CHNN312: Midterm Week

10
Implementing Community Health Interventions
Bachelor of Science in Nursing 3YA
Professor: Adelynne Joie B. San Diego, RN, MAN
IMPLEMENTING COMMUNITY HEALTH INTERVENTIONS / Community organizing
COMMUNITY ORGANIZING 1) Social development methodology utilizes to facilitate the
Partnership process of forming and sustaining self- reliant and self-
- A collaborative relationship between two or more parties determining communities
based on trust, equality and mutual understanding for the 2) Effecting change through community participation
achievement of a specified goal. Partnerships involve risks means : changing condition within the community then
as well as benefits, making shared accountability critical people’s behavior, Introducing new program and policy
Collaboration that would impact health
- Org. Helps each other enhance their capabilities in 3) Level of community participation: Reflects level of power
performing their tasks, as well as provisions of services. an organization has, Reflects capability to tap resources in
Importance of partnership and collaboration order to responds to their needs.
• To get the people work together in order to address 4) Range of participation can be from passive involvement in
problems / concerns that affects them pre-determined activities to full control of health
• Gives peoples opportunities to learn skills in group organization of health organization and health-related
relationship, interpersonal relations, critical analysis and affairs to involvement to full range social development
decision-making in terms of democratic leadership. methodology utilize to facilitate the process of forming
Activities on how to get started in partnership and and sustaining self- reliant and self-determining
collaborative work communities
1) Nurse involve all stakeholders in the process of
partnership and collaboration with people Community Organizing Participatory Research
2) Working together face risk together, they must know and - History: Introduced in 1990’s in social psychology,
trust each other approach that encourages recipient of benefits (family,
3) Determines how each org. Views problems, proposes to providers, policy makers) to partake in research & work
solve the problem and perceived how an org can solve the together as full partners in community organizing.
problem. - Later, it becomes an approach for community
4) Should agree on the kind or level of relationship on better development, a tool for community organizing
accomplishing group goal considering needs and participatory action research or COPAR
available resources - Intention: promoting transformation among participants
5) When org. Agreed on the type of relationship, formulate being studied, be partners In entire phases of research
ground rules to becomes basis of decision-making. Most from design, data collection, analysis dissemination
important points are: - A Participatory Action Research (PAR) Approach
6) Listen to what each has say. Take time to listen to people • Core Group serves as foundation of community
who voice out their concern. Don’t force org. to give up organization
identity. • Community organizer trains and develop core group
for data gathering and analysis
Advocacy • Core group becomes community research team
- The nurse as an advocate, helps empower the people to
make decisions and carry out actions that have potential
to better their lives.
- Activities Involved In Advocacy:
• Informing the people about the rightness of the cause
• Thoroughly discussing with the people the nature of
the consequence
• Supporting peoples right to make a choice & act on
their choice
• Influencing other's opinion.

Social Mobilization
- Social mobilization is the process of bringing together all
societal and personal influences to raise awareness of
and demand for health care, assist in the delivery of
resources and services, and cultivate sustainable
individual and community involvement.
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Community organizing Participatory Action (COPAR) 4) Integration with the people.

- Integration. Involves living with the people.
Understanding their problem, undergoing their
hardship, sharing their hopes & aspirations to help
build mutual trust & cooperation.
- Guidelines in integration
• Recognize role/position of local authorities
• Adapt to lifestyle
• Choose modest dwelling
• economically disadvantage will not hesitate to
enter
• Avoid raising expectations; be clear of objective &
- Transforms apathetic, individualistic & voiceless poor into limitations
a PARTICIPATORY & responsive community mobilizing for
• Participate directly in production process
RESOLUTION of problem
• Make house call
• participate in some social activities
Phases of community organizing
Organizational Phase
Preparatory Phase
- This phase consists of activities that leads to the
1) Area Selection.
formation of people’s organization.
- Guides the nurse in selecting and prioritizing areas for
1) Social Preparation.
community health development.
- Integration paves the way for the nurse to be
- Following questions must be answered:
introduced into the community. It signals beginning of
• Is the community in need of assistance?
the social preparation phase.
• Do the community members feel need to work - Nurse will: While continuously learning conditions of
together to overcome specific health problems?
community, he will deepens & strengthen ties with the
• Are there any concerned groups & organizations people.
the nurse can work with?
• What will the counterpart of the community in
terms of community support, commitment and
human resource?
2) Community Profiling.
- After area was selected, a community member that is
known and accepted by the people will be chosen as
contact person.
• Contact person identifies other person who can be
depended upon to initiate community activities. 2) Spotting and Developing Potential Leaders.
These people will comprise the core group. - Because of living with the people, nurse now knows
• Core group will assist in community profiling. who among them have deep concern and
• Community Profile will :provides overview of ; understanding of community’s conditions.
demographics, community and health-related - Potential Leaders must gain respect, trust of people.
services and facilities. Serves as initial database of To test commitment in community well-being, provide
community. opportunities to demonstrate potential as leaders
- Provides basis for planning & programming of - Nurse will: consciously provide learning experiences
organizing of activities. to prepare them as leaders
- Determines appropriate approach & method of - Characteristics of potential leaders:
organizing specific to the population group or sectors • Not Necessary highly educated, from affluent
that will be organized. family of community
3) Entry in the Community • Important: the people identifies with him,
- Before actual entry in community. Nurse Will: understand & articulate the problems that beset
determine actual information about the area in them
relation to cultural practices, lifestyle of people • Advantage If: has relative wide influence among
- Establishing rapport & integration is easier if he poor & elite
understands, accept / imbibe their community life. • Important Consideration: willingness to work for
desired change
3) Core Group Formation
- Consist of identified potential leaders.
- The training ground for developing potential leaders
- Foundation of organization

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- Diff characteristics: youth, women, worker - Competence & qualities they should possess need to
- Committee decides who will be trained as community health
- Consist of 8 to 10 members who possess leadership workers
potentials formed into a cohesive working group - Nurse will: After Community Health Workers are
- Potential Leaders are: named, conduct a Training Needs Assessment (TNA)
• task with laying down the foundations of a strong to know level of health skills and knowledge trainees
people’s organization possess. TNA serves as basis of health skills
• Ideally represent different sectors of the curriculum to focus on required competencies.
community • In TRAINING the purpose is to develop the leaders
- Training ground for developing them are as follows: skills, knowledge and attitude
• Democratic / collective leadership • An EDUCATION aims to heighten their awareness
• Planning and assuming task or consciousness on existing community
• Conflict resolution problems & its correlation with existing social
• Critical - thinking, decision-making realities
- Nurse will: assist in sectoral representative in forming 3) Health services provision and mobilization.
core group in their respective sectors, facilitate in - Organization now leads in undertaking activities that
skills development of core group members related to will solve problems community is confronted with.
task to assume in organization. - Involve organization in collective work: gives
4) Setting Up Community Organization. opportunities to test & strengthen collective spirit,
- After all sectoral organization has been placed, build/enhance confidence.
setting-up of community- wide organization is now - Nurse will: to prevent frustration on part of people,
ready. The organization facilitates collective action on consider resources available & problem prioritization to
the community problem be addressed at a given time, while strengthening
- Nurse will: after organization was formed, make collective spirit & enhancing community health
certain maximum participation of and control by the worker’s confidence
members in all its activities. 4) Leadership – Formation activities.
• Organizational structure must be simple, - Continuous and sustained process of community
facilitate consultation & decision-making among leaders’ development
its members - Leaders learn engaging in actual organizational
• Part of organizational structure will be working activities such as: conduct of meetings, assessment,
committees specifically created to look into planning, implementation, monitoring and evaluation
different concerns of the organization and of activities.
communities e.g.. health committee. - Skills needed in this phase / master are:
- Nurse will: assists in placing plans of health committee organizational skills, human relations development,
and initial prospective community health workers or supervisory skills
(CHW). CHW may be involved in the next phase. - Formal leadership training skills in financial, project /
Education and Training Phase program management.
- Purposes are to strengthen the organization & develop - Nurse will: assess specific training and practical
capability to attend to community’s basic health health- needs of leaders. Plan for continuing education
care needs. Achieved by conducting community program
diagnosis, training health workers, undertaking health Sustenance – Maintenance Phase
services & mobilization & leadership skills training. 1) Leadership-Formation
1) Conducting Community Diagnosis. - It Is a continuous process
- This is performed to come up with the profile of the - Learn in actual organization activities…conduct
local health situation. Basis for health program and meeting, planning of activities
services to bed deliver in community. - Project / program management
- Nurse will: Assist people in developing plan & actual - Formal leadership training ex. financial
conduct of community diagnosis. Asset identify,
analyze, understand implication of data collected. Intersectoral Collaboration
2) Training of Community Health Workers. - The need for resource-material, human, financial will have
- After presentation of the result of community to be sourced externally.
diagnosis, the community now decides the roles that - Assistance, support through collaboration with other
the community health workers are expected to organizations & communities
perform. - Nurse will: facilitate, coordinate with organizations agency,
- After community diagnosis presentation key people
- Decides on roles community health workers perform a) Networking – relationship among org. exchanging
information about each other's goal, objectives,
services or facilities. Result: aware of worth &

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capabilities, how each other contribute to Methods Used in COPAR

accomplishment of network's goals & objectives 1) Action-Reflection-Action-Session
b) Coordination – Orgs. modify their activities in other to 2) Consciousness Awareness
provide better service to target beneficiary. Time 3) Participatory and Mass-Based
consuming, requires more involvement & trust on the 4) Group-Centered and not Leader-Oriented
part of committed organization
c) Cooperation – sharing of information & resources, COPAR gathering data method
make adjustments in respective agendas to - This are the Transect Walk, Mapping such as Resource
accommodate other organizations agenda. Org Map, Health Map and Seasonal Map.
shares ownership of the success & rewards, as well - Another COPAR Data Gathering method is with the use of
as problems & hassles that go with working together. a Venn Diagram
d) Collaboration – Level of Org. partnership in which • Transect Walk -In an Ocular Survey. Nurse ask a
org. help each other enhance their capabilities in group from the community to lead the walk. Ask
performing their tasks, as well as provisions of critical questions and allow them to analyze and draw
services. People becomes partners NOT competitors. conclusion
e) Coalition or Multi-sector Collaboration – Org & • MAPPING – Allows people to view community in
citizens form a partnership where all parties give different perspective and to people deal with it
priority to the good of the community; requires great effectively
investment in terms of time, trust & will to make a - Resource map is a geographic map depending on
change. purposes can be their source of livelihood or
f) Advocacy Work – Informing people about the physical resources.
rightness of the cause. Thoroughly discussing with the - Health Map – Health worker respondents draws
people the nature of the consequence supporting SPOT MAP. Highlight houses identified with health
peoples right to make a choice & act on their choice problems, houses with vulnerable members,
Influencing other's opinion. - Seasonal Map or Calendar – Shows various event
/ activity significant to community such as
PHASE – OUT livelihood (e.g. harvest season, social events (e.g.
- Community gradually shoulder greater responsibility in Christmas), Historical Mapping (e.g. typhoon in
managing health care needs. Area)
- Nurse gradually prepares the turn-over of work, develop • Venn Diagram – Visual representation of social
plan of monitoring, follow-up of activity until full support system
disengagement and phase-out - Big Circle – represents community
- Purpose: To Practice independence - Small Circle inside the Big Circle – representing
groups/ organization in the community
Critical Activities in COPAR - Draw inside the most active / influential group
1) Integration - Involves living with the people. in the community
Understanding their problem, undergoing their hardship, - Small circle outside the big circle represents
sharing their hopes & aspirations to help build mutual organization outside the community such as
trust & cooperation public or private (govt or private institutions).
2) Social Investigation - Also known as community study. A Proximity or distance of these circle will
systematic, scientific process of collecting & analyzing symbolize their degree of influence in the
data to draw a clear picture of the community community.
3) Tentative Program Plan - Community chooses one issue
to work to start community organizing Basic Qualities of Community Organizers
4) Groundwork - Going from place to place, motivating
people on a one-on-one basis to act on the issue chosen
5) Meetings - People jointly ratify what have been decided
individually. Gives people collective action and
confidence
6) Role Play - Acting out meeting that would takes place
amongst people and government representatives.
7) Mobilization or Action - Actual exercise of people power,
actual confronting of powerful
8) Evaluation - Measures the outcome of the activities
versus objectives
9) Reflections - Dealing with deeper, ongoing, concerns to
look at positive values a community organizer is trying to
build in the organization.

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Core Principles in Community Organizing Emphases of Community Organizing in Primary Health

1) It is people - oriented Care
- People and means are ends of development and 1) People from the community working together to solve
community development is the process and the their own problem
outcome. 2) Internal organizational consolidation as prerequisite to
2) It is participative external expansion
- Community is the prime-mover and determinants 3) Social movement first before technical change
rather than the beneficiary of health efforts. 4) Health reforms occurring the broader context of social
- It is critical for success. Evident in their involvement, transformation
they are well-informed and aware their potentials for
participation. Decision making is in the hand of Area of Evaluation and Parameters
ordinary people not among elite. Distinction is not • Program based
made among different groups and different - were the goal, objective of project/program were
personalities achieved?
3) It is democratic - What strategies were implemented? What worked?
- Empower disadvantaged population. Allows people to What did not?
recognize, analyze needs and articulate aspirations, - What is the overall impact of the project?
Decisions are from whole people/common people - How were the organization resources & community
than the elite or leader alone. utilized?
- Leader needs to do participative and consultive • Organizational
approach to effectively process conflict within the - Were the vision, mission, goal achieved?
group - How are the organizational policies being
4) It is developmental implemented?
- Directed in changing underlying situation. Through - What is the level of participation in the affairs of the
empowerment of marginalized people. Community community?
gains insights, hones capabilities and develops. Later - How were the resources of the organization utilized?
take leads in wholistic improvement of community. - What type of interpersonal relationship is shared
5) It is process – oriented among members of the organization, among the
- It is a process of change. Allow community to leaders and members of the community?
internalize it and embrace the process requires time.
It is dynamic with the evolving community situation Comparison of Community Organizing and Health
and monitoring and periodic review Education
1) Community Organizing
Goals of Community Organizing - work carried out by nurse, seeking wider community
1) People’s Empowerment participation in decision making in activity to impact
- In the process of community organizing allows people positively in health
to develop their capacity to maximize their control - strengthen member capability in problem solving &
over situation. Start placing control over their own decision-making skills for self-reliant development
hands. 2) Health Education
2) Build permanent Structures and People’s Organization - Nurse influence, change & modify attitudes, behavior
- Establish and sustain permanent structures that will of individuals, nurse efforts towards organizing,
support their needs mobilizing people to initiate, sustain change as a
3) Improved Quality of Life group or an organization
- Manifested by collective involvement in decision
making and community action on matters that would Comparison of Traditional Research Approach and COPAR
impact their lives. 1) Decision Making
• Traditional: PAR Top Down
Basic values in community organizing • COPAR: COPAR Bottom up
1) Human rights – universal principle anchored on belief of 2) Emphasis
worth dignity of people. Right of life, self determination • Traditional: PAR Expert / Nurse Driven Process, Much
development. premium is given on data or output
2) Social justice – equitable access to opportunities, • COPAR: COPAR Community Driven Process, Premium
quitable distribution of resources and power. is placed on the process
3) Social responsibility – people should reach out through 3) Roles
and move jointly with others in meeting common needs • Traditional: PAR N. is researcher, C as objects or
and problems. subject of research respondents. DATA ANALYSIS
(PAR) by N & presented to people

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• COPAR N: is facilitator; C as researcher, DATA

ANALYSIS by community collectively
4) Methodology
• Traditional: PAR Research tool & methodology are pre
determined / pre packaged by N
• COPAR Research tool & method Identified &
developed by community
5) Output
• Traditional: PAR Submitted to agency, published,
Recommendations based on finding
• COPAR Conclusion / documentation made by C.
Leads to agreed C actions/ projects Then whole
research CONTINUES until it becomes part of C. life
toward, C Development. C members formulates
recommendations

Terminologies
• Community – Based Approach - Community-‐based
refers to a philosophical approach in which communities
have an active role and participate in highlighting and
addressing the issues that matter to them.
• Comprehensive Approach – Strikes at the root of
community problem.
• Integrated Approach - In health, it considers other areas
like change of lifestyle change of environment and
reorienting health care services
• Intersectoral Collaboration - The joint action taken by
health and other government sectors as well as
representatives from private, voluntary and non-profit
groups, to improve the health of populations.

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