Community Diagnosis BSM Level II PDF

COMMUNITY DIAGNOSIS ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  HEALTH (WORLD HEALTH ORGANIZATION) is a state of complete physical, mental and social well-being, and not merely the absence of disease or...

COMMUNITY DIAGNOSIS ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  HEALTH (WORLD HEALTH ORGANIZATION) is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.  And include the ability to lead a socially and economically productive life.  PUBLIC HEALTH (CHARLES-EDWARD A. WINSLOW) is the art and science of preventing disease, prolonging life, and promoting physical and mental efficiency through organized community efforts. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  PUBLIC HEALTH (CHARLES-EDWARD A. WINSLOW) For the sanitation of the environment the control of community infections, the education of the individual in the principles of personal hygiene, the organization of medical and nursing services of early diagnosis and preventive treatment of diseases, and the development of social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  PUBLIC HEALTH (Institute of Medicine, 1988) An organized community effort to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Analogy of Procedures Patient vs. Community Examination Survey Diagnosis Treatment Community Diagnosis Planning Treatment Program Planning Program Payment Operation Financing Evaluation Appraisal ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Table 1. Comparison Of Clinical Medicine And Community Health Programs Clinical Medicine Community Health Programs Objective Cure patient of disease Improve health status of community Information Clinical history, physical Population data, health problems, disease required examination and patterns, availability of health services laboratory investigations Diagnosis Differential diagnosis and Community diagnosis and priorities for probable diagnosis action Action plan Treatment and Community health programs rehabilitation Evaluation Follow-up and Evaluation of changes in health status assessment ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Other Names o Community Health Assessment o Health Needs Assessment o Community Assessment o Situational Analysis o Situational Assessment ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph It seeks to answer several questions: What is the problem? Why is there a problem? - What are the probable causes? - How serious is the problem? Who are affected by the problem? - How many are they? - Where are they located? - What are their characteristics? What has been done to solve the problem? ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Community Diagnosis as a PROCESS The process of community diagnosis involves four stages: 1. Initiation 2. Data Collection and Analysis 3. Diagnosis 4. Dissemination ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph Initiation: Scope and Objectives Organization Resources Schedule ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Data Collection The process consists of: a determination of the information required an identification of the sources - primary and secondary - qualitative and quantitative a determination of the method/s to collect the collection of data ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph What Information To Collect? ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Influences on Health [Dahlgren and Whitehead (1991); from Acheson (1998)]  What Information To Collect? Examination of Secondary data Collection of Primary data on the community’s history and geography social and health indicators ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? HEALTH INDICATORS: Classification of Health Indicators A. Mortality indicators Mortality rates Maternal Mortality Rate Crude death rates Case Fatality Rate Specific death rates: age/disease Life expectancy Infant mortality rate ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? HEALTH INDICATORS: Classification of Health Indicators B. Morbidity indicators Notification rates Attendance rates: out-patient clinics or health centers Admission and discharge rates Hospital stay duration rates ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? HEALTH INDICATORS: Classification of Health Indicators C. Disability rates Number of days of restricted activity Bed disability days Work/School loss days within a specified period Expectation of life free of disability ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? HEALTH INDICATORS: Classification of Health Indicators D. Nutritional status indicators Anthropometrics measurements Height of children at school entry Prevalence of low birth weight Clinical surveys: anemia, hypothyroidism, night blindness, etc. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? Doctor / Population ratio HEALTH INDICATORS: Doctor / Nurse ratio Classification of Health Doctor / Midwife ratio Indicators: Doctor / BHW ratio E. Health care delivery Doctor / BNS ratio indicators Dentist / Population ratio Population / Health center Population / Barangay health ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? HEALTH INDICATORS: Health care utilization rate Classification of Health Extent of use of health services Proportion of people in need of Indicators service who actually receive it in a F. Utilization rates given period Proportion of infants who are fully immunized in the 1st year of life, i.e.. immunization coverage Proportion of pregnant women who receive ANC ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? G. ENVIRONMENTAL INDICATORS - Measures of pollution - Proportion of people having access to safe water and sanitation facilities - Vectors density ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? H. SOCIO-ECONOMIC INDICATORS - Rate of population increase - Per capita GNP - Level of unemployment - Literacy rates - Family size - Housing condition - e.g. No. of persons per room ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? I. Health policy indicators - allocation of adequate resources - Proportion of GNP spent on health services - Proportion of GNP spent on health related activities - Proportion of total health resources devoted to primary health care ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What Information To Collect? J. Other indicators Suicide & Homicide rates Road traffic accidents Alcohol and drug abuse Indicators of quality of life Basic needs indicators Health for all indicators ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Sampling Method Should be carefully designed and the sample size should be large enough to provide sufficient data to draw reliable conclusions Study results derived can truly review the local community ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Methods of Data Collection A. Survey Interview Questionnaire B. Community Café creates the atmosphere of a restaurant or café in which people from the community discuss issues or questions asked by facilitators in small groups ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph C. SWOT Matrix - used to help analyze the internal strengths and weaknesses of a development situation or an organization ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph D. Asset Inventory a technique for collecting information about a community through observation community members catalogue assets in their community ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Data Analysis Epi-Info6 SPSS ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Diagnosis Diagnosis of the community is reached from conclusions drawn from the data analysis. It should preferably comprise of the: > health status problems - increased morbidity, mortality, fertility - reduced capability for wellness - others > health resource problems - lack or absence of resources ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Diagnosis The process consists of 1. Problem Identification 2. Priority Determination 3. Problem Analysis ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph It is that they can’t see the solution; it is that they can’t see the problem. G.K. Chesterton ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Wrong identification of the problem, will lead to wrong solution to the problem. President Benigno Simeon C. Aquino III ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What is a PROBLEM? A problem can be defined as the difference between things as perceived and things as desired “What is” vs. “What should be” ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  List at most 10 problems ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Barangay Marites, Koronadal City, South Cotabato 1. Low family income 2. incidence of acute respiratory infection and acute gastroenteritis 3. Improper waste disposal 4. Lack of postnatal visits 5. Increase home deliveries 6. High incidence of health risk factors (e.g. Smoking, alcohol drinking) 7. Malnutrition 8. Low educational attainment 9. Households without toilets 10. No electricity ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph DETERMINE PRIORITIES “Priority determination is a method of imposing people’s values and judgments of what is important onto the raw data.” Priority Setting: “First Thing’s First” ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Criteria in the Ranking of a Problem Vulnerability to Change - existence of effective technology - feasibility of implementing the technology - financial, human resources and organization ❖ Availability of technology gets higher score. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Magnitude of the Problem - Many are affected, higher complications ❖ If more are affected, the higher the score. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Social Concern - the value attached by the community to the problem - the problem affects certain age, sex or marginalized ❖ If expressed by the community as important, the higher the score. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Existing Health Policies - the intervention/s on a particular health condition is anchored on existing health policies ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Prioritization Matrix Vulnerability Social Magnitude Existing Total Problem to Change Concern of the Policy Problem ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Magnitude of Vulnerability to Existing Social Problem the Problem Change Health Concern Total Rank Policies Low Family Income 5 2 5 7 19 5 Increase Incidence of 9 6 4 9 28 2 ARI / AGE Improper Waste 3 9 2 2 16 6 Disposal Increase Home 7 3 8 4 22 4 Deliveries Lack of Postnatal 6 10 9 2 28 2 Visits High Incidence of Risk 2 8 3 6 19 5 Factors Malnutrition 8 5 10 8 31 1 Low Educational 4 1 6 1 12 7 Attainment Households without 10 7 7 10 27 3 Toilets No Electricity 1 4 1 5 11 8 ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph Analyze the Problem ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Problem Analysis A process in which planners identify the central or “core problem” Analyze the problem and determine the “cause-effect” relationships between the problems; and Visualize the cause-effect relationships in a diagram. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph Simplified Problem Diagram Problem Tree is a visual problem-analysis tool for the identification of a key problem and its effects (ends) and root causes (means), which will later form the bases for formulating solutions and objectives ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Effects Problem Tree Problem Causes  Standard Chart: The Complete Problem Tree Trunk: The Core Problem Root: The Causes  Poor health Poor performance in Effects school Malnutrition Problem Poor knowledge and attitude Causes Poor practices Effects High Under-5 Stunted Mortality Rate Growth Malnourished Core Problem Children Diarrhea Poor Diet No Poor No Backyard Latrines Hygiene Garden Poor Practices Causes Lack of Knowledge ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph Assess The Causes Based On The Following Criteria Can Be Can Be Immediate Medium to Acted by Acted by Concern Long-term the Health Other Solution / Sector Sectors Needs Legislation ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph Assess The Causes Based On The Following Criteria Acted by Acted by Immediate Medium to Health Other Sectors Concern long-term Sector solution / Needs legislation Lack of knowledge No latrines Lack of knowledge Poor Practices Poor practices Poor hygiene Poor hygiene Diarrhea Diarrhea No backyard No backyard garden garden Poor diet Poor diet ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  What can we do with the causes that can be addressed by OTHER sectors? What can we do with the causes that can be addressed by the Health Sector but can only be achieved on a long term basis? ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  PRESENTATION Some practical tips: o best presented as rates or ratios for comparison o trends and projections are useful for monitoring changes over a time period for future planning o local data can be compared with other districts or the whole population graphical presentation is preferred for easy understanding ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph Community Diagnosis as a part of a PROCESS ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  René Dubos has pointed out that most of human history has been a result of accidents and blind choices – when an immediate crisis occurs, our solutions have generally resulted in a Band-Aid approach involving piecemeal efforts rather than a considered and thoughtful plan. The need to develop our ability to predict, plan and thus prevent the same crisis from recurring should have the highest priority. From Dental Public Health and Community Dentistry, A.Jong ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph The Program Cycle Evaluation Planning Monitoring Implementing ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  The completion of the Community Diagnosis process should answer the following questions for the community: 1. Where is the community now? 2. Where does it want to be? 3. How will it get there? ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph It is important to realize that Community Diagnosis is not an on-off project, but is part of a dynamic process leading to health improvement in the community. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Involving culturally diverse community members in assessments "can alert the effort to potential political and social taboos and help identify the individuals and organizations with the richest sources of information.... By rigorously and creatively assessing community needs, the process gives 'voice' to individuals in the community who have not traditionally been solicited for comment...." - Chang, Leong, & Salazar (1994) ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph  Diagnosis is much broader and aims to understand many facets of a community including culture, values and norms, leadership and power structure, means of communication, helping patterns, important community institutions, and history. A good diagnosis suggests what it is like to live in a community, what the important health problems are, what interventions are most likely to be efficacious, and how the program would be best evaluated. Steckler et al, 1993. ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph End of presentation Salamat, po! ST. A L E X I U S C O L L E G E www.stalexiuscollege.edu.ph