Community Health Management PDF

 ESTABLISHING A GOOD WORKING RELATIONSHIPPRELIM INTRODUCTION: The initial attempts to communicate the intention to help members of the community and inform them of its nature are vital to the success of the Community Health Management. The development of a mutu...

 ESTABLISHING A GOOD WORKING RELATIONSHIPPRELIM INTRODUCTION: The initial attempts to communicate the intention to help members of the community and inform them of its nature are vital to the success of the Community Health Management. The development of a mutually trusting and egalitarian relationship is considered the most vital steps in the community health process. All phases of the community process, especially in the assessment phase, participation of the members of the community is crucial to its success. Thus, the community health manager must fist establish rapport with community members before hoping to gain their cooperation. This is essential in order to accurately acquaint and familiarize himself / herself with the client community and gather specific data to identify its health status. IDENTIFYING KEY COMMUNITY OFFICIALS: Directly influencing executive and legislative officials of the governing agencies for health and development are the most important activities of the community health manager that is pre-empted by a harmonious working relationship, especially with the community officials  ESTABLISHING A GOOD WORKING RELATIONSHIP WITH THE COMMUNITY: In establishing a working relationship with the community using the COPAR approach, the client assumes the role of partner in both health related activities and health development. For many health professionals, this division of power is an unwelcome development because they no longer have a monopoly in decision-making. Frequent consultation with the client is already required to arrive at a decision that is desirable to both and advantageous to the community as a whole. Furthermore, theses health professionals are unaccustomed to working with partners, which is why they lack the necessary skills to effectively relate with them. Today, client have started to assert themselves to forge real partnership with health workers. The community health managers need to further develop their skills to be able to positively influence and negotiate with clients. It is only through adequate resources that meaningful empowerment in the local health system may occur. Maintaining a smooth relationship with community officials is a significant factor in directly influencing health and development officials into taking action regarding the overall health issues and concerns within a given community. This is one of the important responsibilities of the community health managers.  ESTABLISHING A GOOD WORKING RELATIONSHIP WITH THE COMMUNITY: (cont’) The following activities help establish a good working relationship with community officials: ü Initiating contact through home or official visits to the community leaders or attending official meeting of community leaders. ü Introducing yourself and your agency. ü Communicating interest in the community’s welfare. ü Maintaining a two-way communication with the community leaders. ü Expressing / showing willingness to help with the community’s expressed needs.  THE ESSENTIAL INGREDIENTS OF PARTNERSHIP: Partnership is a type of relationship characterized by a close cooperation between parties having specified and joint rights and responsibilities as they try to work on a common venture. It is an egalitarian relationship where partners consider each other as co-equals in so far as rights and privileges of the group are considered. In order to engage in a partnership that is characterized as a mutually growth-promoting relationship, the partners need to internalize the following essential ingredients. a) Belief in egalitarian relationship b) Open-mindedness c) Respect and trust d) Commitment to enhance each others capabilities for partnership. Belief in Egalitarian Relationship Partnership can not be a reality unless an egalitarian relationship is considered vital by the identified partners in health development. The health worker must firmly believe that in order to achieve personal, professional or organizational goals and objectives, she / he must engage in an egalitarian relationship with members of the community and others involved with development work.  Open-mindedness People may become so absorbed in their particular experiences and modes of actions to be open to other ways of doing or looking at things and events. Hence, the danger of presuming to decide in an absolute way on the worth of other people’s conditions or ideals. Partnership requires that participants learn to be open-minded in order to see and understand things, events, and people without limitations imposed by prejudice and idiosyncrasies. Respect and Trust For persons to be able to engage in an egalitarian relationship they need to respect for each other’s worth and trust on the potentialities and capabilities of each despite differences in beliefs, values, and experiences. Respect and Trust also form the basic ingredients of a relationship where each partner does not use the other to get the honor or reward only for himself. Failure to earn respect and trust is one major cause why initial experiences on establishing partnership can not be sustained through the working phase of the relationship.  Commitment to Enhance Each Other’s Capabilities for Partnership As mentioned earlier, not everyone designated to engage in a partnership has the necessary skills to do so. Beliefs. Values, feeling, idiosyncrasies and prejudices affect the partner’s capabilities to initiate and sustain an egalitarian relationship. Partnership requires a co-responsibility. Participants must construct together the foundation of a mutually growth-promoting relationship using themselves as “bricks”. Each one must be able to pull up the other to a level of functioning where both of them can work as co-equals.  CONDUCTING A COMMUNITY ORGANIZATION MEETING: Attaining health for all requires expanding participation in health and health related programs. Empowering community to make decisions on its own health is a major goal of the community health management although the Department of Health is the lead agency in implementing health policies. Members of allied health professions should define their own limits and opt for collaborative actions, reach out to people in the community and involve them in all health care activities. Arcaina (1999) reiterates that meetings give people collective power and confidence by discussing their problems and issues. Gathering the people is one of the effective strategies especially if a decision that needs the consensus of the body has to be made. People are also given a chance to work with one another and thus promotes cohesiveness (unity) with proper motivation. With effective and regular meetings, the morale of the community residents improves. By keeping them informed, providing guidance in decision-making, persuading, motivating, they are led and trained on how to attain group goals. COMMUNITY ASSESSMENT INTRODUCTION: The health status of a community is influenced by various interacting elements such as population, physical and topographical characteristics, socio-economic and cultural factors, health and basic social services and manpower structure in the community. The interrelationship of these elements will explain the health and illness pattern of the community. PREPARING A COMMUNITY SPOT MAP: The next step is Community Health Care Process. Data regarding factors that may affect the health of the population must be gathered, analyzed and interpreted according to health needs and problems. In this regards, community diagnosis is considered basic in developing and implementing health intervention strategies. Comprehensive community diagnosis obtains vital general information about the community.  RELATING THE HISTORY OF THE BARANGAY: Barangay history may be legendary or in folklore or may also be official. Either way, its history will give an insight on the nature of its people and their tendency to act in certain ways CONSTRUCTING / CONSOLIDATING COMMUNITY PEOPLE: A Barangay Profile is a consolidation of important data gathered about the barangay. In the hands of a good leader, it could be the basis for approximating the magnitude of the task at hand or the problems being faced; like the resources needed and resources available and the projects and programs for planning and implementation. By accepting the community first for what it is, the community health leaders will find comfort in dealing with the people whom she / he must work with. As a result, one will find it easy to face the countless challenges that she / he will encounter later on.  GATHERING COMMUNITY DEMOGRAPHIC DATA: Gathering information is essential in administering and performing activities in every enterprise. The community health process is one particular activity that depends for its effectiveness on the quality and quantity of data involved. It is also important that all efforts be directed toward the acquisition, organization and oral data to serve its purpose. Accurate and timely information is necessary in all aspects of health development, thus its availability should be ensured through the identification, collection processing and analysis of the necessary data to allow accurate evaluation of the various aspects of the community health situation. An assessment of the human, 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. A community health manager therefore must collect accurate demographic data about the people in the community where she / he works. As the term aptly means, demography is the science of vital and social statistics as of birth, marriage, death, etc., of the population (Webster Dictionary) In Encyclopedia Brittanica, demography refers to the statistics study of human population specially with reference to size, destiny and distribution.  DATA COLLECTION: After data collection, the nurse is now ready to put together all the information. There are two types of data that may be gathered, either numerical which can be counted or descriptive which can be described. To facilitate data collation, the nurse must develop categories for classification of responses making sure that the categories are mutually inclusive and exhaustive. DATA PRESENTATION: Data presentation will depend largely on the type of data obtained. Descriptive data are presented in narrative reports. Examples of data appropriate for descriptive presentation are geographic data, history of a place or beliefs regarding illness and death. Numerical data may be presented into tables or graphs which are useful in showing key information making it easier to show comparisons including patterns and trends. The choice of graphs will depend on the type of data being presented.  TYPE OF GRAPH DATA FUNCTION Show trend data or changes with time or age with respect to some other Line graph variable Bar graph / pictograph For comparisons of absolute or relative counts and rates between categories. Histogram / frequency Graphic presentation of frequency distribution or measurement. polygon Proportional or component Show breakdown of a group or total where the number of categories is not too bar graph / pie chart many. Scattered diagram Correlation data for two variables. DATA ANALYSIS: Data analysis in community diagnosis aims to establish trends and patterns in terms of health needs and problems of the community. It also allows for comparison obtained data with standard values. Determining the interrelationship of factors will help the nurse view the significance of the problems and their implications on the health status of the community. Use this color codes in the presentation of graphs and pie. 1. RED 2. ORANGE 3. DARK YELLOW 4. DARK GREEN 5. PINK 6. INDIGO 7. DARK VIOLET 8. BROWN 9. YELLOW GREEN 10. SKY BLUE  PRESENTING VITAL STATISTICS AND EPIDEMIOLOGY DATA: Community vital statistics or biostatistics includes data on age and sex distribution, growth rate, birth and death rates presented in geographical illustration. A brief explanation of figures through legends should be included. A simple graph may eloquently describe causes and effects of community health problems. IDENTIFYING COMMUNITY HEALTH PROBLEMS: Community health problems may include the following: 1. Health status problems such as increased morbidity, mortality or fertility; 2. Health resource problems such as lack or absence of manpower, money, or materials / institutions necessary to solve the existing health problems; 3. Health related problems such as the presence of social, economic, environmental or potential factors that aggravate illness, which may cause a potential health situation in the community.  ANALYZING PROBLEMS AND DETERMINING RESOURCES NEEDED: When the problems have been identified, the community, together with its health manager, must analyze why the health problem exist while also recognizing resources available in the community that would help address the said problems. DIRECTION: Within a day, make a problem tree by answering “why questions” regarding identified community health problems. Accomplished form below will serve as your guide. POOR CHILD LACK OF NUTRITION DIARRHEA / POOR DIETARY CARE SUPPLEMENTS CHILDHOOD DISEASES HABITS POOR UTILIZATION LACK OF BASIC LOW LEVEL OF OF BASIC HEALTH HEALTH FACILITIES EDUCATION SERVICES (TOILET, GARBAGE, DRAINAGE) POVERTY PREOCCUPATION LACK OF NEGATIVE ATTITUDE LOW GOVERNMENT WITH EARNING A SUPPLIES BUDGET FOR HEALTH LIVING COMMUNITY HEALTH CARE PLANNING INTRODUCTION: In the book Reading in , Health System Management, Mercado (1993) summarized the concepts of planning according to the following: 1. Planning is futuristic 2. Planning is change-oriented 3. Planning is a continuous and dynamic process 4. Planning is flexible 5. Planning is a systematic process INTRODUCTION: (cont) In addition, he described the planning cycle where in basic questions had to be answered. These may include the followings: 1. Where are we now? 2. Where do we want to go? 3. How do we get there? 4. How do we know we are there?  IDENTIFYING PRIORITY COMMUNITY HEALTH PROBLEMS: Within a day, using the form for prioritizing community health problems compute the score for each problem and list them down according to priority. Then, identify possible / available resources to solve these problems. Example: Community Problem: High frequency of diarrhea CRITERIA SCORE HIGHEST POSSIBLE SCORE WEIGHT ACTUAL SCORE NATURE OF THE PROBLEM 3 1 1 Health status 3 Health resources 2 Health related 1 MAGNITUDE OF THE PROBLEM 4 3 3 75 – 100 % affected 4 50 – 74 % affected 3 25 – 49 % affected 2 less than 25 % affected 1 Example: (cont) Community Problem: High frequency of diarrhea CRITERIA SCORE HIGHEST POSSIBLE SCORE WEIGHT ACTUAL SCORE MODIFIABILITY OF THE PROBLEM 3 4 4 High 3 Moderate 2 Low 1 Non-modifiable 0 Preventive potential High 3 3 1 1 Moderate 2 Low 1 Social concern Urgent community concern 2 2 1 1 Recognized problem but does not need urgent attention 1 Not a community concern 0 score Criteria score : = Score Highest possible score x weight  LIST OF COMMUNITY PROBLEMS ACCORDING TO PRIORITY: DIRECTION: Using the corresponding form, students should be able to arrange the list of community problems according to priority; the one with the highest score will have the topmost rank, thus, they will be able to determine resources needed, both available and unavailable. Priority Problems Resources Needed Resources Available Resources Unavailable List of Community Problems According to Priority: Problem No. Problems Scores 1 high frequency of diarrhea 10 2 high frequency of upper respiratory cases 8 3 high frequency of malnutrition cases 7 4 high birth rate 6 5 high death rate for rabies 5 6 joblessness 5 7 lack of health facilities 4 8 lack of health officers 3 9 high cost od medicines 2 10 lack of toilets 2  PREPARING A COMMUNITY HEALTH ACTION PLAN: DIRECTION: Formulate a Community Health Action Plan for the top five priority community problems together with a community action group in two hours. RESPONSIBLE PERSONS PROBLEMS SOLUTIONS PROJECTS GOALS / OBJECTIVES / SIGNATURES 1. Malnutrition Additional food among 0 to 6 year Feeding program BNS and Aling Jovy supply old children Educated mother Mother Classes Aling Josie and CHM on proper feeding Reduce the number of Monitor weight Operation Timbang 2nd degree malnourished All CHWs 2. Inadequate children ages 0 to 6 water supply years old within three months 3. Garbage 4. Livelihood 5. Toilet system 6. Medicines  WORKING OUT DETAILS OF THE PLAN TOGETHER WITH THE COMMUNITY ACTION GROUP: DIRECTION: Within an hour, the Community Action Group will facilitate the making of a community project plan by accomplishing the succeeding forms. A sample project is provided below as a guide. PROJECT: Feeding Program ACTIVITES RESOURCES NEEDED TIME ALLOTED PERSON/S RESPONSIBLE 1. Meeting with Mothers of Malnourished children Result of OPT Venus One day CHM 2. Decide/ implement fund raising activity Fund raising group – Aling (Nutri-Bingo) One week Noni 3. Acquisition of food supplements / supplies One day Aling Luz 4. Enroll priority children in feeding programs List of supplies needed, jeep fare One day Aling Marie 5. Schedule mothers in food preparations / feeding activities One day Aling Jovy 6. Make schedule of feeding and weighing activities Logbook, pen One day Aling Alice 7. Feeding proper Cooking/ feeding venue, cooking utensils, Daily for 3- Mothers as scheduled stove, eating utensils months