COMMUNITY

HEALTH
CARE
DEVELOPMENT
Approaches to Development

1. Welfare Approach
- assumes that poverty is God-
given and that poverty is destined.
- believes that poverty is caused by
bad luck.
2. Modernization Approach
- when the community began to accept and utilize
technology and industrialization
- assumes that development can be attained by
abandoning the traditional methods/practices and adopt
the technology of industrial countries.
- poverty is due to lack of education, resources and
technology.
3. Transformatory/Participatory Approach
- focused on empowering the poor and
oppressed sectors of society so that they can
pursue a just and human society.
- poverty is not God-given: rather it is rooted
in the historical past and is maintained by the
oppressive structures in the society.
Health Resource Development Program (HRDP)

 Program initiated by the Population center

Foundation as its contribution to the development of
alternative health care system in the Philippines.
 Based on a belief that potential health manpower
exists in the form of students, faculty, and
hospital/clinic staff who can be mobilized to work
with people to act on their own health problem.
 A model for PHC
 HRDP Goals and objectives:

- It seeks to develop health personnel at two levels:

A. NGO or Institution level – staff, faculty and students
B. Community level – community leaders and residents
 Result: a more responsive health care system in the

community
Objectives:
1. Expansion of health services delivered by privates
institutions
2. Capability building of institutions to increase the
involvement of partner communities
3. To develop schemes for innovative services and make
it a part of the curriculum
4. To support initial community efforts in seeking ways
to sustain health service delivery
5. To review and evaluate the efforts and institutionalize
those that work
6. To develop the capability of partner communities
toward self reliance in health
Community Organizing
 A promising tool for achieving the PHC goals of self-
reliance and self-determination
 A continuous and sustained process of educating the
people to understand and develop their critical
awareness of their existing conditions, working with
people collectively and efficiently on their immediate
and long term problems, and mobilizing the people to
develop the capability and readiness to respond and
take action on their immediate needs toward solving
their long-term problems
Objectives:

1. To make people aware of the social realities

toward the development of local initiative and
strengthening people's capabilities
2. To form structures that uphold the people’s basic
interests
3. To initiate responsible actions to address the
community health and social problems
Emphasis of CO in PHC:
1. Community working to solve its own problems
2. Direction is established internally rather than
externally
3. Process of capability building is more important
than output
4. Consciousness-raising is facilitated
Principles:

1. People especially the most oppressed, exploited and

deprived sectors are open to change.
2. Based on the interest of the poorest sectors of society
3. Leads to a self-reliant community and society
Participatory Action Research (PAR)
An investigation of the problems and issues concerning
the life and environment of the underprivileged in
society by way of a research collaboration with the
underprivileged, whose representatives participate in
the actual research process as equal partners in
studying their own problem.
Central Element:
Participation – is an active process whereby the
expected beneficiaries of the research are the main
actors in the research process
Objectives:

1. Encourages consciousness of their suffering and develop

competence in changing their situation
2. Help in organization-building by harnessing both human
and material resources in responding to community needs
3. Enhances the knowledge of the researchers and the
community on the social reality before them
PAR Process:
I. Preparatory Phase
A. Immersion with the community
B. Stages:
1. Preliminary observation of study areas
2. Selection of the research team/ group
3. Choice and definition of the theme
4. Training of the local researchers
II. Operational Phase – data gathering
III. Collective data synthesis and analysis
IV. Dissemination and Research Utilization
COPAR (Community Organizing
Participatory Action Research)
Definition:
 is a social development approach that aims to
transform the apathetic, individualistic and
voiceless poor into dynamic, participatory and
politically responsive community.
 Is 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 effective
change in their existing oppressive and exploitative
conditions (1994 National Rural CO Conference)
 A process by which a community identify
its needs and objectives, develops
confidence to take action in respect to
them and in doing so, it extends and
develops cooperative and collaborative
attitudes and practices un the community.
 A continuous and sustained process of sensitizing the
people to understand and develop their critical
awareness of their existing conditions, working with
the people collectively and efficiently, concerning
immediate and long term problems, and mobilizing
the people to develop their capability and readiness to
respond and take action on their immediate needs
toward solving their long term problems
Processes/Methods Used in COPAR

1. Progressive Cycle of Action-Reflection-

Action-Session.
 Begins with small, local and concrete
issues identified by the people, make an
action about it and then they will have
the evaluation and reflection of the
action taken by them.
2. Consciousness Raising

 an experimental learning where

emphasis on the learning that emerges
from concrete action and which
enriches succeeding action
3. Participatory and Mass based

 it is primarily directed towards and

biased in favor of the poor, the
powerless and the oppressed sector of
the community.
4. Group-centered and not Leader-oriented
 Leaders are identified, emerged and
are tested through action rather than
appointed or selected by some external
force or entity.
Critical Steps (activities) in COPAR
1. Integration- the health-care worker becomes one with
the people in order to:
 Immerse him/herself in the community.
 Understand deeply the culture, economy,
leaders, history, rhythms, and lifestyle in the
community.
Methods:
 participation in direct production activities of the
people
 house-house visits
 Participation in activities like birthdays, fiestas,
wakes, etc.
 conversing with the people where they usually
gather such as in stores, water wells, washing
streams, or in churchyards.
 helping out in households chores like cooking,
washing dishes, etc.
2. Social Investigation

 A systematic process of collecting, analyzing, collating

data to draw a clear picture of the community.
 Use of survey questionnaires is discouraged
 Secondary data should be thoroughly examined because
much of the information might already be available
 Social investigation is facilitated if the health worker is
properly integrated and has acquired the trust of the
people
 Confirmation and validation of community should be
done regularly.
3. Tentative Program Planning
 CO should 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 ratify 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 acting 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 them for such
eventuality.

7. Mobilization
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
successfully or not in their objectives

9. Reflection
- Dealing with the 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 people’s 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.
 Community Health Worker

 One who provides basic community health care

services for promotion of health prevention of
illness, simple treatment and rehabilitation.
Qualities/Traits of a health worker
 Open  Efficient
 Tactful  Flexible
 Objective
 Critical thinker
 Good listener
 Keen observer
 Good communicator
 Creative and
 Systematic

 knowledgeable
resourceful
 With sense of humor
 Functions of a Health Care
Worker
A. Documenter/Reporter
 Records- refer to forms on which information
pertaining the client is noted
 Reports- refers to 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 services/program directed to the clients

2. Provide basis for future planning.
3. Interpret the work to the public and other
agencies, or community.
4. Aid in studying the conditions of the community.
5. Contributes to client care.
B. Community Health Service Provider
 Carries out health services
 Appraise health needs and concerns of clients
(existing or potential).

C. Facilitator
◦ helps plan a comprehensive program with the
people.
◦ Provides continuing guidance and supervisory
assistance.
D. Health Counselor
- provides health counselling including emotional
support to individuals, family, group and
community.

E. Health Educator
◦ Information- provision of knowledge
◦ Education- change in knowledge, attitude
and skills.
◦ Communication- exchange of information
Phases of the HRDP-COPAR process

I. Pre-entry Phase
II. Entry Phase
III. Organization-Building and Capability
Building Phase
IV. Sustenance and Strengthening Phase
Pre-Entry Phase

- the preparatory phase of the HRDP-COPAR process

- simplest phase in terms of actual outputs and
strategies
- it takes only 1 to 2 months to complete
- done usually at the institutional level
- students participation is minimal
 Site Selection
- entails the sequential implementation of sub-
activities to ensure that the project sites will be
responsive to whatever health and development
interventions initiated
- important in determining the working
relationship as well as the need for the project
 Criteria in Site Selection
1. Depressed, poor community
2. Inaccessibility or inadequacy of health services
3. Poor health status of the community
4. With no serious peace and order problem
5. No strong resistance from the community
regarding the model utilized
6. No similar agencies or programs currently in the
community
 Preliminary Social Investigation
- initial gathering of data about potential sites,
focusing on the data necessary to determine the site
that best conforms with the criteria set
Social Investigation- a systematic and scientific
process of collecting, collating, synthesizing and
analyzing data to draw a clear picture of the
community
Methods of Data Collection:
1. Use of secondary data from various
government offices
2. Use of secondary data from other
community-based health programs
3. Coordination with extension workers from
both the government and non-government
agencies
4. Conduct of ocular observations
 Guidelines for Choosing the Final barangay
1. Conduct of ocular survey
2. Conduct of informal interviews with key persons and
informants
3. Assess whether our services are in fact needed in the
area
4. Validate the secondary collected
* It is essential to inform concerned authorities so that
project endorsement and support to the program can
be secured
 Identification of Host Family

 community work becomes more effective if we live in

the area
 Ensures round-the-clock integration and experiencing

the community
Criteria in Choosing Host Family

1. Should be strategically located in the barangay

2. Should belong to the majority of the group in the
community (poor sector)
3. Should be respected by both the formal and informal
leaders
4. Should have a house where neighbors, especially the
poor are welcome
5. No member of the host family will be displaced
Entry Phase
 sometimes called the social preparation phase
crucial in determining which strategies for

organizing would suit best the community

- lays the foundation of the organizing work as
well as determines the relationship of the
people to the organizers
 Guidelines for Entry in the Community

1. Recognize the role of the authorities

2. Appearance, speech, behavior and lifestyle should be
in keeping with those of the community residents
3. Avoid passing expectations off the community
residents

* There are five interrelated and simultaneous activities

that can be carried out in the entry phase
 Integration with the Community
Integration – the process of establishing rapport with
the people in a continuing effort to imbibe
community life by living with them and undergoing
the same experience, sharing their hopes, aspirations
and hardships towards building mutual trust and
cooperation (Ferrer, 1982).
 The success of activities in the latter parts of the

organizing process greatly depend on how much the

community organizer has integrated with the
community.
Methods of Integration
a. Participation in direct production activities
b. Participation in social activities
c. Conversing with people where they usually gather
d. Doing household chores
 Identification of Potential Leaders or Core Group Formation

 a process of selecting and training the core group

which is considered critical in community organizing
Potential leaders – considered the future CO’s and
possible partners in the management and in the
delivery of basic health services
Core Group – group of individuals who possess
leadership potentials to be formed/ organized into a
cohesive working group
Organization-Building Phase
 begins when the community starts to study their
own problems
 usually starts with the formation of research team

 phase where the community leaders develop their

full potential as leaders of the community

- characterized by the formation of working groups
and the capability building activities provided by
the team.
 Research Team Formation

 the team who are charged with the conduct of

Participatory Action Research
 the first working group that is formed in the

formal organization that is being formed in the

community
- initiated by the Core Group and when the
community people starts verbalizing about the
need to look deeper into the problems of the
community
Sustenance and Strengthening Phase

 Consolation and expansion

 Networking and establishing
 Implementation of livelihood projects
 Developing secondary leaders