PHC Original PDF

ORGANIZATION STRUCTURE OF A COMMUNITY IN DECISION MAKING A community has a formal or Informal leader who direct the afairs of the group. The community Is best administered by a democratc leader especially as regards to PHC Example of Decision makers in Yoruba land 1) OBA 2) Baale / sectonal head...

ORGANIZATION STRUCTURE OF A COMMUNITY IN DECISION MAKING A community has a formal or Informal leader who direct the afairs of the group. The community Is best administered by a democratc leader especially as regards to PHC Example of Decision makers in Yoruba land 1) OBA 2) Baale / sectonal head allocated with villages as wards 3) Council of Chief 4) Opinion leaders 5) People Decision makers in Hausa land 1) Emir or sariki 2) Waziri: It is equivalent to prime ministers 3) Magaji Gari 4) marafa 5) Turaki : they are equivalent to sectorial head of village like baale in yorubaland e.g saraki yaki -: Turaki/yaki allocated with villages 4) People A village has the village head as the leader, LGA has the Chairman as the leader, a family has the father as a leader. In a community, every member should have a say in the events been discussed. FAMILY PATTERN It is being Increasingly recognized that the Individual approach to health problems does not sufce to Comprehend health and disease process and therefore to provide Comprehensive health care. The fact that the family consttutes the primary and basic bio-social cell makes it logical, and operatonal to address health Issues within the context of family life, family being by essence a life support system for the sustainability of human kin and human kind. “United natons defned families and households as group of two or more persons living together who make common provision for food and other essentals for living and who are related to a specifc degree through blood, adopton paterns or marriage (Including as consensual the consensual union) Family patern can be defned as the characteristcs qualites of specifc relatonships within relatonship a family between unit or collectve group of Individuals, such as the mother and their daughter. Family patern can also be express as the characteristcs quality of the relatonship between the members of a partcular family e.g between parent and Children. TYPES OF FAMILY PATTERN 1)NUCLEAR FAMILY: - It is also known as elementary or traditonal family , consist of two parent (usually married or common love and their children) 2) SINGLE PARENT:- this type of family consist of one parent with one or more kids ( children ) 3)EXTENDED FAMILY:- this type of family consist of two or more adult who are related through blood or marriage usually along with Children 4) CHILDLESS FAMILY:- these are family with two parent who can’t have or don’t want children 5 ) STEP FAMILY- It Is when two seperate families merge into one It can also be called RE- CONSTITUTED FAMILY 6) GRAND PARENT FAMILY:- this type of family is when one or more grandparent is raising their grandchild or grandchildren STAFFING IN PHC SYSTEM The health work force is composed of a wide range of health professionals, including medical doctors, nurses, midwives, clinical ofcers or physician assistant, Laboratory technicians, Pharmacist, community health workers, management and support staf etc. Though the Optmal number of diferent types of health workers varies from context to context. There is nevertheless a correlaton between the availability of health workers and provision of health services. THE ROLES OR FUNCTIONS OF PHC WORKERS 1)Village Health worker:-VHW or voluntary village Health worker are the grassroots health workers trained to look afer the health and health related problems of members of the community. In which they live. The village healthworkers are selected by community and are not paid for their services. CRITERIA FOR SELECTION OF VVHW 1)A person, male or female who commands respect in the community 2)A person with an independent means of livelihood 3) A resident in be community 4) The choice of the villagers FUNCTIONS OF VVHW 1)Treat minor ailment in the community 2)Give health educaton with emphasis on preventve health Care practces e.g environmental sanitaton 3)Recognise cases that need to be referred and refer 4)Assist the Junior chew (J chew) in planning health program for the community – Community Health Extension workers [chew ] 5)work with J chew to ensure supply of drugs 6) motvate community partcipaton on health maters Community Health Extension worker[ CHEW] S-CHEW:- the Chew is a member of the health team for PHC. The CHEW will spend 50% of his tme in the clinic. He/she has the responsibility of supervising J.Chew and the traditonal birth atendance [TBA] He/she is to be supervised by the community health Ofcer [ CHO ]- The duraton of the course is three(3) calendar years. Functons of S- CHEW 1) Guide and support the VVHW, TBAS,and J. CHEW to Initate Preliminary contact with be leaders 2) Explain to the community, the PHC approach of the Nigerian health System and It’s role as a member of the health team to link the Community with health care system 3)Identfy available resources to solve the health problem 4) Organise and run Integrated PHC services where the community ofcer is not available 5)Identfy learning needs of J.CHEW And VVHW or TBA and members in the community development commitee. J.CHEW:-It is a member of the ward health team who works directly with VVHW and TBA. He/she is employed by formal health system and is expected to spend 80% of his her working tme in the community and 20% in the clinics. He/she is supervised by the S.CHEW.Duraton of the course is Two ( 2) Calendar years FUNCTIONS OF J-CHEW 1)facilitatng health care and social service system navigaton 2 Creatng connectons between vulnerable populaton and health care system. TRADITIONAL BIRTH ATTENDANCE [ TBA] A traditonal birth atendant (TBA) can be defned as a lay midwife that provides basic health care, support and advise during, afer pregnancy, and childbirth, based on experience and knowledge acquired informally through the traditons and practces of the communites where they originated FUNCTIONS OF TBAs 1)They provide care for a broad range of health issues including reproductve and child health to the poorest and most vulnerable communites 2)They are sometmes enlisted to help traditonal midwives to handle entre birth while complicated pregnancies are referred to the distance hospital or local clinics. 3)They serve as an Important link in health educaton for the rural populaton and are critcal to the success of the key Interventons especially in maternal and child health COMMUNITY HEALTH OFFICER (CHO) CHO is the head of health team within the local government. They are trained in teaching hospitals for a minimum period of 2yrs to become the most senior of the community health practtoners 30% of CHO tme is spent in the community and 70% his tme is spent in the clinic. FUNCTIONS OF CHO 1 ) Conduct training to build the capacity of stafs (volunteers the community at large) 2) Carrying and supervising administratve procedure and document 3)organizing and carrying out care and treatment, performing consultaton and other minor medical procedures PUBLIC HEALTH NURSING PHN are trained registered nurse who have undergone 18months or a calendar year post Basic Nursing programme and have been licensed to practce as a public Health Nurse. PHN composes of the largest professional segment of the work place in public health and are involved in the preventon, educaton, advocacy, actvism, assessment and evaluaton of public Health: They hold a vital role in for the preventon of disease and help to promote community health and safety. FUNCTIONS OF PHN 1)Assessing health trends to Identfy health risk factors specifc to communites 2) Assigning priorites for health related Interventons to provide the most signifcant benefts. 3)Advocacy with local, state and federal access to health services in underserved 4)Provide Informaton on local health programmes are available to Improve access to care 5) managing the budget of various community health programmes 6) Referring people to other related services 7)Delivering medical care, when needed etc. COMMUNITY PHYSICIAN It is a medical practtoner whose primary concern is the health status of the populaton within a defne geographical area, Who is usually responsible for assessment and evaluaton of the community’s health needs and for the organizaton of health services to meet those needs. FUNCTIONS OF COMMUNITY PHYSICIAN 1) Diagnosis and treatment of specifc disease such as selected communicable diseases 2) To Identfy and meet the needs of the Individual patent the practce populaton and the community by working with a variety of partner in the community THE ROLE OF VOLUNTARY AND NGO’S OR NGA’S IN PHC (NGO IN PHC ) A voluntary organizaton is a non-governmental autonomous, non – proft organizaton supported mainly by voluntary contributons in cash and tme from the general public or the certain segment of the public specialized to carry out a number of functons related to development aid and emergency relieve. Examples are:- Unicef, Unesco, Rotary club FUNCTIONS OF NGO 1) Supplementng and guarding the work of government agencies 2)Health Educaton:- this is disseminaton of Informaton and creaton of awareness of diseases that has occurred and it is done in a closed manner that Is house to house in a community. And they also health educate people on the preventon of the disease 3)Pioneering:- It has to do with bringing new Initatve about how things are being done. 4 ) Advancing health legislaton:- they are rules and guidelines guides the health policy. NGO look into how they can promote the health legislaton in the health sector and maintain the guidelines guiding a partcular actvites COMMUNITY STRUCTURE,LEADERSHIP AND DECISION MAKING IN A COMMUNITY LEADERSHIP DESCRIPTION OF THE LEADERSHIP COMPOSITION OF THE COMMUNITY. 1)Formal leaders:- these are the frst class Individuals, other wise known as ceremonial leaders in the community who are elected, appointed or chosen to rule the community. Example.... Traditonal Rulers namely chiefs, Ezes, obas, Emirs, district heads and village heads. They are enttled to remuneraton from government. 2) Informal Leaders:- these leaders are unofcially Installed, but nominated and recognized by member of the community to lead them in their day to day actvites Example..... i) market women (ii)youth Leader. (iii)men leader (iv)Women leader etc. 3) Opinion Leader:- these are persons authorized and recognised by consttuted authorites to give opinions on various maters Concerning the community. They are appointed to hold ofces especially in Public bodies and organisatons. Examples are.... 1) chairman of Councils (2) counsellors (3)Pastors (4)Imams Opinion leaders consttute the leadership compositon of a cross-secton of the community in maters of Decision making. COMMUNITY DIAGNOSIS Defniton: Kyari (2002) defned community diagnosis as a process of fnding out about the health needs of the community. The focus of community diagnosis is on the Identfcaton of the basic health needs of the community. FMOH- Federal ministry of Health (2004) defned community Diagnosis as an organized process Involving identfed needs, resources , wants , constraints, problems and disease paterns, physical, social, cultural and demographic characteristcs of the community. In community diagnosis, the entre community Is regarded as a patent requiring community diagnosis and treatment. Community diagnosis generally refers to the identfcaton and quantfcaton of health problems in a community as a whole in terms of mortality and morbidity rate and ratos, and Identfcaton of their correlates for the purpose of defning those at risk and those in need of healthcare THE COMMUNITY DIAGNOSIS PROCESS This is a means of examining aggregate and social status in additon to the knowledge of the local situaton; in other to determine the health needs of the community. TYPES OF HEALTH NEEDS OF A COMMUNITY. 1)Felt Needs:- these needs are those Identfed by the community Itself which require soluton, for example shortage of water supply, poor roads etc. 2) Identfed Needs:- there are health need which the members of the community are not aware of and are identfed during the process of community diagnosis e.g Patern of disease occurrence. This concerns the community and the health team. HOW IS THE COMMUNITY DIAGNOSED ? Community analysis is the process of examining data to determine needs , strength , barriers , opportunites , readiness and resources. The product of analysis is the community profle to analyse assessment data is helpful to categorize the data. There may be in the following ways. 1)Demography 2) Environmental:- It determines what you take into the community to help them. The environmental also tends to deal with the weather conditon a tmes. The environmental conditon needs to considered when 3)Health Resources And services:- it tends to do with health facilites, human material [Health care team] and non- human material [ medical instruments] to render services to the community. 4)Health Policies they are rules and guidelines guiding a health insttuton 5)socio -Economic:- It has to do with the rate of employment on how people meet with their daily needs or their source of Income. 6) study of target group:- within a community there are diferent religious groups, social groups etc.... These group of people will partcipate in the community diagnoses by helping to pass the Informaton of the health service to other member of their group. Community is diagnosed using health Indicators. Indicator of health are variables used for the assessment of Community health. CHARACTERISTICS OF INDICATORS 1) Validity:- they should actually measure what they are suppose to measure. They have to do with qualitatve and quanttatve research/investgatons and It must be in accordance with research topic. 2) Reliability and Objectvity:- the answer should be the same If measured by diferent people in similar circumstances 3) Sensitvity:- they should be sensitve to changes in the situaton concerned. This means that an Instrument should not rigid, it should be fexible and dynamic. 4)Specifc:- that they should refect changes only in the situaton concerned and with a specifc reason 5)Feasibility:- they should have the ability to obtain data when needed. 6) Relevant:- they should contribute to the understanding of the phenomenon of Interest  CLASSIFICATIONS OF HEALTH INDICATORS 1)Mortality Indicators:- these are Instruments used in measuring death rate e.g death certfcate. 2) morbidity Indicators:- these are Indicators for diseases rate in a community. 3) Disability Rate:- this is when an Individual is unable to meet up with the working hard he/she is required to. 4) Nutritonal Status Indicators 5 ) Health Care Delivery Indicators 6) Utlizaton Rate 7) Indicators of social and mental Health 8) Environmental Indicators 9) Socio-economics Indicators 10) Health Policy Indicators 11) Indicators of quality of life 12) Other Indicators 1) mortality Indicator:- mortality or death rate are the traditonal measures of health status. They are widely used because they are readily available. Examples are death certfcate is a legal requirement in many countries: mortality Indicators Includes.... a) Crude death rate b) Specifc death rate:-age and disease c) Expectaton of life d) Infant mortality rate e) Case fatality rate f) Proportonate mortality rate 2) Morbidity Indicators:- mobility rate or disease rate. Data on morbidity are preferable, although ofen difcult to obtain e.g a) incidence and prevalence rate b) notfcaton rate. c) Atendance rate:- out-patent clinic or health centres d) Admission and Discharge rate e)Hospital Stay duraton rate 3) Disability Indicators:- (a) number of days of restricted actvites. b)Bed Disability days c) Work or school loss days within a specifc period d) Expectaton of life free of disability 4) Nutritonal Indicators:- (a)Anthropometrics measurement b)Height of children at school entry c)Prevalence of low birth weight d)Clinical surveys:- anaemia, hypothyroidism, night blindness 5) Health Care Delivery Indicator:- this refect equity and provision of healthcare. Examples are a) Doctor/populaton rato b) Doctor/Nurse rato c) Populaton/bed rato d) Populaton/per health centres 6) Utlizaton Indicators:- they are health care utlizaton rato which show the extent of use of health services. It Indicate the proporton of people in need of service who actually receive it in a given period or year. Examples are:- a)Proporton of Infant who are fully Immunized in the 1dy year of life b)Immunizaton coverage c)Proporton of pregnant women who receive ante-natal care d) Hospital bed occupancy rate e) Hospital bed turnover rato 7) Social and mental Health Indicators:- Indicators of social and mental health are Indirect measure of health status, ofen valid positve Indicators do not ofen exist so Indirect measures are commonly used. Examples are.... a) suicide and Homicide b) Road Trafc Accident [RTA] c) Alcohol and drug Abuse 8)Environmental Indicators:- environmental health Indicators refect the quality of environment. Examples are:- a) measures of polluton b) The proporton of people having access to safe water and sanitaton facilites c) vectors density 9) Socio-Economic Indicators:- these are not direct measures of health status. They are used for the Interpretaton of healthcare Indicators. Examples... a) Rate of populaton Increase b) Per capital gross net proft c)Level of unemployment d)Literacy Rate (females) e)Family Size f)Housing conditon e.g number of person per room g) Age 10 ) Health Policy Indicators:- [HPI] assesses the allocaton of adequate resources. Examples are... a)Proporton of gross net proft spent on health services b) Proporton of gnp spent on health related service c)Proporton of total health resources devoted to PHC 11) Other Indicators a) Indicator of quality of life b) Basic needs Indicator c) Health for all Indicators GOALS OF COMMUNITY DIAGNOSIS 1) Analysed Health Status of the community 2) Evaluate the health resources services and systems of care within the community 3) Assess attude towards Community health services and issue 4) Identfy priorites, establish goals and determine causes of acton to improve the health status of the community 5) Establish an epidemiologic baseline, for measuring Improvement overtme IMPORTANCE/RATIONALE FOR COMMUNITY DIAGNOSIS 1) Community diagnosis provides realistc Informaton specifc to a community for which defnite relevant plans are made in other to solve problems 2)It make the community to be self-reliance and enable the people to have their Initatve. 3) It enables the people to identfy their health needs and use resources in a cultural and acceptable manner to promote their health. 4) It helps to Identfy constraint (impediment) which can be addressed in the planning process of any health program in the community. STEPS IN COMMUNITY DIAGNOSIS 1)make entry through the LGA into the community 2)Identfy boundaries of the community 3) make a sketch map of the community using established symbols e. G rivers, schools, market and other Important landmarks Or obtain a sketch map of the community from the Local government ofce. 4)make a list of resources available in the community. Examples are Industries, market, churches, mosque, health care facilites, personnel, as well as NGO 5)make a list of cultural practces and attude afectng health, Those that are useful, harmful and harmless. 6) Describe social customs and Important festvals of the community. e.g Egungun festval,Eyofestval,Isese day. 7) make a list of Infrastructures in the Community. Example electricity, water supply, means of transportaton etc. 8) Collate informaton from the community. 9) Conduct Interviews and survey of social groups in the community 10) Write reports using FMOH format. STEPS IN COMMUNITY HEALTH ASSESSMENT DEVELOPMENT PROCESS Assessment , Planning models and frameworks, identfes ten (10) steps in the CHADP 1)Establish the assessment team 2) Identfy and secure resources 3) Identfy and engage community Partners ( ofcial or unofcial ) 4)Collect, analyse and present data 5) Set health priorites 6) Clarify the Issue 7)Set goals and measure progress 8) Choose the strategy 9)Develop community health assessment document 10)Manage and sustain the process. METHODS FOR COMMUNITY DIAGNOSIS There are various ways in gathering Informaton:- 1) Observaton 2) Interview 3) Group discussion 4) Review of existng records  Observaton :- It is very Important to determine the disease that afect the community through observaton and Physical examinaton because some disease are not easily recognized in the community E.g anaemia, dental caries, malnutriton diabetes etc. In observaton, you observe their surroundings, living Conditons, eatng habit and life patern to avoid wrong impression. In observaton also you are to use your eye to see and hear some relevant Informaton with your ears. Interview:- the act of interviewing involves communicatng With somebody e.g household head, mothers. There are people who Play Important role in the community in decision making on health maters or issues. You should create a good rapport with the person so that he/she will feel free to talk to you and give you the correct informaton about what you need. The interview may be face to face or through questonnaire. Group discussion:- focus group discussion, unlike interview is held within a groups of people not with an Individual. It is useful in getng Informaton on health needs of the community. I.e. what they feel as their most pressing needs or problem. Review of Existng Records:- Useful Informaton can be Obtained by reviewing existng record partcularly when trying to determine the populaton of a community. The health facilites and the health personnel as well as disease paterns in the area. These Informaton can be obtained from excitng record. These records may be found in the..... 1) L.G.A ofce or in the health statstcs department 2) Report on nutritonal status surveys, basically, monitoring of health status in the communites to determine the Incidence of malnutriton disease and proper treatment. This survey report Is Important in community diagnosis. 3) maps:- the map of the area is required for community diagnosis 4)Report by private organizatons 5)Research records of disease patern Informaton Sought During Community Diagnosis 1) Geography of the Area :-map, Ibet – Iraguina ( 2006 ) defned map as a fat representaton of a place Including villages, town, local government area, state and Country on a paper in a diagrammatc form. Maps enables one to obtain Informaton about the topography of the area which Include physical texture of a place e.g, Terrain, mountains, rivers, streams, vegetaton seasons etc. It also ensures the Identfcaton of target areas, shows distances to various facilites and setlement as well as to locate populaton and proximity of one setlement to another. 2)Epidemiological Informaton:- Akinsola (1993) defnes epidemiology as the study of the patern of distributon of disease in human populaton and the factors which Infuence the distributon. Some of these epidemiological factors includes a) Disease b)Occurrence c) Frequency d) Distributon e) Populaton f) Dynamism g) Determinant h Populaton at risk i) Morbidity j) Mortality 3)Demographic Informaton:- i) Populaton size. (ii) Death rate. (iii)sex. (iv) populaton growth. (v) Emigrant. (vi) Birth rate. (vii) Age. (viii)Immigrant 4) SOCIO-ECONOMIC CONDITION OF THE COMMUNITY:- i)occupaton. (ii)income level. (iii)Housing types and living conditon (iv)Educatonal level etc. SITUATION ANALYSIS Situaton Analysis consist of a comprehensive inventory of health facility in the LGA, their distributon, the category of personnel and Other existng infrastructure. No health programme can be adequate and efectve without the personnel in the system carrying inventory of what Is on ground. Therefore, situaton analysis is a prerequisite for efectve health services in any area – The Idea is to tackle the problems identfed during community diagnosis. DEFINITIONOF SITUATION ANALYSIS Situaton Analysis can be defned as the process of fnding out the actual states of health in a given community. Ransom Kut (1993) defned Situaton Analysis as the process of the determining the ability of the health services to respond to the problem Identfed through community diagnosis. So also, S.A can be defned as the ability to fnd out the health status of the community and the available personnel and Infrastructure to meet their need. INSTRUMENTS USED IN SITUATION ANALYSIS For situaton analysis to be efectvely conducted, certain instrument have been established for this purpose by the FMOH. Their specifc Instruments designed for this exercise Includes:- Form H – Household, Form C – Children, Form F – married women under 50years and women who have never been Pregnant ( nullipara) 1) FORM-H :- This Is called household questonnaire , these forms contains the list of all members of the household, their demographic characteristcs and also documented illness episode for the past month. 2)FORM-C:- This is called the Children questonnaire , It focus on children, their Immunizaton status, diarrhoea episode and what was used for treatment or cure them. Informaton from this forms gives an In-depth understanding of the health problem on each LGA and It also gives Informaton on health knowledge seeking behaviour. The questonnaire also provides a list of illness that are prevalent in the community or local government area. 3)FORM-F:- This is the female questonnaire, married or unmarried under 50 years and women who have never been pregnant. This questonnaire probes into the number of children each woman in the household had dead or alive. It also Inquires into what maternal health services the woman had during her last pregnancy. STEPS IN CONDUCTING SITUATION ANALYSIS 1) Contactng the L.G.A ofce 2) contactng the village development commitee 3) Obtaining the Instrument to be used from the FMOH 4) training the Interviewers 5)Practce role playing with the instrument 6)Arranging for snacks ( refreshment) and transportaton for the Interviewers 7)Assign the Individuals and provide them with materials 8) collatng data from the feld 9) Writng report using FMOH format 10) Give feedback to the community and other health worker 11) Submit report to L.G.A/State (FMOH) CLINICAL SKILLS IN PRIMARY HEALTH CARE -History taking -Physical Examinaton Physical Examinaton:- physical examinaton which is a complete health assessment, is an integral part of nursing assessment, which Involves basic human tools like vision, hearing, touch, and smell. These tools can be augmented by special, tools like stethoscope, Ophthalmoscope, refex hammer ( Patella hammer ), turning fork etc. It is usually performed afer the health history has been obtained and for an average of 30 minutes. Physical examinaton maybe conducted startng from the head and proceeding in a systematc manner downward and it Is otherwise called Head to Toe examinaton However, the sequence of physical examinaton depends on the circumstances and the clients reason for seeking health care. DEFINITION: Physical examinaton is the assessment of the bodily state or anatomical fndings of a patent/client, by ordinary physical means such as inspecton, palpaton, percussion and auscultaton Purpose of Physical Examinaton 1) To obtain baseline data about the patent’s functonal abilites 2) To supplement, confrm or refute data obtained in the nursing history 3) To obtain data that will help establish nursing diagnosis and plan of care 4) to make clinical judgement about a client health status 5) To Identfy areas for health promoton and disease preventon. 6) To promote nurse/client relatonship 7) To evaluate the physiological outcome of health care and therefore the progress of a client health problems Guidelines for Physical Examinaton 1) Client’s preparaton:- there is need to explain what the procedure is all about to the client as well as when and where it will take place, why it is Important and what will happen during the examinaton, you must let the client know that is a painless procedure and allow them to assume a comfortable positon and make sure the client empty the bladder before the examinaton so as to be more relaxed during the procedure. 2) Preparing the Environment:- This is done before startng the assessment. The nurse must make sure that where the assessment will be done is well ventlated, well lit/illuminated warm and the equipment should be well organized. The examiner’s hand should be washed before and Immediately afer the examinaton, the fnger nails should be kept short to avoid Injuring the client and gloves should be worn properly. Ensure privacy is provided and the tming should be convenient to both the nurse and the clients 3) Positoning:- Although diferent positoning method can be used. It is also Important to consider client’s ability to assume a positon in relaton to his /her physical conditon, energy level, and ages 4) Draping:- this is necessary to prevent, undue exposure of the body part, and to provide warmth. 5) Instrumentaton:- all equipment required for the health assessment should be clean and in a good working conditon and also readily accessible. Requirements for the Examinaton 1) stethoscope. (2) Thermometer (3) Flashlights. (4) Patella hammer. (5)Lotons e.g Detol, Purit, Savlon (6) Ophthalmoscope. (7)Otoscope (8)Sphygmomanometer (9)coton wool swab (10) Turning fork. (11) vaginal speculum (12)Tongue depressor. (13) Lubricant. (14)Gloves. (15) Gallipot. (16) Tape measure (17) Receiver or Kidney dish (18) Proctoscope (for inspectng rectum and anus) Method of Physical Examinaton There are four primary methods that are used in physical examinaton and they Include.... 1) Inspecton:- It is also called observaton method and it is the visual examinaton, that is assessing by the use of the sense of sight. Inspecton is a deliberate, purposeful and systematc procedure which start with frst contact with the client. Among the general observatons that should be noted in the inital examinaton of the client include posture and stature, body movement, dentton and speech patern. 2) Palpaton:- This means feeling with the hands and fngers, It is a vital part of physical assessment that Involves the examinaton of the body, using the sense of touch. The part of the fngers, are used because their concentraton of nerve endings makes them highly sensitve to tactle discriminaton. Palpaton is used to determine texture, temperature, vibraton, positon, size, mobility of organs, muscles, distension, Pulsaton, presence of pain upon applying pressures. 3)Percussion:- This is the tapping with the fngers to determine resonance characteristcs. This method means the applicaton of physical force into sound. It is act of striking the body surface to elicit sound that can heard or vibraton that can be felt. It Is used to determine the size and shape of Internal organs such as liver, spleen or, heart, by establishing their borders. 4)Auscultatons:- this is the process of listening to sound produce within the body created by the movement of air or fuid. It is the medical term for using a stethoscope, to listen to the sound inside your body. It is the act of listening to sound produce by the functon of body organs like the heart, the lungs, stomach. Auscultaton requires a lot of concentraton therefore the nurse must limit movement of stethoscope and hold frmly to exclude external noise. The knowledge and use of stethoscope are Important. Procedure for Physical Examinaton 1)Establish a friendly relatonship and treat client with respect throughout the examinaton. 2 ) Provide Privacy and ensure quiet environment 3)Prevent undue exposure as much as possible 4)Explain the procedure and share relevant fndings using appropriate language as the examinaton progresses 5) Proceed in an orderly manner with minimal positon shif by the client during the procedure. 6) Ensure completon of the examinaton once it’s started 7) Ask the client to empty his/her bladder before proceeding the examinaton 8) Ask client to remove all clothing and put on a loose hospital gown 9) Provide additonal sheet to keep client covered and comfortable during the procedure. 10) Observe client overall appearance, general health and behaviour 11) Measure the client height and weight 12)Record the patent’s vital signs 13)Allow client to adopt a comfortable positon either sitng or lying down. HISTORY TAKING SCOPE History taking in a systematc and contnues collecton, documentaton and evaluaton of a client data to facilitate quality health care as well as detect any deviaton from normal. It is Important that the nurse knows or at least has an idea of conditon he/she is treatng.  To make a diagnosis, a protocol must be followed which should Include obtaining history from the client or a close relaton as the case demand and this must be property documented in clients fle or Card. Component Of History Talking 1) Personal profle e.g name, sex, age, marital status, address, Phone number, tribe, religion, occupaton, natonality, Name and Contact of next of kin. 2) Complain and duraton of illness 3)Actons taken since the ailment started either at home or in any health facility 4)Previous medical history, e.g past ailment/illness, admission, operaton & medical check-up. 5)Family and social history e.g similar sickness, in the family, client’s lifestyle e.g smoking, drinking of alcohol, drug abuse which may afect client health; occupaton, family setup, development, Immunizaton history 6)Obstetric and Gynaecological history. Purpose of History Taking 1) For personal Identfcaton 2) For clinical judgement a correct diagnosis 3) To provide Informaton on some family history on occupaton that may negatvely Infuence the client health 4) To classify and manage case as either In- patent , out-patent or referral Requirements For History Taking 1) well ventlated room with adequate Privacy 2)Tables and chair for the nurse and the client. 3)Client record card/fle folder 4) Writng materials for the Nurse to document 5) Client at atendant register. Procedure For History Taking 1) Greet client cordially, Ofer them a seat, and Introduce your self. 2) seek your client’s consent 3)Provide Privacy in a well ventlated room and out of hearing range 4) Assemble all requirement and material needed. 5) Assign a client registraton number 6) Record the date of visit in the appropriate column. 7) Explain why all questons to be asked Including those private by client 8)Take adequate and detailed history, using appropriate language in the client profle, social, medical or surgical history 9) Document all Informaton including source of referral using appropriate client record card or case note 10) Atach other diagnostc forms, documents and X-ray flm 11) Inform, educate and counsel client when necessary 12) keep client record in the atendance register. NUTRITIONAL ASSESSMENT This Is a method used in evaluatng the client nutritonal Status. Nutriton is the provision of energy and essental nutrients to maintain optmal growth and development. An adequate diet Contains all kind of food in the right proporton and to remain healthy. An Individual, either a child, adolescent or an adult must have the right amount and right kind of food. Inadequate diet may result in under- nutriton, overweight or malnutriton. Elements of Nutritonal Assessment There are for main element of nutritonal assessment:- 1)Biochemical data :- It Include PCV, urinalysis, HB (haemoglobin) 2)Clinical data:- It Include Informaton such as; Individual medical history e.g If there is any acute or chronic illness that afect a client nutritonal status or any diagnostc procedure or treatment which can Increase or decrease patent nutrients. 3)Dietary Data:- it is obtained from nutritonal Interview about the meal taken or food eaten during the previous day or previous hours. 4) Anthropometric data/measurement:- this Is use for assessing the level of malnutriton in children and this Include weight, height, wrist circumference, skin fold thickness, mid -upper arm circumference, chest and head circumference and also body mass index(BMI) In adolescent and adult. It is used for measuring human body. INFANT WEIGHT Infant weighing is a process by which a child weight is measured with the use of appropriate scale of choice. WEIGHT CHARTING It Is the recording of the weight correctly on the child weight chat Purpose of Infant Weighing 1) To keep a watch on a child’s health 2) To Identfy the nutritonal status of the child 3 ) To take acton that will help the child to grow beter REQUIREMENTS 1)Growth chart 2)Disposable paper 3) Clean cloth 4) Weighing scale 5) Writng material 6) Metric ruler PROCEDURE 1)Welcome the mother and get her seated 2) Explain the reason of weighing to the mother 3) Select appropriate age scale and other material required 4) Obtain bio data of the child from the mother and document appropriately. 5) Clean the scale and spread disposable paper on it 6) Balance the scale pointer at zero before weighing 7)Ask mother to undress the baby 8) Wash your hands properly, air dry and rub them against each other to keep warm 9)Gently place the baby correctly on the scale 10)keep the child quiet during weighing. I.e. calm and stable 11) Read the weight by standing in front of the scale and show it to the mother. 12) Ask the mother to remove the child and dress him/her Immediately. 13) Plot the weight correctly on the child’s health card of growth chat 14) Show the mother a copy of the growth chart 15) Give follow-up Instructon e.g next appointment date 16) Tidy up the environment 17) Wash your hand properly afer the procedure. MEASURING HOLD-UPPER ARM CIRCUMFERENCE This is an age independent measurement to assess the nutritonal status or to screen malnutriton in children between the age of 1-5 years or under 5 years children PURPOSE The main purpose is to assess the nutritonal status of a child between the age of 1 -5 years. Measuring MUAC is one of the direct anthropometric techniques of assessing the nutritonal status of Children between 1-5yrs. It’s one of the easiest, quickest and cheapest. The MUAC changes with about 1cm or less from 1-5yrs regardless of the of the sex of the baby. At birth, It is between 7- 9cm and It increases minimally in diameter. In a normal healthy child, If the value of MUAC is below 4-6cm, The Child is malnourished or undernourished. The device for measuring the MUAC is Shakir Strip. MUAC Tape:-. In its simplest form , the strip has 3 areas marked by “Green, Yellow & Red”. GREEN:- it indicates healthy baby YELLOW:- It Indicates cauton or warning i.e. The baby is not getng enough nutrient or not growing well. RED:- It Indicates danger. :-The three ( 3) colours of the strip that be efectvely used as nutriton educaton tools [NET ] for mother and encourage them e.g Green Colour can help to encourage the mother to keep giving their child green-leafy veggies and fruit. Yellow colour signifes to give food and fruits like paw paw, banana, orange, yellow yam and other yellowish fruit and food. Red Colour Indicates the need for reddish food & fruits like tomatoes, red-apple, water-melon, carrot, red pap. REQUIREMENTS 1) Tape measure 2) writng material for recording 3) MUAC Tape or Shakir Strip 4) Biro to mark the measurement indicate PROCEDURE 1)Greet and explain the reason for using the strip 2) Collect appropriate requirement needed Including MUAC tape. 3) Give the strip to the child to hold before applying 4) Mark the mid-way as the arm hang freely by measuring the length between the tp of the shoulder and the elbow of the lef am using a non-stretchable tape to locate the mid-point. 5) Place the strip on the marked like of the tape on the middle upper arm. 6) Wrap the strip round the middle am appropriately and let it crossover the marked line 7) Read and record the colour where the strip Intersect the original marked line on the strip 8) counsel the mother according to their result on the MUAC strip. COUNSELLING [Talking Therapy] Counselling is a person to person, face to face interacton in which the provider ( counsellor) gives adequate Informaton which will enable a client ( counselee) to make an Informed decisions about his/her health. The counsellor must be a professional to an elderly person. Importance of Counselling 1) It helps the client to understand his/her feelings and deal with her specifc personal concerns. 2)Efectve counselling empowers a client and the family to man make his own decisions. 3) It helps the client to clarify his/her feelings or thinking 4) Counselling motvate and encourage a client and their family to adopt new health behaviours e.g visitng the clinic regularly 5) It helps in educatng people by providing specifc Informaton and gives Informaton that state the facts efectvely. Skills And Techniques of Counselling. 1) Actve listening 2) Observaton 3) Clarifcaton 4) Questoning 5) Explaining in language that clients understand 6) Use of support material e.g picture 7) Refectng. Qualites of a Good Health Care Provider In Counselling 1) Passion for work and desire to help people 2) Respect for people regardless of who your patent is 3) Be comfortable with expressions of feelings (Do not query or disapprove) 4) Fairness to all i.e. don’t force your values on your client or people you are counselling 5) Have empathy for clients i.e. Do not Judge or condemn them 6) Have ability to maintain confdentality i.e. Do not divulge your Client’s Informaton to others. 7) Tolerance for other people’s values 8) Self awareness of one’s value and limitatons Rights Of Client In Counselling 1) Right to courtesy:- i.e. they should be treated with courtesy when receiving service 2) Right to Confdentality:- i.e. to be assured that her Informaton would be kept secret 3)Right to Informaton 4) Right to Access:- i.e. the client should Obtain services regardless of their sex, age, religion, tribe, status 5) Right to choice:- the client should be given ability to decide freely. 6) Right to safety 7) Right to Privacy 8) Right to contnuity of care 9) Right to Opinion COMMUNITY MOBILIZATION This is defned as a means of encouraging, Infuencing and arousing the Interest of people in the community to make them actvely Involved in fnding solutons to their problems. For example, reproductve health problem such as high maternal mortality rate, cervical cancer, neonatal death etc. This Includes Partcipaton of all health workers e.g Nurse, Doctors, midwives and community health extension workers. Others Include, Chairman of local government areas, religious group leaders e.g (lmam and pastors). market women, women leaders , village head etc. Importance of Community mobilizaton For Health Actons 1)Early Identfcaton of health problems e.g reproductve health problems and Solutons e.g family planning services. 2) Identfcaton of people at risk, groups or Individual in the community. 3) Increase level of health workers among Community members. 4)Utlizaton of community social workers services. Such as women group, village commitee to promote health 5) Informed Individuals are beter equipped for self-care and self-reliance. Steps To Be Taken in mobilizaton Actvites The Community Involvement cannot be dictated, a Systematc way should be made to see the be need to be involved in the afairs of their health. The steps can be into 3 stages.... Stage I –Fact Finding Stage II – Planning Stage III – Implementaton and Evaluaton Stage I—Fact Finding Before the Individual goes into the community to try to mobilize It for any actons, the Individual must frst collect some relevant informaton about the community in other not to make a wrong entry. The Informaton may be goten through Informant discussion with individual and also through the result of community health survey that may be goten from the ministry of health or other health insttuton. Inital Informaton to be collected may includes:- 1)Who the community leader or decision maker is 2 ) Who the Innovators are? And the organizatons in the community that can Infuence community partcipaton 3) Community Traditon 4)Statstcs of the community problems With the help of the informaton and using them to advantage, the mobilizers would be able to penetrate the community. Stage II- Planning This is the stage in which the mobilizer enter the community ofcially. The mobilizer should pay a courtesy visit to the community leader or decision maker and arrange a meetng with him and his cabinet members. During the meetng, the mobilizer should explain their purpose of being there and exchange Ideas with them so as to solve health the problems in the community. This is usually more efectve if they can Support their points with relevant facts within the community. It is a necessary that leader and cabinet members see the community problems as real and their soluton is really important. If not It may be difcult to mobilize the community to carry out the solutons to solve the problem. But if they are convinced enough to support the programme then the mobilizer is on the way to success similar discussions should be held with leaders of diferent organizatons and Innovators in the Community. At the end of awareness campaign, the mobilizer can now request for health commitee that she will work with.The commitee should have chairman and secretary from the Community members that are selected by the members themselves. The health worker must remain in the background and help with this selecton. The health workers should allow the commitee members bring suggestons on how the problems will be solved and the best alternatve will be selected. The health worker should Inform them of the resources required to tackle the problem, those that would be provided by the government, NGO, those that will be provided by the community members. The mobilizer should make sure that the community members partcipate in health promotonal actvites such as raising funds to ensure achievement of set goals. Having done all these, the health workers and community are ready to move on to the next stage. Stage III – Implementaton And Evaluaton This is the last stage and it’s used to implement the plan Some of the actons that can be undertaken to Promote health and prevent diseases. Include:- 1) Co-operatve Farming:- to ensure that the community has sufcient food of right kinds 2) They can come together to ensure the source of water is safe for use and free from polluton. 3) They can Insist on acceptable standards of hygiene in and out and around homes, market, shops etc. 4)Women can help one another to bring up their children in a healthy manner and ensure they are Immunized against Infectous disease.  COMMUNICATION SKILLS AND GROUP DYNAMICS The study of group dynamics is a search for the social infuences that afect the way people behave in groups. Dynamics refers to the factors that ofen lies just outside one’s awareness but have efect on how people behave. Elements Of Group Dynamics 1)who is in the group ? 2)What the group is asked to do ? 3)where the group operate ? 4)which Other groups are actve ? COMMUNICATION SKILLS Communicaton skills are needed to speak appropriately with a wide variety of people. 1)Actve Listening:- this requires that you don’t only use your ears , but also your heart and mind. Is Involves the act of hearing and trying to Interpret your client’s words. E.g :- A Client can say she thinks a woman should have as many Children as God gives her. Possible response by Health provider you think a woman Should have as many children as God gives her? Do you think God wants you to stay healthy to take care of your children? 2)Praise And Encouragement:- This is speaking to client using words that motvate and assure client that you approve of her. Praise and encouragement helps build a client’s confdence, and help to achieve desired behaviour. Praise client feelings of self worth in clients which in turn empowers them with the right decision or execute the right task with enthusiasm. E.g A woman comes in afer several hours of labour The midwife response – should be “you did well to come here for help” 3)Questoning:- This is a techniques for learning from the client specifc informaton, or general feeling and concern. It is used for screening and educatng sessions. Types of Questoning A) Open – Ended Queston:- This helps to elicit In-depth response from client e.g what treatment care are you hoping to receive during this visit? It begins with “how,” what”, when. B) Close Ended Questons:- This elicit shot answers, ofen with “ yes” or “no”. It is used to clarify understanding of Informaton given or make a point e.g Do you want another family planning method C) Probing Queston:- This Intend to discover the truth on a problem ( concern or hidden Informaton about issues problem). E.g Did your husband complain about the method? 4) Paraphrasing:- This is restatng what client has said to you. i.e. restatng or repeatng the Client’s message simply. It is an efectve way to make sure that you and your client understand each other. E.g I want to use the pill but my friends said It can Cause breast Cancer. The nurse can say you have some questons about your Pill and you want to fnd out what Is true. Refecton And Acknowledgement:- This is similar to summarizing and paraphrasing. Refecton is a process of refectng client’s emoton back to them E.g A client may say I’m taking tablet but my Sister says that with Injecton, the pain will be relieved faster. The nurse can respond that “ if I may understand you, you are thinking of changing to Injecton. 5)Acknowledgement: it’s a verbal recogniton of fears, Concerns or satsfacton. Both refecton and acknowledgement validates the Client’s feelings and show empathy, and show respect on the part of their provider. E.g The client may say, this clinic is too far away. Why can’t you people build one in our village. The nurse should respond” It sounds like you are tred of travelling”. 6) Observaton:- This Is looking and listening to the client behaviour, reacton and physical appearance. This allows the health provider to evaluate her educatonal level, socio – economic level, state of mind e.g calm or distressed 7) Translatng into Simple Language:- This is making a Complex, concept or procedure comprehensible to the client according to her level of educaton. Client will be less fearful and beter prepared for the decision that will beneft their health If they fully understand what has happened, what is been required of them and why. The nurse should avoid using medical term that the client did not understand. How To Achieve Efectve Communicaton 1) Establishing Rapport by welcoming the client warmly, Introduce yourself, ofer him/her a seat, ensure privacy and assure confdentality. 2) Employ or use good listening skills 3) Use simple language that is understood by the client 4) Ask open ended questons because this will elicit more responses. ADVOCACY This is defned as the act or process of building support for, a cause, an issue or programme. It is a set of acton taking by a group, Individual or organizaton working in partnership to build Consensus, gain support or create a favourable environment for introducing or changing specifc strategies or policy.  Reasons For Advocacy 1) To build support for a cause, or an issue 2) To Infuence of opinion leaders and others to support that causes or issue 3) Infuence change of legislaton that afect a cause or issue Qualites of A Good Advocate 1) He/she must be dedicated to community and the reproductve health program he/she is trying to change. 2) He/she must be able to bring people together in coaliton and network i.e team work 3) He/she must be accessible to the people he/she is trying to afect 4) He must possess leadership qualites and can recognizes or nurtures such qualites in other people as well 5) He/she must have tolerance and perseverance in the face of problem Steps In Advocacy Process 1)Proper understanding of subject mater for which advocacy is done. The type of Ideas and argument to be used to a persuade the audience should be properly understood, Language, Personality, channel, tme and place use to get the message across clearly and efectvely. 2) Need Analysis:- You need to identfy and clarify issue why advocacy is needed and also the expected result e.g The problem magnitude (how big the problem is), how it can be solved, who and how the problem will be solved. 3) Identfy support and Oppositon among the Target Audience 4) Select audience by identfying the stakeholders i.e. the primary stakeholders or benefciaries who are really afected by the Issue. For example people of the community. While secondary stakeholders are the Intermediary that are being used to reach the target audience. E.g policy maker at the government level and traditonal or opinion leaders at the community 5)Formulate strategies for successful advocacy 6) Build coaliton:- the power of advocacy is seen in the number of people who support your goal and cause by involving many Interest groups to champion the cause 7)To Prepare simple and clear messages centred on your goal 8) Determine communicaton channels that will be cost efectve in relaton to target audience. Also know the limit and merit of each channel based on your goal 9) Prepare carefully for meetng with people and also antcipate possible queston that may arise when you meet with the target audience. 10) monitoring and evaluaton:- this is taking stock of the advocacy efort. 11) Ensure contnuity of efort by concentratng on what works  Tools For Advocacy 1) Lobbying:- this is an act of persuading people through presentaton factual Informaton and use of good communicaton skills to Convince them to support a cause or see things from your own perspectve. Lobbying is an efectve tools when in need of something specifcally from the legislatve system or decision makers. 2) Building Networks:- network refer to a group of Individual or organizaton, working together with a common goal of achieving change in policy or programme for a partcular Issue or cause.e.g organize meetng, rallies or carnival. 3) Media Tools:- e.g press release, press conference, editorials artcles in newspaper e.t.c. 4)Testmonies – i.e. testfy to previous achievement and positve result on the cause. This will encourage people to take actons and partcipate. 5) Visit organizatons who has experience in conductng advocacy actvites. This combined with other method will enhance your success. Strategies For Advocacy 1) coaliton Building:- this is aimed at achieving support and Infuencing others. 2) Build Trust with your colleague and audience 3) Identfy potental oppositon and develop ways to address them 4) Build relaton with the media i.e. identfy the journalist, reporters who may have relatonship with the community. This help in promotng the program 5) Identfy spokesmen among members of your coaliton who are totally convinced of the Issue and are credible source of Informaton to Communicate with them in ways they can understand 6) Learn how to make an Impression and convince people. 7) Develop of a culture of reading to help with Intellectual exchange on Issue. 8) Control your personal biases and be objectve as much as possible 9) Do not create enemies, learn to Identfy your opponent and develop a capacity to handle oppositon and resistance 10) Develop critcal skills such as leadership, fund raising etc. 11) Reward partcipaton and positve result 12 ) Do not give up, persevere and aim at achieving success Behavioural Change In Communicaton Behavioural change is the process of educatng, Persuading and disseminatng Informaton to people to positvely Infuence their Behavioural patern about a partcular health Issues.  Behavioural Change model Individual go through a series of Steps or stages before Partcular change become ongoing or permanent. The health Provider is to intervene in specifc way during each of the stages in the efort to help the clinic progress from stage to stage. Stages of Behavioural Change There are fve stages of behavioural change and they are as follows.... Stage 1 – Pre Contemplaton This is the frst stage, and the clients does not perceive any risks sks and has no Intenton of changing behaviour. E.g Having multple sexual partners, he/she is not aware that a given problem exerts or may be aware, that there is a problem but deny that the potental consequences are as serious as they appear. Client may be aware of the risks, but stll decided not to change his/her behaviour. Behavioural change does not happen during this stage and client is not usually open to suggestons about resolving the problem during this stage because they did not believe it is relevant. So as a nurse, try to help the client to see that he/she is at risk. E.g A 25 year old lady who has multple sexual partners and does not use female condom and does not see the risk of HIV or other sexually transmited Infecton (STI) should be thoroughly counselled on the risks Involved. Stage II – contemplaton In this stage, the clients realise that there are some risks, but Stll not ready to change. During this stage people become more and more aware of the potental benefts of making a change, but the acts tend to standout even more. This conficts create a strong sense of ambivalence about changing mind because of this uncertainty. The contemplaton stage of change can last months or even years. Many people never make it past this stage because they may view changes as a process of giving something up rather than a means of gaining emotonal, mental or physical benefts. As a nurse, help the client to see the beneft of changing and also help to identfy barriers to change. Stage III – Preparaton This is the stage where the client understand the risk and he/she is motvated. During this stage, you might begin making small changes to prepare for a larger life change.E.g if loosing weight is your goal, you might switch to lower fat foods, or If your goal is to quit smoking, you might switch brands or smoke less each day, you might also take some sort of direct acton Such as consultng a therapist. If you are in the preparaton stage, there are some Steps you can take to Improve your chances of successfully making a lastng life change. You can gather as much Informaton as you can about ways to Change your behaviour or prepare a list of motvatng statements. You can also write down your goals and fnd resources such as supports groups, counsellors or friends who can ofer advise and encouragement. As a nurse, contnue to provide support and encourage client to speak with people who will help him/her see the risk and benefts of Changing behaviour. Do not pressurized your patent because pressure from health workers and counsellors will make client to be overwhelmed and relapse to the previous behaviours.  Stage IV – Acton During the fourth Stage of change, people begin taking direct acton in other to accomplish their goals. In this stage, client has changed behaviour and contnue to do so for at least a short period of tme. Relapse is Possible And as a nurse praise client progress and help client identfy and develop support for keeping up with the behaviour and also encourage patent to keep trying when relapse occur, Also encourage patent to seek out social support. Stage V- Maintenance In this stage, change in behaviour is ongoing and has been one part of his/her life. The maintenance phase of the model Involves successfully avoiding former behaviours and keeping up new behaviour. Relapses are common and are a part of the process of making a life long changes and during this stage, people become more assured is that they will be able to contnue their change. As a nurse, provide as much help as you can to the client and help him/her recognise the trigger/contributng factors to release, and practce skills to help him resists former behaviour, and encourage ways of replacing old habits with more positve actvites. Also, suggest follow -up visits to help him check progress and Provide any additonal support that may be needed. Be patent when relapse occurs and remind him/her of progress made so far and encourage him/her that Change is stll possible and encourage him/her to contnue trying. Medium/Channels For BCC 1) Health talk, role play, Jingles, flm Show, Play entertainment drama on television, demonstratons, situaton analysis 2)Visual Aids:- e.g real object like using an HIV/AID patents , pamphlets, Handbills. Steps For Behavioural Change 1) Preparaton by selectng an appropriate date, choosing a quiet environment to ensure privacy for Individuals, preparing the sitng arrangement and also gather visual aids that are relevant to the culture of the Community. 2) Introducton:- By greetng the clients, Introduce yourself and encourage the client or group themselves, explain the process and use simple language. 3)Motvatonal Informaton:- By discussing the health benefts and the consequences of topic to be discussed. Issues For Behaviour Changes 1) Reproductve Health Issues 2) General behaviour of people 3) Government policies on health and others 4) Government Issues e.g policy making and budgetng.  Categories of People That Needs Behavioural Change 1) Individuals, families, countries, 2) Public & private workers with partcular reference to health workers 3)Bankers, Contractors, Businessman and women 4) Policy makers 5)Market women and men Expected Issues/Areas For Behavioural Change 1) morals, socials, Health policies 2) Financially budgetng and Administraton Strategies For Behavioural Change 1) Use of mass media e.g TV,Radio 2) Community based actvites and small groups actvites 3) Entertainment through modelling and reinforcement 4) Smart goal setngs 5) observing your own actons and their efects 6 ) Health Educaton.