperative and
collaborative attitudes and practices in the community (Ross 1967).
 A continuous and sustained process of educating the people to understand and develop
their critical awareness of their existing condition, working with the people collectively
and efficiently on their immediate and long-term problems, and mobilizing the people to
develop their capability and readiness to respond and take action on their immediate
needs towards solving their long-term problems (CO: A manual of experience, PCPD).

Process
 The sequence of steps whereby members of a community come together to critically
assess to evaluate community conditions and work together to improve those conditions.

Process and Methods Used in COPAR

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 actions taken by them

Consciousness Raising
 through experiential learning
 is central to the COPAR process because it places emphasis on learning that emerges
from concrete action and which enriches succeeding action

Participatory and Mass –based

 It is primarily DIRECTED TOWARDS and BASED in favor of the POOR, the powerless
and the oppressed

Group centered and not leader oriented

 Leaders are identified, emerge and are tested through action rather than appointed or
selected by some external force or entity

Structure
 Refers to a particular group of community members that work together for a common
health and health related goals.

Emphasis
 Community working to solve its own problem.
 Direction is established internally and externally.
 Development and implementation of a specific project less important than the
development of the capacity of the community to establish the project.
 Consciousness raising involves perceiving health and medical care within the total
structure of society.
Importance
 COPAR is an important tool for community development and people empowerment as
this helps the community workers to generate community participation in development
activities.
 COPAR prepares people/clients to eventually take over the management of a
development programs in the future.
 COPAR maximizes community participation and involvement; community resources are
mobilized for community services.

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

Phases of COPAR
Pre-Entry phase
 Is the initial phase of the organizing process where the community organizer looks for
communities to serve and help. Activities includes:

Preparation of the Institution

 Train faculty and students in COPAR.
 Formulate plans for institutionalizing COPAR.
 Revise/enrich curriculum and immersion program.
 Coordinate participants of other departments.

Site Selection
 Initial networking with local government.
 Conduct preliminary special investigation.
 Make long/short list of potential communities.
 Do ocular survey of listed communities.

Criteria for Initial Site Selection

 Must have a population of 100-200 families.
 Economically depressed. No strong resistance from the community.
 No serious peace and order problem.
 No similar group or organization holding the same program.

Identifying Potential Community

 Do the same process as in selecting municipality.
 Consult key informants and residents.
 Coordinate with local government and NGOs for future activities.
Choosing Final Community
 Conduct informal interviews with community residents and key informants.
 Determine the need of the program in the community.
 Take note of political development.
 Develop community profiles for secondary data.
 Develop survey tools.
 Pay courtesy call to community leaders.
 Choose foster families based on guidelines

Identifying Host Family

 House is strategically located in the community.
 Should not belong to the rich segment.
 Respected by both formal and informal leaders.
 Neighbors are not hesitant to enter the house.
 No member of the host family should be moving out in the community.

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

Guidelines for Entry

 Recognize the role of local authorities by paying them visits to inform their presence and
activities.
 Her appearance, speech, behavior and lifestyle should be in keeping with those of the
community residents without disregard of their being role model.
 Avoid raising the consciousness of the community residents; adopt a low-key profile.

Activities in the Entry Phase

 Integration. Establishing rapport with the people in continuing effort to imbibe
community life.
 living with the community
 seek out to converse with people where they usually congregate
 lend a hand in household chores
 avoid gambling and drinking
 Deepening social investigation/community study
 verification and enrichment of data collected from initial survey
 conduct baseline survey by students, results relayed through community assembly

Activities in the Entry Phase

 Core Group Formation
 Leader spotting through sociogram.
 Key Persons. Approached by most people
 Opinion Leader. Approached by key persons
  Isolates. Never or hardly consulted

Core Group Formation Phase

 Once the community health nurse identifies the potential leaders, they are formed into a
core group.
 The core group will be given the role of community organizer.
 Integration with the core group members
 Deepening social investigation
 Training and education
 Mobilizing the core group

Organization – building phase

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

Key Activities
 Community Health Organization (CHO)
 preparation of legal requirements
 guidelines in the organization of the CHO by the core group
 election of officers
 Research Team Committee
 Planning Committee
 Health Committee Organization
 Others
 Formation of by-laws by the CHO

Sustenance and strengthening phase

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

Key Activities
 Training of CHO for monitoring and implementing of community health program.
 Identification of secondary leaders.
 Link aging and networking.
 Conduct of mobilization on health and development concerns.
 Implementation of livelihood projects.

Phase-out
 The phase when the health care workers leave the community to stand alone
  This phase should be stated during the entry phrase so that people will be ready for this
phase
 The organizations built should be ready to sustain the test of the community itself
because the real evaluation will be done by the residents of the community itself.

CRITICAL STEPS IN BUILDING PEOPLE ORGANIZATION

Activities in Building People’s Organization

Methods of Integration includes:

 Participation in direct production activities of the people
 Conduct of house visits
 Participation in activities like birthdays, fiestas, wakes, etc.
 Conversing with people where they usually gather such as stores, water, walls, washing
streams, or churchyards
 Helping out in the household chores like cooking, washing the dishes, etc.

SOCIAL INVESTIGATION
A systematic process of collecting, collating, analyzing data to draw a clear picture of the
community.
Also known as community study

Pointers for the conduct of Social Investigation

 Use of survey or questionnaires is discouraged
 Community leaders can be trained to initially assist the community worker/organizer in
SI
 Data can be more effectively and efficiently collected through informal methods-house
visits, participating in conversations in jeepneys and others
 SI is facilitated if the community worker is properly integrated and has acquired the trust
of the people
 Confirmation and validation of community data should be done regularly
 Secondary data should be thoroughly examined because much of the information might
already be available

TENTATIVE PROGRAM PLANNING

 Community organizer to choose one issue to work on in order to begin organizing the
people

GROUNDWORK
 Going around and motivating the people on something or an issues
 A time to spot and develop potential leader
 The entry phase or sometimes called the social preparation phase

MEETING
 Core group formation
 People collectively ratifying what they have already decided individually
  The meeting gives the people the collective power and confidence
 Problems and issues are discussed

ROLE PLAYING
 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 eventually

MOBILIZATION OF ACTIONS
 Actual experience of the people in confronting the powerful and the actual exercise
power

EVALUATION
 Determines whether the goal is met or not
 The people reviewing the steps 1- 7, so to determine whether they were successful or not
in their objectives

REFLECTION
 Dealing with deeper, on-going concerns to look at the positive values Community
workers are trying to build in the organization
 It gives the people time to reflect on the stark reality of life compared to the ideal

ORGANIZATION
 The result of many successive and similar actions of the people
 Occurs when the community organization has been established and the community
members are already participating in a community wide undertaking

The Community Health Worker as a Documenter/Reporter

 The community health worker keeps a written account of services rendered, observations,
condition, needs, problems and attitude of the client in community activities,
accomplishments made etc.
 Community workers takes responsibility to disseminate pertinent information to
appropriate authorities, agencies, and most especially to the client
 At the same time, the community worker develops the people’s capabilities to keep/
maintain their recording and reporting system