Health Statistics and Epidemiology PDF

HEALTH STATISTICS AND EPIDEMIOLOGY b. economic groups 1. TOOLS c. educational attainment 1. Demography d. Ethnic Group - Study of population size, composition and spatial e. D...

HEALTH STATISTICS AND EPIDEMIOLOGY b. economic groups 1. TOOLS c. educational attainment 1. Demography d. Ethnic Group - Study of population size, composition and spatial e. Distribution distribution as affected by births, deaths and Urban-Rural – shows the proportion of migration people living in urban compared to the rural a. Sources of Data areas Crowding Index – indicates the ease by - Census which a communicable disease can be – complete enumeration of the population transmitted from 1 host to another susceptible host. 2 Ways of Assigning People Population Density – determines congestion De Jure – people assigned to the place they of the place usually live regardless of where they are at the time 2. HEALTH INDICATORS of census. VITAL STATISTICS De Facto – People were assigned to the place where they are physically present at are at the time of - Statistics refers to a systematic approach of census regardless, of their usual place of residence. obtaining, organizing and analyzing numerical facts so that conclusion may be drawn from b. Population Size them. c. Composition - Vital statistics refers to the systematic study of vital events such as births, illnesses, - Age Distribution marriages, divorce, separation and deaths. - Sex Ratio - Statistics of disease(morbidity) and death(mortality) indicate the state of health - Population Pyramid of the community and the success or failure → Median age of the health work. - age below which 50% of the population falls - Statistic on population and the characteristic and above which 50% of the population falls. such as age and sex, distribution are The lower the median age, the younger the obtained from the National Statistics Office population (high fertility, high death rates). (NSO). → Age – Dependency Ratio – used as an index of USE OF VITAL STATISTICS: age-induced economic drain on human resources - Indices of the health and illness status of a community. Other Characteristics: a. occupational groups nk ⋆𐙚₊˚⊹♡  - Serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and services. Sources of Data: ▪Population census ▪Registration of vital data ▪Health survey ▪Studies and researches Rates and Ratios: Rate - shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during a specifies unit of time. Ratio - is used to describe the relationship between two (2) Adjusted or Standardized Rate Methods: numerical quantities or measures of events without - By applying observed specific rates to some taking particular considerations to the time or place. standard population Crude or General Rates - By applying specific rates of standard population to corresponding classes or - referred to the total living population. groups of the local population - Case Fatality Ratio- index of a killing power Specific Rate of disease and is influenced by incomplete - specific population, class or group. reporting and poor morbidity data. Presentation of Data 1. Line or curved graphs- shows peaks, valleys and seasonal trends nk ⋆𐙚₊˚⊹♡ 2. Bar graphs- represents or expresses a quantity in - The life expectancy for Philippines in 2019 terms of rates or percentages of a particular was 71.16 years, a 0.18% increase from 2018. observation - The life expectancy for Philippines in 2018 was 71.03 years, a 0.23% increase from 2017. 3. Area Diagram- (Pie Charts)- shows the relative - The life expectancy for Philippines in 2017 importance of parts to the whole. Functions of the was 70.87 years, a 0.23% increase from 2016. Nurse Crude Birth Rate ▪Collects data - Chart and table of the Philippines birth rate ▪Tabulates data from 1950 to 2020. United Nations ▪analyzes and interprets data projections are also included through the year 2100. ▪Evaluates data - The current birth rate for Philippines in 2020 ▪Recommends redirection and/ or strengthening of is 20.177 births per 1000 people, a 0.98% specific areas of health programs as needed. decline from 2019. - The birth rate for Philippines in 2019 was PHILIPPINE HEALTH SITUATION 20.377 births per 1000 people, a 0.97% Population decline from 2018. - The birth rate for Philippines in 2018 was - Chart and table of Philippines population 20.576 births per 1000 people, a 3.31% from 1950 to 2020. United Nations decline from 2017. projections are also included through the - The birth rate for Philippines in 2017 was year 2100. 21.280 births per 1000 people, a 3.2% decline - The current population of Philippines in 2020 from 2016. is 109,581,078, a 1.35% increase from 2019. - The population of Philippines in 2019 was Infant Mortality Rate 108,116,615, a 1.37% increase from 2018. - Chart and table of the Philippines infant - The population of Philippines in 2018 was mortality rate from 1950 to 2020. United 106,651,394, a 1.41% increase from 2017. Nations projections are also included - The population of Philippines in 2017 was through the year 2100. 105,172,925, a 1.46% increase from 2016. - The current infant mortality rate for Life Expectancy Philippines in 2020 is 18.815 deaths per 1000 live births, a 2.2% decline from 2019. - Chart and table of Philippines life expectancy - The infant mortality rate for Philippines in from 1950 to 2020. United Nations 2019 was 19.239 deaths per 1000 live births, projections are also included through the a 2.16% decline from 2018. year 2100. - The infant mortality rate for Philippines in - The current life expectancy for Philippines in 2018 was 19.663 deaths per 1000 live births, 2020 is 71.28 years, a 0.18% increase from a 3.96% decline from 2017. 2019. nk ⋆𐙚₊˚⊹♡  - The infant mortality rate for Philippines in - Epidemiology is the study of occurrences and 2017 was 20.474 deaths per 1000 live births, distribution of diseases as well as the a 3.81% decline from 2016. distribution and determinants of health states or events in specified population, and the application of this study to the control of health problems. This emphasizes that epidemiologist is concerned not only with deaths, illness and disability, but also with more positive health states and with the means to improve health. - Two main areas of investigation are concerned in the definition, the study of the distribution of disease and the search for the determinants (causes) of the disease and its observed distributions. The first area describes the distribution of health status in terms of age, gender, race, geography, time and so on might be considered in an expansion of the discipline of demography to health and diseases. The second area involves explanations of the patterns of disease contribution in terms of casual factors. - Epidemiology, therefore is the backbone of the prevention disease Uses of Epidemiology: According to Morris, epidemiology is used to: 1.Study the history of the health population and the rise and fall of diseases and changes in their character. 2.Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence, prevalence, disability and mortality, to set health problems in perspective and to define their relative importance and to identify groups needing special EPIDEMIOLOGY attention. nk ⋆𐙚₊˚⊹♡ 3.Study the work of health services with the view of - composed of the inanimate surroundings improving them Estimate the risk of disease, such as the geophysical conditions of the accidents, defects and the changes of avoiding climate. them. ❑Biological environment 4.Identify syndromes by describing the distribution - makes up the living things around us such as and association of clinical phenomena in the plants and animal life. population. 5.Complete the clinical picture of chronic disease ❑Socio-economic environment and describe their natural history. - which may be in the form of level of economic 6.Search for causes of health and disease by development of the community, presence of comparing the experience of groups that are clearly social disruptions and the like. defined by their composition, inheritance, Approach to Disease and its Determinants experience, behavior and environments. The present epidemiology approach is based on the interaction of the host, the causative agent, and the environment. The presence of infectious materials varies with the duration and the extent of its excretion from an infected person the climactic conditions affecting survival of the agent, route of entry into the host and the existence of alternative reservoirs or host of the agent. CLASSIFICATIONS OF AGENTS, HOSTS AND ENVIRONMENTAL FACTORS WHICH DETERMINE The Epidemiology Triangle THE OCCURENCE OF DISEASE IN HUMAN - The host is any organism that harbors and POPULATION provides nourishment for another organism. 1.Agents of Disease - Agent is the intrinsic property of microorganism to survive and multiply in the a. Nutritive elements environment to produce disease. b. Chemical agents - Environment is the sum total of all external condition and influences that effects the c. Physical agents development of an organism which can be d. Infectious agents biological, social and physical. 2. Host factors (Intrinsic Factors) – influences The Three Components of the Environment: exposure, susceptibility or response to agents. ❑Physical Environment a. Genetic nk ⋆𐙚₊˚⊹♡ b. Age PATTERNS OF OCCURRENCE AND DISTRIBUTION c. Sex - The variables of disease as to person, time, and place are reflected in distinct patterns of occurrence d. Ethnic group and distribution in each community. e. Physiologic 1.Sporadic occurrence is the intermittent occurrence f. Immunologic Experience of e few isolated and unrelated cases in each locality. The cases are few and scattered, so that g. Inter- current or pre-existing disease there is no apparent relationship between them, and h. Human behavior they occur on and off, intermittently, through a period. 3. Environmental factors (Extrinsic factors) 2.Endemic occurrence is the continuous occurrence – influences existence of the agent, exposure, or throughout a period, of the usual number of cases in susceptibility to agent. each locality. The disease is therefore always A. Physical environment occurring in the locality and the level of occurrence is less or more constant through a period. B. Biologic environment 3. Epidemic occurrence is of unusually large number C. Socio-economic environment of cases in a relatively short period of time. There is DISEASE DISTRIBUTION no disproportionate relationship between the number of cases and the period of occurrence, the - The methods and technique of epidemiology more acute is the disproportion, the more urgent and are desired to detect the cause of a disease serious is the problem. in relation to the characteristics of the person who has it or to a factor present in his 4. Pandemic is the simultaneous occurrence of environment. Since neither population and epidemic of the same disease in several countries. environment of different times or places are Epidemics similar, these characteristics and factors are called epidemiology variables. Factor’s Contributory to Epidemic Occurrence: - Time refers to both the period during which Agent Factor – the result of the introduction the cases of the disease being studied were of new disease agents in the population. exposed to the source of infection and the Host Factors – are related to lower period during which the illness occurred. resistance as a result of exposure to the - Persons refers to the characteristics of the elements during floods or other disaster, to individual who were exposed and who relaxed supervision of water and milk supply contacted the infection or the disease in or sewage disposal, or to changed habit of question. eating. - Place refers to the features, factors or Environmental factors – changes in the conditions which existed in or described the physical environment: temperature, environment in which the disease occurred. nk ⋆𐙚₊˚⊹♡  humidity, rainfall may directly or indirectly care providers, public health agencies and influence equilibrium of agent and host. the public. OUTLINE OF PLAN FOR EPIDEMIOLOGICAL ROLE OF THE NURSE IN SURVEILLANCE INVESTIGATION - One of the areas where public health nurse 1. Establish fact of presence of epidemic function as researcher is disease surveillance. 2. Establish time and space relationship of the - Surveillance is a continuous collection and disease analysis of data of cases and death. 3. Establish time and space relationship of the The objectives of surveillance are: disease 1.To measure the magnitude of the problem. 4. Correlation of all data 2. To measure the effect of the control program. Epidemiology and Surveillance Units The National Epidemic Sentinel Surveillance - Epidemiology and Surveillance Units have System (NESSS) and its Role been established in regional and some local office as support to the public health system. - National Epidemic Sentinel Surveillance As an epidemiologic information service, the System is a hospital-based information unit is mainly responsible for providing timely system that monitors the occurrence of and accurate information on diseases in the infectious diseases with outbreak potential. It locality. also serves as a supplemental information system of the Development of Health. Among its responsibility includes: Objectives: 1. Surveillance of infectious diseases with outbreak potential - To provide early warning on occurrence of outbreaks. 2. Assisting local government units in investigation of - To provide program managers, policy makers, outbreak and their control and public administrators, rapid accurate 3. Developing information package on public health. and timely information so that inventive and control measures can be instituted. 4. Providing technical assistance related to epidemiology. The NESSS Data shows: Public Health Surveillance 1. Trends of cases across time - Public Health Surveillance is an on-going 2. Demographic characteristics of cases systematic collection, analysis, 3. Estimates of case fatality ratio interpretation and dissemination of health data. 4. Clustering of cases in geographical area - Surveillance system is often considered in information loops or cycles involving health nk ⋆𐙚₊˚⊹♡ 5. Information to formulate hypothesis for disease - Public, political or legal concerns causation Training Sources: Disease Under Surveillance (NESSS) 1. Surveillance data Laboratory Diagnosed: 2. Medical practitioner - Cholera 3. Affected persons / group - Hepatitis A - Hepatitis B 4. Concerned citizen - Malaria 5. Media - Typhoid Fever STEPS IN OUTBREAK INVESTIGATION: Clinically Diagnosed: Step 1 ▪Dengue Hemorrhagic Fever – Prepare for field work Investigation ▪Diphtheria - Scientific knowledge ▪ Measles - Supplies / equipment ▪Meningococcal disease - Administration - Administrative procedures like travel ▪Neonatal tetanus documents, allowance ▪Non neonatal tetanus - Consultation - Know expected role ▪Pertussis - Local contact person ▪Rabies Step 2 ▪Leptospirosis – Establish the existence or an outbreak ▪Acute Flaccid Paralysis (poliomyelitis) ▪Cluster Under Surveillance System: – is an aggregation of cases in each are over a - Acute Flaccid paralysis particular period without regards to whether the - Measles number of cases is more than the expected. - Maternal and neonatal tetanus ▪Outbreak or an epidemic - Paralytic shellfish poisoning - Fireworks and related injury – is the occurrence of more cases of disease rather - HIV / AIDS than expected in each area or among a specific group of people over a particular period. Importance of Outbreak Investigation: ▪Compare the current number of cases with the - Control and prevention measure numbers of cases from comparable period during the - Severity and risk to others previous years. - Research opportunities nk ⋆𐙚₊˚⊹♡ ▪Surveillance records Clinical information – death of onset, hospitalization, death ▪Hospital records, registries, mortality statistics Risk factors information – food or water ▪Data from neighboring areas sources, toilet facility Reporter information ▪Community survey Step 5 Step 3 – Perform descriptive epidemiology – Verify diagnosis 1. Describe and orient the data in terms of time, ▪Ensure proper diagnosis of reported cases place and person ▪Rule out laboratory error as basis for the increase in 2. Characterized by time diagnosed cases 3. Characterized by place ▪Reviews clinical findings 4. Characterized by persons ▪Review laboratory results Step 6 ▪Summarize clinical findings with the frequency distribution – Developing Hypothesis ▪Visit patients 1. Consider Step 4 2. Source of agent – Define and Identify cases 3. Mode of transmission A. Establish a case definition 4. Vectors of transmission - Standards set of criteria for the health condition; 5. Risk Factors - Clinical criteria (signs and symptoms) 6. Hypothesis should be testable - Restrictions by time, place, persons Step 7 -Apply without bias – Evaluate hypothesis by: - Note – exposure or risk factor is not included in the 1. Comparing with established facts case definition 2. Use of analytical epidemiology B. Identify and Count Cases 3. Case control studies Identify information – name, address, 4. Retrospective control studies contact number Demographic information – age, sex, race Step 8 and occupation nk ⋆𐙚₊˚⊹♡ – Refine hypothesis and execute additional studies 6. Assist in the conduct of training course in because: epidemiology 1. Unrevealing analytical studies = poor hypothesis 7. Assist the epidemiologist in preparing the annual report and financial plan. 2. May need more specific exposure histories 8. Responsible for inventory and maintenance of 3. May need more specific control group epidemiology and surveillance unit (ESU) equipment. Step 9 SPECIFIC ROLE DURING EPIDEMIOLOGICAL – Implement control and prevention measures INVESTIGATIONS: 1. Prevent additional cases ❖Maintains surveillance of the occurrence of notifiable disease. 2. Prevent outbreaks in the future Step 10 ❖Coordinates with other members of the health team during the disease outbreak – Communicate findings ❖Participates in case findings and collection of Through; laboratory specimens - Writing and disseminating full report ❖Isolates cases of communicable disease. - Meetings and discussions - Local and mass media ❖Renders nursing care, teaches and supervises giving care. Step 11 ❖Performs and teach household members method, Follow- up Recommendations concurrent and terminal disinfection. - What activities have been undertaken? - If health status has improved ❖Gives health teachings to prevent further spreads - If health problems have been reduced of disease to individual and families. FUNCTION OF THE EPIDEMIOLOGY NURSE: ❖Follow up cases and contacts 1. Implement public health surveillance ❖Organizes, coordinates and conducts community health education campaign / meetings. 2. Monitor local health personnel conducting disease surveillance ❖Refers cases when necessary 3. Conduct and / or assist other health personnel in ❖Coordinates with other concerned community outbreak investigation agencies. 4. Assist in the conduct of rapid surveys and ❖Accomplishes and keeps records and reports and surveillance during disasters submits to proper office / agency. 5. Assist in the conduct of surveys, program DEPARTMENT OF HEALTH evaluation, and other epidemiologic studies. nk ⋆𐙚₊˚⊹♡ 5 MAJOR FUNCTIONS: BY 2030 (DREAM OF DOH) A Global Leader for attaining better health outcomes, competitive and 1. Ensure equal access to basic health services responsive health care systems, and equitable 2. Ensure formulation of national policies for proper health financing division of labor and proper coordination of operations among the government agency jurisdictions 3. Ensure a minimum level of implementation MISSION nationwide of services regarded as public health To guarantee EQUITABLE, SUSTAINABLE and goods QUALITY health for all Filipinos, especially the poor 4. Plan and establish arrangements for the public and to lead the quest for excellence in health health systems to achieve economies of scale THREE STRATEGIES IN DELIVERING HEALTH 5. Maintain a medium of regulations and standards to SERVICES (ELEMENTS) protect consumers and guide providers ✓ Creation of Restructured Health Care Delivery BASIC HEALTH SERVICES UNDER OPHS OF DOH System (RHCDS) regulated by PD 568 (1976) ◦ E ducation regarding Health ✓ Management Information Systems regulated by R.A. 3753: Vital Health Statistics Law ◦ L ocal Endemic Diseases ✓ Primary Health Care (PHC) regulated by LOI 949 ◦ E xpanded Program on Immunization (1984): Legalization of Implementation of PHC in the ◦ M aternal & Child Health Services Philippines ◦ E ssential drugs and Herbal plants 3 LEVELS OF HEALTH CARE ◦ N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils. ◦ T reatment of Communicable & Non communicable Diseases ◦ S anitation of the environment (PD 856): Sanitary Code of the Philippines ◦ D ental Health Promotion Referral System in Levels of the Health Care: ◦ A ccess to and use of hospitals as Centers of ✓ Barangay Health Station (BHS) is under the Wellness management of Rural Health Midwife (RHM) ◦ M ental Health Promotion ✓ Rural Health Unit (RHU) is under the management or supervision of PHN VISION: nk ⋆𐙚₊˚⊹♡ ✓ Public Health Nurse (PHN) caters to 1:10,000 ▪ Oresol population, acts as managers in the implementation A. TRAINING OF HEALTH WORKERS of the policies and activities of RHU, directly under the supervision of MHO (who acts as administrator) 3 Levels of Training: REFERRAL SYSTEM: Grassroot/Village BHS→ RHU→ MHO→ PHO→ RHO→ National Agencies→ Barangay Health Volunteers (BHV) Specialized Agencies Barangay Health Workers (BHW) Nonprofessionals, didn’t undergo formal training, receive no salary but are given incentive in the form of honorarium from the local government since 1993 CHARACTERISTICS OF PUBLIC HEALTH CARE Intermediate - these are professionals Acceptable including the 8 members of the Public Health Workers Accessible First Line Personnel - the specialist Affordable B. CREATION OF “BOTIKA SA BARYO & BOTIKA SA Available HEALTH CENTER” Sustainable RA 6675: Generics Act of 1988: Attainable Implementing SENTRONG SIGLA MOVEMENT (SSM) 1. “Oplan Walang Reseta Program”-solution to the absence of a medical officer who prescribed the -was established by DOH with LGUs having a logo of medicines so PHN are given the responsibility to a Sun with 8 Rays and composed of 4 Pillars: prescribe generic medicines 1. Health Promotion 2. “Walong Wastong Gamot Program”- available 2. Granted Facilities generics in “Botika sa Baryo” & Health Center 3. Technical Assistance Father of Generics Act: Dr. Alfredo Bengzon 4. Awards: Cash, plaque, certificate C. HERBAL PLANTS 4 CONTRIBUTIONS OF PHC TO DOH & ECONOMY: RA 8423: Alternative Traditional Medicine Law a program where patient may opt to use herbal plants ▪ Training of Health Workers especially for drugs that are not available in dosage ▪ Creation of Botika sa Baryo & Botika sa Health form or patients has no financial means to buy the Center Drug ▪ Herbal Plants Traditional Medicine: ▪ Use of herbal plants nk ⋆𐙚₊˚⊹♡ D. ORESOL services, and to be reimbursed by PhilHealth with regard to health care expenditures. IMPROVED ACCESS TO QUALITY HOSPITALS AND HEALTH CARE FACILITIES - Improved access to quality hospitals and health facilities shall be achieved in a number of creative approaches. - First, the quality of government-owned and UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED operated hospitals and health facilities is to TO AS KALUSUGAN PANGKALAHATAN (KP) be upgraded to accommodate larger capacity, to attend to all types of - is the “provision to every Filipino of the emergencies, and to handle non- highest possible quality of health care that is communicable diseases. accessible, efficient, equitably distributed, adequately funded, fairly financed, and The Health Facility Enhancement Program (HFEP) appropriately used by an informed and - shall provide funds to improve facility empowered public” preparedness for trauma and other - It is a government mandate aiming to ensure emergencies. The aim of HFEP was to that every Filipino shall receive affordable upgrade 20% of DOH- retained hospitals, and quality health benefits. This involves 46% of provincial hospitals, 46% of district providing adequate resources – health hospitals, and 51% of rural health units human resources, health facilities, and (RHUs) by end of 2011. health financing. ATTAINMENT OF HEALTH-RELATED MDGS UHC’S THREE THRUSTS - Further efforts and additional resources are 1.) Financial risk protection through expansion in to be applied on public health programs to enrollment and benefit delivery of the National reduce maternal and child mortality, Health Insurance Program (NHIP); morbidity and mortality from Tuberculosis 2.) Improved access to quality hospitals and health and Malaria, and incidence of HIV/AIDS. care facilities; and Localities shall be prepared for the emerging disease trends, as well as the prevention and 3.) Attainment of health-related Millennium control of non- communicable diseases. Development Goals (MDGs). - The organization of Community Health Teams FINANCIAL RISK PROTECTION (CHTs) in each priority population area is one way to achieve health-related MDGs. CHTs - Protection from the financial impacts of are groups of volunteers, who will assist health care is attained by making any Filipino families with their health needs, provide eligible to enroll, to know their entitlements health information, and and responsibilities, to avail of health nk ⋆𐙚₊˚⊹♡ FIELD HEALTH SERVICE INFORMATION SYSTEM address of patient, presenting symptoms or (FHSIS) complaint of the patient on consultation and the diagnosis (if available), treatment and It is a network of information date of treatment. It is intended to address the short-term needs of DOH and LGU staff with managerial or supervisory functions in facilities and program areas. It monitors health service delivery nationwide. IMPORTANCE OF FHSIS Helps local government determine public health priorities. Basis for monitoring and evaluating health program implementation. Basis for planning, budgeting, logistics and decision making at all levels. Source of data to detect unusual occurrence of a disease. Needed to monitor health status of the community. Helps midwives in following up clients. Documentation of RHM/PHN day to day activities. COMPONENTS OF FHSIS 1. Individual Treatment Record (ITR) 2. Target Client List (TCL) 3. Summary Table 4. The Monthly Consolidation Table (MCT) INDIVIDUAL TREATMENT RECORD (ITR) - The fundamental building block or foundation of the Field Health Service Information System is the INDIVIDUAL TREATMENT RECORD. - This is a document, form or piece of paper upon which is recorded the date, name, nk ⋆𐙚₊˚⊹♡  - The second purpose of Target Client Lists is to facilitate the monitoring and supervision of service delivery activities. - The third purpose is to report services delivered. - The fourth purpose of the Target Client Lists is to provide a clinic-level data base which can be accessed for further studies. TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS 1. Target Client List for Prenatal Care 2. Target Client List for Post-Partum Care 3. Target Client List of Under 1 Year Old Children 4. Target Client List for Family Planning 5. Target Client List for Sick Children 6. NTP TB Register 7. Non- Communicable Disease TARGET CLIENT LIST (TCL) - The Target Client Lists constitute the second “building block” of the FHSIS and are intended to serve several purposes. - First is to plan and carry out patient care and service delivery. Such lists will be of considerable value to midwives/nurses in monitoring service delivery to clients in general and in particular to groups of patients identified as “targets” or “eligibles” for one or another program of the Department. nk ⋆𐙚₊˚⊹♡  THE SUMMARY TABLE (SUMTAB)/RHIS MONTHLY CONSOLIDATION TABLE (MCT) - The Summary Tables is a form with 12-month ✓ The Consolidation Table is an essential form in the columns retained at the facility (BHS) where FHSIS where the nurse at the RHU records the the midwife records monthly all relevant reported data per indicator by each BHS or midwife. data. The Summary Table is composed of: ✓ This is the source document of the nurse for the (1) Health Program Accomplishment this can serve Quarterly Form. as proof of accomplishments to show LGU officials whenever they visit the facility. ✓ The Consolidation Table shall serve as the Output Table of the RHU as it already contains listing of BHS (2) Morbidity Diseases the source of ten leading per indicator. causes of morbidity for the municipality/city. This summary table will help the nurse and MHO to get THE MONTHLY FORM the monthly trend of diseases. Program Report (M1) - The Monthly Form contains selected indicators categorized as maternal care, child care, family planning and disease control. Morbidity Report (M2) - The Monthly Morbidity Disease Report contains a list of all diseases by age and sex. nk ⋆𐙚₊˚⊹♡  The Midwife uses the form for the monthly statistics: demographic, environmental, consolidation report of Morbidity Diseases natality and mortality. and is submitted to the PHN for quarterly - Annual Form 2 is the report that lists all consolidation. diseases and their occurrence in the municipality/city. The report is broken down by age and sex. - Annual Form 3 is the report of all deaths occurred in the municipality/city. The report is also broken down by age and sex. THE QUARTERLY FORM Program Report (Q1) - The Quarterly Form is the municipality/city health report and contains the three-month total of indicators categorized as maternal care, family planning, child care, dental health and disease control. Morbidity Report (Q2) - The PHN uses the form for the Quarterly Consolidation Report of Morbidity Diseases to consolidate the Monthly Morbidity Diseases taken from the Summary Table. THE ANNUAL FORMS (A-BHS, A1, A2 & A3) - ABHS Form is the report of midwife which contains data on demographic, environmental and natality. - The report of nurse at the RHU/MHC are the Annual Form 1 which is the report on vital nk ⋆𐙚₊˚⊹♡  diabetes mellitus, chronic obstructive pulmonary disease and stroke. ◦ - Listing of persons – monitoring decision making and program management. ◦ Census CENSUS DATA ◦ It is a periodic governmental enumeration of the population. It provides for a national census of population and other related data in the Philippines every 10 years. ◦ - The Philippine statistical system (PSS) provides statistical information and services to the public. The NSCB is the policymaking and coordinating body of the PSS. ◦ - NSO is the PSS arm that generates general- purpose statistics: population, employment, process, and family income/ expenditures. DISEASE ◦ - During a census, people may be assigned to a REGISTRY locality by de jure or de facto method. De jure ◦ - A listing of assignment is based on the legally established place persons of residence of people, whereas de facto is according diagnosed to the actual is according to the actual physical with a location of people. specific type of disease in ◦ - The NSO conducts the national census using the de jure method. The census population consists of: a defined population. Filipino nationals, to include those residing in and out of the Philippines, Data collected ◦ Nationals of other countries having their usual through residence in the Philippines. disease registries serve as a basis for monitoring decision ◦ - Census information that the nurse can utilize for making and program management. needs assessments. ◦ - The department of health has developed and ◦ - Demographic characteristics, household size, and maintained registries for HIV / aids and chronic non data on fertility and mortality are some of the census communicable disease, particularly cancer, nk ⋆𐙚₊˚⊹♡ information that the nurse can utilize for needs assessment. Census data are accessible at the NSO. COMMUNITY HEALTH INDICATORS Fertility ◦▪▪ Crude Birth Rate (CBR) - Overall total reported births Morbidity-Illnesses affecting the population group. ◦▪▪ Incidence Rate (IR) COMMUNITY HEALTH NURSING PROCESS -reported new cases affecting the population group. FAMILY HEALTH NURSING PROCESS ◦▪▪ Prevalence Rate (PR) ◦ a systematic approach of solving an existing problem/meeting the needs of family. -determine sum total of new + old cases of diseases per percent population R-apport Mortality -Reports causes of deaths A-ssessment ▪▪ Crude Death Rate (CDR)-overall total reported P-lanning death I-ntervention ▪▪ Maternal Mortality Rate (MMR)-maternal deaths E-valuation due to maternal causes COMMUNITY HEALTH NURSING PROCESS ◦ ▪▪ Infant Mortality Rate (IMR)-# of infant deaths (0- 12months) or less than 1 year old A. Assessment ◦ ▪▪ Neonatal Mortality Rate (NMR)-# of deaths - provides an estimate of the degree to which a among neonates (newborn 0-28 days, < 1 month) family, group or community is achieving the level of health possible for them, identifies specific ◦ ▪▪ Swaroops Index (SI)-deaths among individual in deficiencies or guidance needed and estimates the the age group of 50 and above. possible effects of the nursing interventions. Methods in Collecting Data: - Community surveys - interview of individuals, families groups and significant others. - Observation of health-related behaviors of individuals, families, groups and environmental factors (review of statistics, epidemiological and relevant studies- individual and family health records, nk ⋆𐙚₊˚⊹♡  laboratory and screening test and physical obtains, nursing literature and conferring with examination) colleagues contribute to a wealth of knowledge and experience which the nurse can use in assessing the ASSESSMENT client’s health needs and planning for care and Data Gathering: tools or instruments used during intervention. survey: ✓ Interview Methods of Data Collection: ✓ Observation 1. Interview - is a process which involves talking to ✓ Questionnaires-mostly patronized & used in CHN people. ✓ Records & Reports available ◦ Asking questions Consolidation or Collation: collecting back the ◦ Interrogating questionnaires, tabulate and summarize ◦ Inquiring for the purpose of fact finding and/ or Validation: uses statistical approaches verification of facts Sources of Assessment Information: 2. Observation 1. The client provides the subjective data and is ◦ Watching usually the primary source of information regarding ◦ Surveillance past and present illnesses, lifestyle, health beliefs and practices and healthcare needs. ◦ Scrutiny 2. The family or significant others are the sources of ◦ Use the sense (sight, hearing, smell, touch, and objective data in situations where the client is unable smell) to participate. 3. Physical Assessment 3. Medical records and nurses’ notes provide Objective data - what you observe, measure. reliable and pertinent information regarding the client’s past medical history, current health status Subjective data - what the client states regarding and the nursing diagnoses and intervention. his health status. 4. Nursing staff and other members of the health Changes in the physical assessment data may team. prompt alterations or additions to the plan of care. 5. Communication with other members of the health Documentation of Assessment Data care, nursing care conferences, change of shift ◦ Indicate subjective information from the client or reports, nursing rounds, Kardex, and nursing notes other persons by quotation marks. also provide important sources of assessment data. e.g. chief complaint: “I have sharp pains in my 6. Other sources - during the nurse-patient stomach” interaction, the first-hand data that the nurse nk ⋆𐙚₊˚⊹♡ ◦ Avoid generalizations like “good”, “normal”, and ◦ e.) Health behaviors such as smoking “fair” ◦ f.) Health services use ◦ Record data completely, objectively, and concisely 3) Local factors affecting health (strengths and observing correct grammar and spelling, as much as weaknesses) possible. ◦ a.) Work and employment Steps to Community Health Needs Assessment ◦ b.) Poverty and income 1.) Profiling is the collection of relevant information that will inform the nurse about the state of health ◦ c.) Environment and health needs of the population. Analysis of this ◦ d.) Social cohesion/ social support information enables the nurse to identify the major health issues. ◦ e.) Destabilizing factors 2.) Deciding on priorities for action. ◦ f.) Resources, formal and informal 3.) Planning public health and health care programs COMPONENT OF COMMUNITY HEALTH NEEDS to address the priority issues. ASSESSMENT 4.) Implementing the planned activities. HEALTH STATUS 5.) Evaluation of health outcomes. ◦ Is the health standing or condition of the population as indicated by the morbidity, mortality and fertility Data to be Included in the Assessment rates (MMF) 1) Characteristics of the population ◦ There is increasing empirical evidence that a ◦ a.) Geography complex set of contextual factors (including social, economic and physical environmental factors, such ◦ b.) Numbers as poverty, air pollution, racism, inadequate housing, ◦ c.) Age distribution and gender distribution and income inequalities) play a significant role in determining health status of a community. ◦ d.) Ethnicity and religion ◦ These factors contribute to the disproportionate ◦ e.) Population trends burden of disease experienced by marginalized ◦ f.) Language and literacy communities. 2) Health status of the population 1. Mortality data ◦ a.) Mortality and morbidity rates - The information generally describes patterns of death in relation to age, gender and cause of death. ◦ b.) Communicable diseases a) It is a basic measure of epidemiology which is the ◦ c.) Low birth weights study of disease in populations. ◦ d.) Breast feeding rates and immunization rates nk ⋆𐙚₊˚⊹♡ b) Information is collected nationally, regionally and HEALTH RESOURCES sometimes at local level, usually from death ◦ Are assets, means, strength and skills that are certificates. contributory to the promotion of health and well- c) It indicates deaths from disease, accidents, being that exist within communities to meet the suicides and homicides, and the general health of needs of individuals, families or social groups. the population in terms of life expectancy. ◦ These resources may be formal services or informal 2. Morbidity data this information is on the types resources or networks. of illness and disability, their incidence and 1. Informal - families deliver the greatest part of all prevalence. care services in the community. a) Taken from hospital records, infectious disease ◦ a) The burden of care normally falls primarily on notifications and disability registers, sickness women and can have significant effects on their records, general medical practice, child health health status. records, census material and other surveys. ◦ b) Government, private and voluntary systems of b) It is a reflection of illness and not health care supplement the family or fill in where no family 3. Behavior measures These are often used as network exist. indicators of health. 2. Formal a) Smoking a) Can be provided at a variety of levels and by many b) This is an activity proven to cause ill health, so if a agencies including both health services and those lot of people smoke it shows a large potential for provided by other sectors that have an impact on illness in the population. health. 4. Quality of life measures a means of assessing b) educational resources in a community are an physical health, functional ability and important resource for health. psychological wellbeing. The assessment scales c) Many political and religious organizations also are based primarily on an individual’s own have resources that communities use to provide assessment. economic assistance and health and social care. 5. Use of service information This information HEALTH ACTION POTENTIAL gives an account of the morbidity status of the community, the hospital admissions and use of Action planning consist of the following stages: preventive services, like immunization and 1. Preparation stage screening programs. 2. Agreeing to the aims set by the group 6. Health inequalities Most disease and illness patterns are closely associated to economic 3. Describing the objectives of the program or project circumstances where there is high rate of death 4. Detailing the activities needed to meet the and illness among the poor sectors of society. objectives nk ⋆𐙚₊˚⊹♡ 5. Evaluation of the outcomes Types of Community Diagnosis Statistical Approaches: 1) Comprehensive community diagnosis 1. Central Tendencies: 3 M’s - This aims to obtain the general information of the community with the intent of determining prevalent Mean=average health conditions and risk factors (epidemiologic Median=range (Highest – Lowest Score) approach), lifestyle behaviors and attitudes that affects their health (behavior approach) as well as Mode=frequency of occurrence of a variable, used if their socio-economic condition (socioeconomic there’s too many variables occur. approach). 2. Standard Deviation: - used if there are too many variables available to be treated which is seldom used in CHN. SD=√ Σ (x-x) Σ=summation of n-1 x=variables available x=mean (given special attention) n=# of existing variables 3. Percentile (%) Method: - most commonly used in CHN by adding all cores Elements of a Comprehensive Community then multiply by 100. Diagnosis: COMMUNITY DIAGNOSIS 1. Demographic variable - Determining community health status is a process ◦ The analysis of the community’s demographic called community assessment. characteristics should show the size, composition - It is the process of community diagnostics and a and geographical distribution of the population as keystone in developing community health nursing indicated by the following: process. a. Total population and geographical distribution - Community diagnosis in nursing consist of two including urban-rural index and population density. parts. b. Age and sex composition 1) The nurse collects data about the community in c. Selected vital indicators such as growth rate, order to find different factors that may directly and crude birth rate, crude death rate, and life indirectly influence health of the population. expectancy at birth. 2) Analyze and seeks explanation to the occurrence d. Patterns of migration. of health needs and problem of the community. nk ⋆𐙚₊˚⊹♡ e. Population projections 2. Leading cause of morbidity ❑ It is also important to know whether there are 3. Leading causes of infant mortality population groups that need special attention such 4. Leading causes of maternal mortality as indigenous people, internal refugees and other socially dislocated groups as a result of disasters, 5. Leading causes of hospital admission calamities, and development programs. 4. Health resources 2. Socio-economic and cultural variables Manpower resources a. social indicators Material resources Communication network (whether formal or 5. Political/Leadership patterns informal channels) necessary for disseminating health information or facilitating referral of clients. Reflects the action potential of the state and its people to address the health needs and problems of Transportation system the community Educational level Mirrors the sensitivity of the government to the b. Economic indicators people’s struggle for better lives. Poverty level income 2) Problem-oriented Community Diagnosis Employment rate - Made to responds to a particular need of a target group Types of industry present in the community - Ex. April 2020, a reported incidence of a certain Occupation common in the community incinerator in Navotas that is expelling huge black of c. Environmental indicators fumes in frequent numbers this pandemic. The Physical/geographical/topographical residents near the area complained and feared its characteristics effect for their health. Water supply - The PHN will investigate the community: the people its environment Waste disposal - PHN will identify the population affected, Air, water and land pollution characterize info specific to the problem: d. Cultural factors biophysical, psychological, physical environment, socio cultural & behavioral as well as health system Variables that may break up people into groups factors Elements of comprehensive community within community. diagnosis. 3. Health and illness patterns Steps in Conducting Community Diagnosis 1. Leading causes of mortality 1. Determine the objective. nk ⋆𐙚₊˚⊹♡ 2. Define the study population 3. Determine the data to be gathered 4. Collect the data Methods to Collect data: a. Records review b. Surveys and observations - can be used to obtain both qualitative and quantitative data. c. Interviews d. Participant observation 5. Develop the instrument Most common instruments (data collections): Survey questionnaire Interview guide Observation checklist 9. Data analysis 6. Actual data gathering 10. Problem identification Community health 7. Data collation Two types of data nursing problems are categorized as: 1. Numerical data - can be counted a. Health status problems - they may be described in 2. Descriptive data - can be described terms of increased or decrease mortality, morbidity, fertility or reduced capability for wellness. b. Health resources problems - they may be described in terms of lack of or absence of money, manpower, material, or institutions necessary to solve health problems. c. Health- related problems - they may be described in terms of existence of social, economic, environment, culture, and political factors that aggravate the illness-inducing situations in the community. 11. Prioritization of health problems (Priority setting) nk ⋆𐙚₊˚⊹♡ A. Nature or Categories of Health Problems - This refers to the nature and magnitude of future problems that can be minimized or totally prevented 1. Health threat - conditions that are conducive to if intervention is done on the problem under disease, accident or failure to realized one’s consideration. potential. ◦ High ----------------- 3 points ◦ Does it promote disease/injury or prevent people from realizing their health potential? ◦ Moderate ---------- 2 points 2. Health deficit - when there is a gap between ◦ Low ------------------ 1 point actual and achievable health status which may be E. Salience or Social Concern due to failures in health maintenance. Often brought about by a history of repeated infections or - It is the degree of seriousness or importance of the miscarriages and absence of regular health check- problem as perceived by the community. up. ◦ A serious problem, immediate attention needed ---- 3. Foreseeable crisis - anticipated periods of ---- 2 points unusual demand on the individual or family in terms ◦ A problem, but not needing immediate attention ---- of adjustment/family resources. --- 1 point B. Magnitude of the problem ◦ Not a felt need / problem ------- 0 point - This refers to the percentage of the population that has been affected and may be categorized as follows: ◦ 75-100% affected------------ 4 points ◦ 50-74% affected-------------- 3 points ◦ 25-49% affected-------------- 2 points ◦ Less than 25% affected----- 1 point C. Modifiability of the problem TYPOLOGY OF NURSING PROBLEMS - This refers to the probability of success in First Level Assessment: minimizing, alleviating or totally eradicating the problem through interventions. - to determine problems of family Sources of Problems using IDB Family: ◦ Easily modifiable --------- 2 points - use of Initial Data Base (IDB) Nature: ◦ Partially modifiable ----- 1 point - Health Deficit (HD), - Health Threat (HT), ◦ Not modifiable ----------- 0 point - Foreseeable Crisis (FC) D. Preventive Potential USE OF INITIAL DATA BASE (IDB): nk ⋆𐙚₊˚⊹♡ ◦ Nuclear 4. Home environment: -Father, mother, children - assessment according to ES, treatment of garbage, preparation of food, availability of toilet, water & food ◦ Extended (3rd generation) sanitation, sources of diseases. -Relatives staying with the family 5. Health Illness Pattern: ◦ Multi-generational extended - history of certain disease, family member with -“apo sa tuhod” or “apo sa talampakan” disease. ◦ Dyad 6. Health Source Resources available in community for use by the family: -Husband & wife only (childless couple) 5 Generalized M’s in Resources Available in ◦ Blended Community -widow married another widow & have child ❖Man/Manpower ◦ Gay ❖ Money -Same sex living together ❖Machine ◦ Matriarchal ❖Materials - Mother is the decision maker ❖Methods ◦ Patriarchal DEFINE THE PROBLEM AFTER IDENTIFYING IT -Father is the decision maker ACCORDING TO NATURE ◦ Communal Health Deficit (HD) -different families forming a community - if identified problem is an abnormality, illness or 1. Demographic variables disease, there’s a gap/difference between normal status (ideal, desirable, expected) & actual status - This shows the size, composition and geographical (the outcome/result/problem encountered on that characteristics of population actual day). 2. Socio-economic: Health Threat (HT) - poverty level, educational attainment & nature of -any condition or situation which will be conducive to occupation of members of the family (sources of health alteration, health interference & health income) disturbance. 3. Socio-cultural: Foreseeable Crisis (FC) -different nature of religion - stress points, anything which is anticipated/expected to become a problem. nk ⋆𐙚₊˚⊹♡ CATEGORIES OF HEALTH PROBLEMS: - Entrance at school - Divorce or separation Health Threat - Menopause -conditions that are conducive to disease and - Loss of job accident, or may result to failure to maintain - Hospitalization of a family member wellness or realize health potential. - Death of a member - Resettlement in a new community Examples of this are the following: - Illegitimacy A. Presence of risk factors of specific diseases (e.g. - Adolescence lifestyle diseases, metabolic syndrome) 1) Total population, geographic distribution, B. Threat of cross infection from communicable including urban-rural index and population density. disease case 2) Age and sex composition. C. Family size beyond what family resources can 3) Household size. adequately provide 4) Selected vital indicators such as growth rate, D. Accident hazards crude birth rate, crude death rate and life expectancy at birth. CATEGORIES OF HEALTH PROBLEMS: 5) Patterns of migration. Health Deficit – instances of failure in health 6) Population projections maintenance. - Be sure to indicate groups needing special attention Examples include: such as indigenous people. Internal refugees and other dislocated population due to calamity, disaster A. Illness states, regardless of whether it is and development program. diagnosed or undiagnosed by medical practitioner. C. Planning Nursing Action Is based on the actual B. Failure to thrive/develop according to normal rate and potential problem Steps: C. Disability-whether congenital or arising from Goal setting illness; transient/temporary (e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. Constructing a plan of action leg amputation secondary to diabetes, blindness Developing an operational plan from measles, lameness from polio) Four (4) Standard Steps: CATEGORIES OF HEALTH PROBLEMS: 1. Prioritization -start if there are multiple identified - Marriage problems - Pregnancy, labor, puerperium - Parenthood Additional member-e.g. 2. Formulation of objectives -planning a procedure newborn, lodgers will start here if there is only one problem - Abortion nk ⋆𐙚₊˚⊹♡ 3. Developing strategies of action expected outcomes in an organized nursing care plan. 4. Formulation of evaluation tools for the identified strategy developed Health Planning Cycle Concept of Planning (by Mercado, 1993) 1. Surveying the environment (what is) 1. Planning is futuristic. 2. Setting directions (what ought to be) 2. Planning is change-oriented. 3. Problems and challenges (differences between what is and what ought to be) 3. Planning is a continuous and dynamic process. 4. Range of solutions (ways to get from what is, to 4. Planning is flexible. what ought to be) 5. Planning is a systematic process. 5. Best solution(s) (preferred way(s) to get to what PLANNING CYCLE ought to be. 1. Surveying the Environment 6. Implementation (putting in place the best solutions) 2. Setting Directions 7. Evaluation (did we get from what it is to what ought 3. Problems and Challenges to be) 4. Range of Solutions IV. INTERVENTION 5. Best Solution(s) ✓ Is the capacity to provide management 6. Implementation ✓ Is the professional phase of nursing process. 7. Evaluation ✓ Is the time when the PHN executes the standard Essential Steps in the Planning Process function of an RN 1. Prioritizing the identified nursing ✓ Three (3) Standard Functions of RN: problems/diagnoses based on the nature of the ▪▪ Dependent-giving of medicines problem and its modifiability, preventive potential and salience. ▪▪ Independent-monitor, assess, provide, educate 2. Developing goals/outcome statements - ▪▪ Interdependent-referrals identifying expected outcomes, and discussing them Guidelines in Formulating Nursing Intervention with the patient when possible. 1. Put safety first! Remember that nursing actions 3. Planning nursing actions - writing the nursing must be safe. orders, i.e. nursing behaviors that will help the patient achieve the identified outcomes. 2. Individualized the nursing actions for each client and be sure they are appropriate to the expected 4. Documentation of the Nursing Care Plan - outcome for that particular client. recording the diagnoses, nursing strategies, and nk ⋆𐙚₊˚⊹♡ 3. Base nursing actions on scientific rationale. 1. Identifies its needs or objectives 4. State nursing actions clearly and specifically so 2. Orders or ranks these needs or objectives that they may be interpreted in the same way by all 3. Develops the confidence and will to work at these nurses responsible for the client’s care. needs and objectives 5. Make nursing actions realistic for: a. The client 4. Finds the resources (internal/external) to deal with based on his/her limitations, age, developmental needs and problems level, preferences. b. The nurse based on his/her knowledge and capabilities; and c. Resources 5. Takes action concerning their needs available (equipment, personnel). 6. Develops cooperative and collaborative attitudes 6. Do not let nursing actions interfere with other and practices in the community. therapies the client is receiving. 1. PREPARATORY PHASE 7. Whenever possible, involve the client in planning A. Area selection the nursing actions. ◦ Is the community in need of assistance? 8. Strive to help the client understand how nursing actions will result in achievement of a goal. ◦ Do the community members feel the need to work together to overcome a specific health problem? COMMUNITY HEALTH NURSING PROCESS ◦ Are there concerned groups and organizations that D. Implementation of Planned Care the nurse can possibly work with? -Involves various nursing intervention which have ◦ What will be the counterpart of the community in been determined by the goals/objectives that have terms of community support, commitment and been previously set. human resources? E. Evaluation of Care and Services Provided B. Community profiling Components of Program Implementation ◦ Once the area has been selected, a community 1. Coordinating the health programs member who is known and accepted by the people will be chosen to act as the contact person. 2. Monitoring health programs ◦ A community profile provides an overview of 3. Supervising the program staff demographic characteristics, community and COMMUNITY ORGANIZING health-related services and facilities. - Is a social development methodology used to ◦ It will serve as an initial database of the community facilitate the process of forming self-reliant, C. Entry in the community and integration with the self-determining communities, which are people able to sustain their development activities. ◦ Ross (1993) defined community organizing as a process by which the community: nk ⋆𐙚₊˚⊹♡ ◦ Before actual entry into the community, basic ◦ The nurse must plan to establish and maintain information about the area in relation to the cultural valuable working relationships with people such as practices and lifestyle of the people must be known. peoples’ organizations, health organizations, educational institutions, the local government units, ◦ Establishing rapport and integrating with them will financial institutions, religious groups, socio-civic be much easier if one is able to understand, accept organizations, sectoral groups and the like. or imbibe their community life. ◦ The aim of partnership and collaboration is to get ◦ Living with the people, undergoing their hardships people to work together in order to address problems and problems and sharing their hopes and or concerns that affect them. aspirations help build mutual trust and cooperation. Networking 2. ORGANIZATIONAL PHASE - is a relationship among organizations that consist of A. Social preparation exchanging information about each other’s goals and B. Spotting and developing potential leaders objectives, services or facilities. C. Core group formation - This results in the organization’s becoming aware of each other’s worth and capabilities and how each D. Setting up the community organization can contribute to the accomplishment of the 3. EDUCATION AND TRAINING PHASE EDUCATION network’s goals and objectives. AND TRAINING PHASE -requires small amount of time, yet it has great A. Conducting community diagnosis potential in terms of joint actions. B. Training the community health workers Coordination C. Health services and mobilization - is a relationship where organizations modify their activities in order to provide better services to the D. Leadership-formation activities a) Intersectoral target beneficiary. Collaboration Phase b) Phase-out - time-consuming as it requires more involvement GOALS OF COMMUNITY ORGANIZING and trust on the part of the committed organization. 1. People’s empowerment - Modification of activities that are more responsive 2.Building relatively permanent structures and to community’s needs may significantly improve people’s organizations people’s lives. 3. Improved quality of life. Cooperation PARTNERSHIP AND COLLABORATION - is a relationship where organizations share information and resources and make adjustments in ◦ Working with other people or groups to increase the one’s own agenda to accommodate the other probability of accomplishing the goals that they have organization’s -organizations share ownership of the set. nk ⋆𐙚₊˚⊹♡ success, rewards as well as problems and hassles B. Thoroughly discussing with the people the nature that go