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Community Health Management 1

o Focus: facilitating community empowerment to act on community health problems
by using the community health process and the philosophy of Community Health
Nursing
o Ultimate goal: to improve the quality of health of the citizenry
o It is geared to help communities and families cope with health problems and have
them assent to health services
1. Establishing a good working relationship
o Initial attempts to communicate the intention to help members of the community
and inform them of its nature are vital to the success
o Vital step development of a mutually trusting and egalitarian (open relationship
1.1Identifying key commnity officials
o Community health manager must possess the ability to effectively influence and
negotiate with people from both ends of the social spectrum
o the most important activities of the community health manager : !irectly
influencing e"ecutive and legislative officials and governing agencies for health
and development are
o First step in initiating a smooth relationship: to learn the correct full name and
designation of #ey community officials
BARANGAY OFFICIALS
___________________________________________
(Name of Barangay, City, Town, or Provine!
N$%& !&'I(N$)I*N $!!+&'',)&-. N*. C*%%I))&&
1.!. Establish a good working relationship with the commnity
o Using COPAR: the client assumes the role of partner in both health related
activities and health development
o /requent consultation with the client is required to arrive at a decision that is
desirable to both and advantageous to wor#ing with partners
Activities to help establish a good working relationship with community officials
o Initiating contact through home or offical visits to the ocmmunity leaders or
attending official meetings of community leaders
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Community Health Management 2
o Introducing yourself and your agency
Activities to help establish a good working relationship with community officials
o Communicating interest in the community0s welfare
o %aintaining a 12way communication with the community leaders
o &"pressing,showing willingness to help with the community0s e"pressed needs
1.3. Conducting a community organization meeting
o $ttaining health for all requires e"panding participation in health and health related
programs
o major goal for community health management: &mpowering community to ma#e
decisions on its own health
o Arcaina (1999 reiterates that meetings give people collective power and
confidence by discussing their problems and issues
o (athering people is one of the effective strategies especially if a decision that
needs the consensus of the body has to be made
o 3eople are also given a chance to wor# with one another and thus promotes
cohesiveness with proper motivation
o 4ith effective and regular meetings5 the morale of the community residents
improves
o 6y #eeping them informed5 providing guidance in decision2ma#ing5 persuading5
motivating5 they are led and trained on how to attain group goals
"teps in organi#ing a commnity health action
(ain entry into the community and accomplish the following:
o (ather information about the community form other members of the +H7
or from records and reports
o Identify persons to contact for a courtesy call
'chedule and ma#e your courtesy calls
Introduce yourself5 your role5 your functions and your initial plans as
a representative of the agency
"teps in organi#ing a commnity health action
o $rrange first meeting with identified #ey community leaders. Have barangay
officials sign invitation for a meeting
o 3repare an agenda for the first meeting
Integrate with the people in the community
. Community assessment
o )he health status of the community is influenced by various interacting elements
such:
8. 3opulation
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Community Health Management 3
1. 3hysical and topographical characteristics
9. 'ocio2economic and cultural factors
:. Health and basic social services
;. %anpower structure in the community
o )he interrelationship of these elements will e"plain the health and illness pattern of
the community
!.1. $reparing a commnity spot map
o Conduct a preliminary ocular survey
o !raw a spot map of your assigned community
o $ community spot map with the aid of community residents can also be a chance
to acquaint yourself with the people and places in the community
o *ld maps may be reviewed
!.!. Relating the history of the barangay
o 6arangay history may be legendary or in fol#lore or may also be official
o Its history will give an insight on the nature of its people and their tendency to act in
certain ways
"orces%
o Community residents5 and officials
o 3ertinent write2ups about the baranagay
!.&. Constrcting and consolidating commnity profile
o !arangay Profile a consolidation of important data gathered about the barangay
o It could be a basis for appro"imating the magnitude of the tas# at hand or the
problems being faced< li#e:
8. +esourses needed
1. +esources available
9. 3ro=ects and programs
!.'.(athering commnity demographic data
o &ssential in administering and performing activities in every pro=ect
o $ccurate and timely information is necessary in all aspects of health development5
thus its availability should be ensured through the identification5 collection
processing and analysis of necessary data to allow evaluation of the various
aspects of community health situation
(athering commnity demographic data )Contination*
o $ccurate and timely information is necessary in all aspects of health development5
thus its availability should be ensured through the identification5 collection
processing and analysis of necessary data to allow evaluation of the various
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Community Health Management 4
aspects of community health situation
o $ssessnment of the human5 material and other resources of the community will
greatly help to come up with a rational and systematic health program responsive
to the community needs
o "emography (&ncyclopedia 6ritanicca statistical study of human population
specifically with reference to size5 destiny and distribution
+emographic featres
o 3opulation
o 3opulation density
o 3ower supply
o Communication services
o -and use
$hysical infrastrctre
o roadwor#s
o )ransportation
o 4ater supply
"ocial featres
o Health status
8. >ital statistics
o Health facilities and services
o )oilet facilities
o (arbage collection and disposal
o reduction
!.,. $resenting -ital "tatistics and Epidemiology +ata
o Community vital statistics or biostatistics:
8. !ata on age and se" distribution
1. (rowth rate
9. 6irth and death rates
$ brief e"planation of figures trough legends should be included
$ simple graph may eloquently describe causes and effects of
community health problems
!... identifying commnity health problems
o )ypes:
Health status problems such as increased morbidity5 mortality or fertility
Health resource problems suchas lac# or absence of manpower5 money5 or
materials,institutions necessary to solve the e"isting health problems
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Community Health Management 5
!... identifying commnity health problem )contination*
Health related problems such as the presence of social5 economic5 environmental or
potential factors that aggravate illness5 which may cause a potential health situation
in the community
Barangay" __________________________________________
Health status problems
8.
1.
9.
:.
Health resources problems
8.
1.
9.
:.
Health related problems
8.
1.
9.
:.
!./. analy#ing problems and determining resorces needed
o Community5 and health manager must analyze why the health problem e"ists while
also recognizing resources available in the community that would help address the
said problems
E0ample
problem% increased cases of malntrition
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Community Health Management 6
3. Community health care planning
$lanning is% )1ercado2 133&*
futuristics
change2oriented
Continuous and dynamic process
/le"ible
'ystematic process
&.1.identifying priority health problems
o Compute for the score for each problem and list them according to priority
o Identify possible,available resources to solve these problems
(ide for prioriti#ing problems
Community problem _________________________________________________________
CRITERIA SCORE
HIGHEST
POSSIBLE
SCORE
WEIGHT ACTUAL SCORE
NATURE OF THE PROBLEM
? Health status
? Health resources
? Health related
3
2
1
3 1
MAN!TU"E OF THE
PROBLEM
4 4 3
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Community Health Management #
? #5$1%%& a''ected
? 5%$#4& a''ected
? 25$4(& a''ected
? Less tha) 25& a''ected
3
2
1
MO"!F!AB!L!T* OF THE
PROBLEM
? H+,h
? Moderate
? Lo-
? No).od+'+a/le
3
2
1
%
3 4
PRE0ENT!0E POTENT!AL
? H+,h
? Moderate
? Lo-
3
2
1
3 1
1O2!AL 2ON2ERN
? Ur,e)t co..u)+t3
co)cer)
? Reco,)+4ed 5ro/le.
/ut does )ot )eed
ur,e)t atte)t+o)
? Not a co..u)+t3
co)cer)
2
1
%
2 1
F+)al score
Actual score 6 score78h+,hest 5oss+/le score 9 -e+,ht:
&.!. list of commnity problems according to priority
o $rrange the list of community problems according to priority
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Community Health Management ;
o )he one with the highest score will have the topmost ran#
Li#t of omm$nity %ro&'em# aor(ing to %riority
3roblem
No.
3roblems 'cores
8
1
9
:
;
@
A
B
C
8D
&.&. preparing a commnity health action plan
o /ormulate a community health action plan for the top ; priority community
problems together with a community health action group
4ction plan
Problems Solutions projets Go!ls" objeti#es Responsible
persons"
si$n!tures
1<
2<
3<
4<
5<
E0ample% 4ction plan
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Community Health Management (
Problems Solutions projets
Go!ls"
objeti#es
Responsible
persons"
si$n!tures
1<Mal)utr+t+o
) a.o), % to
6 37o
ch+ldre)
Add+t+o)al 'ood su55l3 Feed+), 5ro,ra. Reduce the
)u./er o' 2
)d

de,ree
.al)our+shed
ch+ldre) a,es %
to 6 3ears old
-+th+) 3 .o)ths
Educate .others o)
5ro5er 'eed+),
Mother classes
Mo)+tor -e+,ht O5erat+o) t+./a),
3.!. working out details of the plan together with the community action group
PRO%ECT PLA&
Projet ' _______________________________________
A2T!0!T!E1 RE1OUR2E1
NEE"E"
T!ME ALLOTE" PER1ON71 RE1PON1!BLE
1<
2<
3<
4<
5<
6<
#<
E0ample% pro5ect plan
PRO%ECT PLA&
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Community Health Management 1%
Projet '(ee)in$ pro$r!m
A2T!0!T!E1 RE1OUR2E1
NEE"E"
T!ME ALLOTE" PER1ON71
RE1PON1!BLE
1<Meet+), -+th .others
o' .al)our+shed ch+ldre)
Result o' OPT =e)ue 1 da3
2<dec+de7+.5le.e)t 'u)d
ra+s+), act+=+t3
1 -ee>
3<Ac?u+s+t+o) o' 'ood
su55le.e)ts 7 su55l+es
1 da3
4<E)roll 5r+or+t3 ch+ldre)
+) 'eed+), 5ro,ra.s
L+st o' su55l+es
)eeded@ 'are
1 da3
5<1chedule .others +)
'ood 5re5arat+o)s7
'eed+), act+=+t+es
1 da3
6<Ma>e schedule o'
'eed+), a)d -e+,h+),
act+=+t+es
Lo,/oo>@ 5e) 1 da3
#<Feed+), 5ro5er 2oo>+),7'eed+),
=e)ue@ coo>+),
ute)s+ls@ sto=e@ eat+),
ute)s+ls@ soa5@ -ater
"a+l3 'or 3 .o)ths
!. Community health care implementation
o $ll strategies in building people0s organization should be considered
o Community should be active participant in all the activities that will be implemented
o #mplementation phase: refers to the actual implementation of the plan5 the
mobilizaiton of resources to meet ob=ectives5 and the active participation of the
people
6o meet the ob5ecti7es2 the following acti7ities shold be employed%
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Community Health Management 11
Home visits
'chedule a conference or a demonstration
!eliver basic health care services
!isseminate information or health education
%obilize all indigenous resources
!.1. health education and training"information communication campaign
Facilitating a class $iscussion
+ules to enable the group to learn quic#ly:
Have a very clear idea concerning the topic to be discussed and the activities that
the group will ta#e part in before the session begins
'upervise the discussion
!irect the discussion
3rovide feedbac#
6e diplomatic and tactful
&ncourage group spirit
Effecti7e edcator
*ne must answer the ff questions
o Can they clearly hear and understand what you are saying and red what you are
writingE
o !o you use simple languageE
o !o you use visual aidsE
o !o to summarize the main pointsE
1ethods of teaching skills
!escribing a s#ill or tas# analysis
!emonstrating a s#ill
3racticing
+ole playing
3ro=ect completion
'imulation
Case study
Fob e"perience
1ethods of teaching knowledge%
)each only the facts that the clients need to #now
Carefully plan activities for the clients where they can apply what they have =ust
learned. !o not limit yourself to lectures
&ncourage them to learn more from their own e"periences5 from boo#s5 from role
models and from each other
7se visual aids and handouts
1ethods of teaching attitdes
$ttitude is the tendency to behave in a certain way.
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Community Health Management 12
$ttitudes are not easily developed
$ttitudes are shaped by:
8. 3roviding relevant bac#ground information
1. 3roviding models or e"amples
9. 3roviding e"perience
:. &ncouraging discussion among cleints
;. +ole playing activities
6eaching plan
Topi' ________________________________
Teach+), o/Aect+=es
Attract+), cl+e)t
+)terests
act+=+t+es e=aluat+o)
'.!. Intra8inter agency coordination
o Health activities underta#en outside the health sector have impact on health that is
possibly greater than those underta#en within it.
o $ll health efforts should be unified within the heath organization itself5 as well ass
all other sectors concerned
9ther sectors closely related to health%
o $griculture
o &ducation
o 3ublic wor#s
o -ocal government
o 'ocial welfare
o 3rivate sector
o %a#e a directory of #ey government and nongovernment agencies in the
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Community Health Management 13
community5 including:
@. Heads
A. 'ervices
B. 3ossible resources
'.&. commnity mobili#ation
o 'uccessful implementation of a community health care programs can be ensured b
using 3articipatory $ction +esearch
C. +elies on effective facilitation when wor#ing with people
8D. &ffective facilitation ensures that the groups achieve their aims and reach
their goals
C9$4R%
o 7ses a progressive cycle of $C)I*N2+&/-&C)I*N2$C)I*N
o +aises consciousness through e"perimental learning
o Is participatory and biased towards the masses
o Is group2centered and not leader2oriented
Critical acti7ities in bilding people:s organi#ation%
Integration or living with the people
)entative program planning
(round2wor#ing
%eetings
+ole play
'ocial investigation
%obilization or action
Contination% Critical acti7ities in bilding people:s organi#ation%
&valuation
+eflection
*rganization
'.'. Rral Health $rograms
o 3rovision of basic health services through participation in the +H7 programs is a
ma=or responsibility of the Community Health %anager
o Nursing students are e"pected to help in the improvement of health service
delivery system especially in rural areas while delivering new insights from
e"periences of wor#ing with the people in the community
community health care evaluation
$rogram8 $ro5ect E7alation
o Output refers to the products or services which an activity is e"pected to
produce
88. &"ample: number of children weighed
o Effect refers to the outcome of the utilized pro=ect outputs
81. &"ample: number of malnourished children
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Community Health Management 14
o Impact refers to the outcome of the program,pro=ect effects
o Impact evaluation assess the impact of care administered of the impact of
implemented pro=ect,program on the client by comparing the conditions of the
quality of life
89. &"amples: mortality or death rates5 average life e"pectancy
o Cost effectiveness analysis can be done to compare alternative pro=ects,care
intervention in terms of the cost of producing a given output