HKE224 COMMUNITY ORGANIZATION FOR HEALTH PROGRAMMES

COURSE OUTLINE

1. CONCEPT AND DEFINITION OF TERMS

 Personal health

 Family health

 Community health

 Public health

2. HEALTH EDUCATION AND HEALTH PROMOTION

3. COMMUNITY HEALTH EDUCATION

 Dimensions in community health promotion

 Approaches in community health education

4. COMMUNITY PARTICIPATION

 Factors promoting community participation

 Community involvement

5. COMMUNITY MOBILISATION

 steps in community mobilization

 stages of community mobilization

 community engagement

6. PRINCIPLES OF HEALTH AND SOCIAL BEHAVIOUR IN THE

COMMUNITY

7. THE COMMUNITY HEALTH EDUCATOR

 Roles and characteristics of a community health educator

8. COMMUNITY HEALTH PLANNING (The health planning process)

1
 9. COMMUNITY ASSESSMENT:

 For health problems/Types of health problems

 For health programmes

10. COMMUNITY HEALTH DIAGNOSIS

11. HEALTH COMMUNICATION IN COMMUNITY SETTINGS

12. HEALTH AGENCIES IN NIGERIA

13. HEALTH POLICIES IN NIGERIA

14. PUBLIC HEALTH ISSUES AND COMMUNITY HEALTH

15. PROJECT WORK

GRADING

CONTINUOUS ASSESSMENT-40%

EXAMINATION- 60%

TOTAL- 100%

2
HKE 224 COMMUNITY ORGANIZATION FOR HEALTH PROGRAMMES

Concept and Definition of Terms

The word “Community” was derived from the Latin “Cum” and “Munus” which
means “together” and “gift”. So community literally means to give among each other.
Community is a group of people living in a locality, who have common interests, meet
and react with one another, share social organization and cohesion, share political,
economic, social and cultural characteristics and health aspirations.

According to WHO, a community is a social group determined by geographical

location, common values, interest or specific activity. The members know and interact
with each other, function within a particular structure, exhibits, create certain norms,
values and social institutions (WHO, ). Hence, community is viewed as:

a collection of people
as a place
as a social system
as goal or role or goal-oriented
as an institution
as character-based
as a culture
as community of value
as hierarchical
as community with expectations
as behavioural
with geographical boundaries
as membership
as people with needs

3
Community Health

This is a field in public health that focus on studying, protecting or improving health
within a community. It provides healthcare interventions, including health promotion,
disease prevention and management.

Definition

Community health is defined as a group of people who share important features of

their lives and utilize common agencies and institutions, to identify community needs,
problems and manage interactions within the community.

Factors affecting Community Health

The various factors that can affect community health includes:

1. Physical factors such as geographical location and environmental localization of

the community that may affect disease prevalence, community size, cause
overcrowding, industrial development and level of pollution.
2. Socio-cultural factors like beliefs, norms and traditions. These define attitudes
towards health and influence practices that are either beneficial or harmful to
health. Economic and political status of a community also affect the affordability
and availability of healthcare.
3. Community organization plays a role in the presence of healthcare options as well
as the extent to which members know the priorities and participate in lobbying and
promotion of community healthcare.
4. Individual behaviour or personal choices, such as freely participating in
immunization or prevention of diseases or knowledge of waste recycling also
contribute to the wellbeing of the whole community.

Health Community

A healthy community makes use of its resources and is prepared to meet threats and
dangers through the conduct of community assessment. In assessing the health of a

4
community, information are collected on variables specific to location and on the
relationship between the community and its location; this is to ask if:

 groups cooperate to identify threats;

 community members have information about resources and dangers
 the community is properly profiled and the inventory include the six location
variables listed:
- community boundaries
- location of health services
- geographical features
- climate
- flora of fauna
- human-made environment

The dimensions of healthy community include:

1. spirituality and wellness

2. life-long learning
3. economic opportunity
4. community leadership
5. safety and security
6. infrastructure and services
7. environmental stewardship
8. recreational and artistic opportunity
9. inclusion

The ways a community’s health can be protected or improved include health

promotions, health protection and health services.

Health promotion is any combination of educational and social efforts designed to

help people take greater control of and improve their health. Health protection and
Health services include the implementation of laws, rules, policies approved in a

5
community as a result of health promotion or legislation. Health protection and Health
services differ from health promotion in the nature or timing of the actions taken.

Examples of health protection includes:

 Restriction of sales of Sugar –Sweetened Beverages (SSBs) in primary schools

 Restriction of involvement of minor in the advertisement of Sugar –Sweetened
Beverages (SSBs)

Example of health services include:

Health Policy; - Immunization of children 0 to 5 years

- COVID-19 vaccination for ages 18 and above

- Booster doses of OPV, measles and COVID-19 vaccines

Hancock & Dhil (1986) defined healthy community as one that is continually creating
and improving those physical and social environments and expanding those
community resources that enable people to mutually support each other in performing
all the functions of life and in developing to their maximum potential.

Health

Different concepts exist in the definition of health, these concept is inclusive of

biomedical, ecological, psychosocial and holistic definitions of health.

The WHO (1945) holistically, defined health as a state of complete physical, mental
and social well-being and not merely an absence of disease or infirmity. The
principles of health are: healthy nutrition /diet, regular exercise, work, adequate rest,
positive thinking, sunshine, portable water, temperature, quality air, spiritual health
(trust in God/spirituality), moderate drinking (no drinking), quit smoking, no drugs,
relationship and passion, Relaxation and recreation

Good health and wellness are interdependent on various dimensions; physical,

emotional, environmental, occupational, mental, intellectual, financial, cultural, social,
economic, and spiritual. These dimensions are extended to wellness continuum by
Kathryn Stolle of transcending, finding meaning, intimacy, communicating, thinking,
6
feeling, playing and working, moving, eating, sensing, breathing, self-responsibility
and love.

The dimensions of healthy community include: spirituality and wellness, life-long

learning, economic opportunity, community leadership, safety and security,
infrastructure and services, environmental stewardship, recreational and artistic
opportunity and inclusion

Personal health is a state of wellbeing of the whole body of an individual necessary

for the person’s sound growth and development. Personal health as five area, which
are physical, emotional, social, spiritual and intellectual. Personal health involves
personal attention to and maintenance of overall health through:

 Physical activity
 Sleep and rest
 adequate nutrition for age
 Positive healthy habits to maintain a healthy quality of life.

These components are:

Diet and Nutrition: What and how individuals eat

Environment: Environment selection and modification of surrounding

Activity: Exercise, rest and sleep

Psychology: Self-perception, interaction and communication with others

Personal health may be influenced by the following health determinants:

 Genetics
 Behaviour
 Environmental influence
 Physical influence
 Medical/health care
 Social factors.

7
Family Health

According to World Health Organization (1978) family health is a state of positive

dynamic interaction between families, which enables each and every member of the
family to experience optimal physical, mental, social and spiritual wellbeing whether
disease or infirmity is present or not. The family services as a resource for the day-to-
day living and health of its members. Determinant of family health include:

 Education and economic factors

 Family dynamics
 Physical environment
 Living and working conditions
 Psycho-social environment
 Health practice
 Cultural factors
 Gender

Protective factors improving family health and enhancing parenting include:

 Nurturing and attachment

 Knowledge of parenting of a child and youth development
 Parental resilience
 Social connections
 Concrete supports for parents.

Public Health

This is the science of protecting and improving the health of people and their
communities through organized efforts and informed choices. According WHO,
public health refers to all organized measures (whether public or private) to prevent
diseases, promote health and prolong life among the population as a whole. Its
activities aim to provide conditions in which people can be healthy with focus on
entire populations and not on individual patients or diseases.
8
This is achievable by promotion of healthy lifestyles, research on disease and injury
prevention and detection, prevention and response to containment of infectious
diseases to protect the health of the populace.

The domains of public health core competence include:

1. Data analytics and assessment skills

2. Policy development and program planning skills
3. Communication skills
4. Health equity skills
5. Community partnership skills
6. Public health sciences skills
7. Management and finance skills
8. Leadership and systems thinking skills

HEALTH, DIMENSIONS OF HEALTH, WELLNESS, HEALTH EDUCATION

AND HEALTH PROMOTION

Health is a state of physical, mental and social wellbeing, it is been free from
diseases.

Wellness is a state of living a healthy lifestyle, it aims to enhance wellbeing, and it is

the overall balance of a person’s health.

Kathryn Stolle ( ) classified wellness into 12 dimensions in a continuum which

are:

Transcending Finding meaning Intimacy Communicating

Playing and working Thinking Feeling Moving

Eating Sensing Breathing

Self-responsibility and love

9
Health Education

This is a science-based course that draws from social sciences and restorative sciences
to advance health of a community. The practice of health education is a tool or
mechanism for health-related learning resulting in increased knowledge, skill
development and change in behaviour. Health Education is an essential tool for
community health programmes, the promotion, maintenance and restoration of health
requires understanding. Health education is an integral part of all health services. It is
a learning process which is concerned with changes in knowledge, feelings and
behaviour of people.

Health Education is defined as a process which brings about changes in the knowledge
and attitudes of the people and thereby effect change in health practices. It is the
gradual process of learning that informs, motivates and helps people to adopt and
maintain healthy practices and lifestyles.

Health education is any combination of learning opportunities designed to facilitate

voluntary adoption behaviour which will improve or maintain health.

A health education programme aims to bring out changes in the following:

 Knowledge
 Attitude
 Behaviour
 Habits
 Customs

Scope of Health Education

 Family/community involvement
 Health promotion
 Healthy school environment
 School health services
 Counselling

10
  Psychological and social services
 Physical education
 Food and nutrition
 Common diseases, prevention and control
 First aid and safety measures
 Mental health
 Hygiene education: personal, environmental
 Pollution: air, water, noise and land
 Wastage management
 Water safety and purification
 Good health habits
 Good body posture
 Sleep, rest, relaxation and recreation

Components of Health Education

 Personal health
 Family health
 Community health
 Consumer health
 Intellectual health
 Environmental health
 Sexuality education
 Mental and emotional health
 Injury prevention and control of diseases
 Substance use and abuse
 Reproductive health
 Social health
 Spiritual health
 School health

11
Principles of Health Education

1. Interest 2. Participation 3. Motivation 4. Credibility

5. Known to unknown 6. Learning by doing 7. Reinforcement

8. Communication 9. Comprehension 10. Need-based

11. Good human-behaviour12. Change in behaviour 13. Leadership

14. Scientific-based knowledge 15. Creating rapport 16. Good intra and
interpersonal relationship 17. Compare and upgrade knowledge 18. Feedback

People targeting for Health Education

 Healthy individual
 Client seeking health services
 Patients in health facilities
 Groups: students, workers, pregnant woman, breastfeeding mothers, youths, club
members, professionals, senior citizens, public servants, retirees
 Community: villagers, kings, chiefs, stakeholders, urban areas
 Populace at large

Aims of Health Education

1. To help people understand that health is the most valuable community asset.
2. To develop a sense of responsibility for improvement of their health as individual
members of families and communities
3. To alter behaviour which may have directly or indirectly influenced occurrence or
spread of diseases in a community setting.

Approaches to Health Education

1. Regulatory approach
2. Servicing approach
3. Educational approach
4. Individual approach

12
5. Family approach
6. Group approach

Why Community Health Organization for Health Programme

The purpose of community organization for health programmes is to help people

attain greater levels of health and well-being through its various programmes. The
following are some of the reasons:

 to ascertain the nature and extent of disease and disability in the community
 to take suitable measures to:
- promote healthful living
- prevent disabilities
- correct remedial defects
- treat illness
- rehabilitate
 to evaluate the progress and success of current programmes
 to conduct research into causes of community diseases and investigate and proffer
solutions through improved methods and techniques.
 to provide the necessary organization of medical care, healthcare, to deal with
community ill-health
 to educate the public in prevention of health hazards in the best use of medico
socia measures and appropriate technology.

Health Promotion

This is any planned combination of educational, political, environmental, regulatory

or organizational, mechanisms that support actions and conditions of living conducive
to health of individual, group and communities.

It is the science and art of helping people change their lifestyle towards a state of
optional health. Health promotion is explained as a process by which health is
improved from a broad multi-dimensional, socio-ecological approach. It is any plan
directed at enhancing the quality of health and wellbeing of individuals, families,
13
groups, communities and nations through strategies involving supportive-
environments, coordination of resources and respect for personal choices and values.

The Multidimensional Nature of Health Promotion

The health of individuals and families is affected by the environmental, community or

society in which they live. This environment, living condition or geographical location
either sustains and expands the person’s health potential or inhibits the emergence of
health and well-being.

Health promotion dimensions are classified into the following levels:

 individual wellness
 family wellness
 community wellness
 environmental wellness
 societal wellness

Individual Wellness: An individual plays a critical role in the determination of

his/her own health status. Personal self-care, daily decision made by him shapes
lifestyle and the social and physical environments. Health Promotion at the individual
level improves personal decision making and health practices.

Family Wellness: The family plays a critical role in the development of health beliefs
and health behaviours. Each individual identify with a family group that influences
him and other’s ideas and actions. A family as a group has a characteristic value, role
and power structure as well as unique communication patterns. Family fulfil affective,
socialization, health care and coping functions in various ways. Parenting styles and
family environments encourage healthy, or unhealthy behaviours that may persist
throughout the life span. Health promotion at this level emphasizes development of
strategies to promote family wellness.

14
Community Wellness: This is achieved by multiple actions that improve the
conditions of family and community life. A number of benefits of community based
health promotion programs are identified as follows:

1. Enhanced opportunities for information exchange and social support among

members of the target population.
2. Reduced unit cost of programming because large group of people rather than
individuals receive health-promotion services.
3. Availability of networks that facilitate and coordinate health-promotion efforts
4. Potential for widespread change in social norms regarding health and health
behaviours.
5. Coordinated rather than individualized approach to the promotion of health in
large populations
6. Access to a broad array of media for dissemination of health information
7. Availability of aggregate indices to be used for tracking the health status of the
population
8. Utilization of community resources resulting in a sense of commitment to health-
promotion programming.

At this level, community programming for prevention and health promotion will result
in rapid dissemination of health information and changes in cultural norms relevant to
health and health behaviour.

Environmental Wellness: An environment is the physical, interpersonal and

economic circumstances in which human lives. The quality of the environment is
dependent on the absence of toxic substances, the availability of aesthetic or
restorative experiences and the accessibility of human and economic resources needed
for healthful and productive living. Socioeconomic conditions such as unemployment,
poverty, crime, prejudice and isolation have adverse effects on health. Environmental
wellness is the balance and harmony between human beings and their surroundings.

15
Health promotion at this level affect the extent to which individuals, families and
communities achieve their optimum potential.

Societal Wellness: The wellness of a society depends largely on the enactment and
implementation of laws and the establishment of polices that protect the health and
welfare of all age groups. A healthy society is one in which all members have a
standard of living and way of life that enables them to meet basic human needs and
engage in activities that express their human potential. It is a society in which
members collectively are willing to accept responsibility for health and to foster a
level of education that improves healthy informed decision making.

A healthy society recognizes the dignity of all human beings, adopts policies to
maintain that dignity and avoids policies and programs that are demeaning or
belittling to its members. It empowers its members to use their talents throughout the
life span without premature retirement or relegation to a status of less value with age.
Societal wellness requires involvement of a number of sectors, including those of
education, food production, housing and employment as well as the health sector to
collaborate towards improving a population’s health profile.

Pre-requisites for a healthy society include:

a. a belief that disease and illness are not inevitable consequence of human existence
b. a vision for the population beyond that of immediate survival
c. awareness of the close relationship between individual, family, community health
assets and the well-being and productivity of a society
d. acceptance of high-level wellness as the goal of the society.

At this level, societal wellness provide the framework in which individual, family,
community and environmental wellness occur. Bureaucracy at any of the collaborative
sectors affect the range of health-priority options available, so a coordinated
intervention at all the levels will result to the most cost-efficient and effective
approach to health promotion.

16
Measures for Achieving Health Promotion

Health promotion can be achieved through:

1. health education programmes, which could be formal or/and informal

2. risk-reduction intervention programmes
3. environmental awareness and improvement programs
4. strategic initiative to change laws or regulatory policies to be supportive of health
5. community activation program.

Planning Community Intervention Programme

To plan effective and acceptable community intervention programme either targeted at

majority of the population, high-risk persons or the community as a whole. A
community model that must be used is based on the following:

1. acknowledging that communities shape individual behaviours through community

values and norms
2. accepting that communities can be mobilized to change individual behaviours by
legitimizing the desirable behaviours and changing environments to facilitate the
new behaviours
3. arousing the interest of members to participate
4. acknowledging that participation of community leaders is crucial for community
ownership
5. ensuring that members of the community have a sense of responsibility and control
over the planned change for the intervention to be successful.

People are more likely to commit to and sustain change if they participate in
identifying the problem, develop and implement the program to address the problem.
Community interventions must engage participants to promote successful behaviour
change. Community members must be involved early in the planning process to
identify needs, develop priorities and plan programs to promote change. Community-
based models take into consideration individuals’ interaction with their families,
cultures, and social structures as well as the actual physical environment. Community-
17
based health promotion programs are planned on community empowerment and
community participation.

Community Empowerment

The concept of empowerment refers to a process by which people and communities

gain mastery over their lives. Community empowerment is a social action process by
which people and communities are enabled to participate and act to transform their
lives and their environments. Empowerment principles are essential components of
participatory research in health promotion. Empowered communities are visible when
people within the community participate in equal partnership with health professionals
and practitioners in defining their problems and developing solutions. This enables
community members receive the benefits of the interventions and are partners in
evaluation of the effectiveness of the intervention.

Community Participation

Community participation is a basic principle in health education for disease

prevention. It is the process of taking part in activities, programs or discussions to
promote planned change or improve the community. It is expected to empower
individuals and communities through group decision making and knowledge of
resources as well as creating new networks and opportunities. Community
participation by members of a community results in greater buy in, greater
participation and greater sustainability. Both community empowerment and
participation conform, as empowered members participate in the health programmes
for the community. The most valuable resources for health program for the
community are the community members (people themselves).

World Health Organization [WHO] (1983) defined community participation as a

process by which individuals and families assume responsibility for their own health
and welfare and for those of community and develop capacity to contribute to their
and the community’s development.

18
Community Participation can be multiples of the following:

1. The participation in development effort not only at all levels but also in all sectors,
including those of food and water and others which have bearing on health.
2. The participation at all levels in planning and decision concerning the structure and
functioning of health services.
3. The participation for the provision of facilities, materials, funds, labour and other
support for health.
4. The participation in provision of health services to special group in the community
e.g. elderly people to improve health, care for the ill elderly, assisting physically
challenged in need of social rehabilitation.
5. The participation to enhance attention to out-of school pupils, street urchins,
destitute homes to enhance individual’s personal hygiene, diet and self-care.

Factors Promoting Community Participation in Health Programmes

 development of interest
 identification of community’s needs
 community involvement
 identity with community
 previously successfully conducted community programmes
 willingness to serve the community
 melt needs of the community
 peer pressure

Types of Community Participation

Participation according to Sarah White (1996) can be nominal, instrumental,

representative and transformative. Some participatory process are classified as
Horizontal participation, Vertical, focused, Decide-announce-defend, Symbolic and
Intense participation.

19
Classification of Participatory Process

Participatory process can be classified into the following namely:

Horizontal Participation: This allows for the consultation of many community

members; stakeholders, rulers, community development, committees, opinion leaders,
youth leaders, market leaders etc. related to planning of community intervention
programme. It allows involvement of every members through town hall meetings,
interactive sessions or surveys.

Vertical participation: This involves a selected group or representative of the

community members in a very tense way in terms of activity, internal transparency,
flexibility and power sharing. This types of participation only have majority of
stakeholders or leaders who are those that are informed about the intervention.

Focused Consultation: In this type of participation, only the most important

community members such as village heads, women leader, youths leaders etc. are
involved with minimal effort in a bilateral way in order to gain from them the
information and support needed.

Decide-Announce-Defend: This class of participation is limited to gain stakeholders’

support for decision already made by all community members at a town hall meeting.

Symbolic Participation: This describes a participatory process suggesting an intense

participatory process in which community members are actively involved and are
supported by enough information to influence decision making.

Intense Participation: This describes a process that allows for a direct dialogue
among representative of a community. It gives the members opportunity to exchange
knowledge and opinions on relevant questions relevant to the intervention health
programme. Participants have access to relevant information and the results of the
participation. Intense participation is achievable through methods such as organization
of workshop, meetings or surveys.

20
Self-mobilization: This is a type of participation in which community member take
initiatives independent of external policy maker to change their community. This self-
initiated mobilization and collective action may or may not challenge existing
inequitable distribution of resources and power.

Interactive Participation: This is a type in which there is joint assessment of the

needs of the community. This leads to action plan and formation of new groups within
the community from the members of the community or to the strengthening of pre-
existing committees. It involve interdisciplinary methodologies that seek multiple
perspectives and make use of systematic and structured learning process. The group or
committee take control of decision-making to ensure the planning and implementation
of health interventions.

Functional Participation: In this type, people participate by forming groups to meet

predetermined objectives related to the planned health programmes. This involvement
do not occur at the planning stage or early stage of proposal of intervention but after
major decisions have been made.

Participation for material incentives: In this people participates by providing

resources such as food, cash or other material incentives.

Participation by Consultation: This is a type of participation that policy makers

consult community members, listen to their views or opinion on an intervention. This
allows identification, definition, questions and modification of solutions from the
responses of community members.

Participation in Information-giving: This participation allows members to answer

questions posed by policy makers. This is performed by questionnaire surveys. The
odds of this participation is that members of a community do not have opportunity to
influence decision making.

Community Participation is classified into

21
 a. Active participation
b. Passive participation
c. Community involvement

ACTIVE PARTICIPATION

Active participation is the degree of active involvement of members of a community.

It is an approach to empower individuals in the activities and relationships of
everyday life leading to living as independently as possible. It is community
member’s enablement and involvement in all aspects of their life. It is recognition of
the right of community members to participate in activities and build relationships of
concern to them. It is inclusive of building competences that community members
need to reach a level of awareness of themselves in relation to the environments they
live in and to take informed decisions and participate actively and positively in the
community.

The two key principles guiding active participation are:

1. The rights of the individual

2. The independence or autonomy of the individual

Examples of active participation: community organized litter and waste clearing

campaigns

Characteristics of Active Participation

 Independence

 Sense of dignity

 Sense of control over action-taken

 Sense of connection to other community members

 Increased independence

 Formation of relationships

 Increased self-awareness
22
  Increased self esteem

 Greater levels of physical activity

How health educators promote active participation in community

 Knowledge of the community members

 Spending time with community members

 Attending town hall/stakeholders meeting with community members

 Be available and accessible

 Being genuinely interested in community

 Possession of adequate knowledge, skills and understanding

 Seek guidance and respect for the cultural values and norms of the community

 Building hierarchy of participation

How to build the Hierarchy of Active Participation

Prior to plan of community participation for health programme. A hierarchy must be

established for the community members to be active in taking part in the programme.
This will enable the effectiveness of the mode of communication and the degree of the
community members’ influence on decision-making.

There are four hierarchy of active participation, namely:

 Information

 Consultation

 Collaboration

 Empowerment

Information: This level involves telling people about intervention or health service
and decision to be made. The one-way communication is the mode employ to provide

23
information on the intervention for joint planning. This may be performed through the
use of newsletter, intervention plan introduction programme brochures.

Consultation: This level includes asking for community member’s opinions and
decision to conduct health programme based on their feedback. The two-way
communication is used at this level, the question and answer method, interview;
asking and listening to take community members’ voice and view in decision to carry
out intervention is the best method. Consultation may be through surveys, polls,
interview, message board or suggestion boxes.

Collaboration: A dialogue-based communication is perfect to provide information,

obtain feedback share responsibilities with community members. This builds
togetherness and teamwork and collaborative decision-making. This is achievable
through organized event, distribution of tasks (division of labour) and making
decisions together.

Collaborative efforts may be achieved through idea-collection, voting, forums

mapping, organized education events and volunteer activities.

Empowerment: This is rendering power of decision making to the community

members by giving relevant information to support healthy living. The dialogue-based
communication is used to enable implementation of the community’s decision. The
technique of community empowerment include organize events for members, placing
full decision-making power in the hands of the community members through
community members proposals, or community-selected committees.

Barriers of active participation

 Lack of active participation

 Non-involvement

 Non-inclusiveness

 Insufficient time
24
  Wrong-timing

 Lack of self-motivation

 Disrespect for cultural values and norms

The six dimensions of Intensity of Active Participatory Process

Activity

Reach Equality
Intensity of
participation

Flexibility Transparency
Power
sharing

Beierle F. C. & Cafford J. (2002)

The concept of measurement of intensity of participation is a way to describe the

characteristics of a participatory process. It explains high activity for high equality and
covers different questions as listed in the intensity dimensions which may either be
high, medium or low.

Intensity Main question covered

Dimension

Activity Do community members have the opportunity to take active part in

the participatory process, by expressing opinions, ideas and

25
 discussing planning options?

Equality Do all community members have equal chances to influence the

output of a planning procedure?

Transparency Are community members informed about the projects as well as

the procedure of the planning process and decision making in a
way that enables them to advocate their interests in a competent
way?

Power sharing Does the health policy maker share power with the community
members by giving their opinion a formal status in decision-
making?

Flexibility Does participation take place at a time when major aspects of the
intervention programme are still open for discussion?

Reach Is participation limited to a small group of representatives or does

it involve major parts of the whole community?

Description of the Levels of Intensity Dimensions in Active Participation

Intensity Low Medium High

Dimension

Activity Only representative of Consultation of Active involvement of all

26
 the community are stakeholders to asked members of the
informed them to give their opinion community. Stakeholders
or view on the plan with different interests
intervention programme meet to discuss about the
planned intervention
program

Equality Some affected All community members All community members

community members, are involved personally or have a similar influence on

represented by an the outcome of the
groups or stakeholders
appropriate person, but process. They are either
are excluded from the
with a different degree of taking part personally or
planning process.
influence on the outcome. are represented by an
appropriate person. All
community members have
access to the same
information and their
voices have the same
weight.

Transparency Relevant information is Community members are All community members

withheld from well informed, although are at an early stage
members of the there are some minor informed about all relevant
community on purpose. deficits. aspect of the intervention

Example: some messages and the process in a way

or information is not that they can effectively
delivered at an early advocate their own

stage. It may be given in a interests.

not clear and difficult to They are also informed
understand language. about progress and results
27
 of the active participation
of the community.

Power Community members Community members Community members and

sharing opinions, ideas, views opinion counts, has health policy makers take
are ignored by the official status and have a the decision to improve the
health policy makers. pre-defined weight in the health of the community.
decision-making.

The health policy makers

will explain reasons if the
decision made deviate
from the community
members suggestion.

Flexibility Community members Community members are Community members are

are involved only after involved early enough to involved at an early stage
all relevant decisions influence some significant and can influence major
have been made. questions or aspects in the questions or query location
intervention plan. or measure e.g. location of
a tap or well or if the plan
intervention is based on
felt need of the
community.

Reach Only a small group or A large number of All known relevant

representative is community member member of the community
involved cannot take part have an opportunity to
personally. take part personally.

28
Passive Participation

This is otherwise referred to as “compliance”. This is a type of participation in which

members of a community allows health programme to be conducted without
influencing the decision of health policy maker. Passive participation is the acceptance
of an intervention by a community without influencing measures taken or probe to
change decisions made for the community by others. The members of the community
participate in health programmes by being informed of the decision unilaterally made
for them by the team of health program. It is the opposite of active participation.

Community Involvement

Community involvement is the power to bring positive measurable change in health

and health behaviour of both individuals and the communities in which they inhabits.
Community involvement or community control entails involving the community in
planning, implementation, management and evaluation of programs.

Examples of community involvement.

1. Nonprofit partnership
2. Volunteerism
3. Financial and material donations

Community Mobilization

This is the process of engaging communities to identify community priorities,

resources, needs and solutions in such a way as to promote representative
participation, good leadership, accountability and positive change in health behaviour.

A community can be mobilized into action by the following activities:

1. Door-to-door outreach
2. Public meeting
3. Dialogue
4. Participatory theatre and puppet shows
5. Health fairs (village literacy fairs)

29
6. Community meetings
7. Public debates
8. Print media
9. Dance and concerts
10. Mobile cinema
11. Motorized campaign
12. Listening groups
13. Social media

Components of Community Mobilization

 Leadership
 Organizational capacity
 Communication channels
 Community assessment
 Problem-solving skills
 Resource mobilization
 Administrative and operational management

Steps in Carrying out Community Mobilization

Goals and strategies of a community organized programme determines the methods

that will be employed. Strategies may be advocacy, diagnosis, planning or
sustainability.

Step-by-step method of community mobilization.

 Create a community profile

 Perform community survey
 Create a working group
 Conduct SWOT analysis of the working group
 Meet the identified needs of each of the working group
 Prioritize the problems within the coalition
 Work out strategic plan for advocacy campaign
30
 Develop an action plan
 Monitor outcome of results of advocacy
 Secure a strong leadership
 Establish a formal structure
 Engage diverse organizations and sectors, community leaders and residents
 Ensure authentic participation and shared decision-making
 Ensure authentic and productive roles for young people
 Develop a shared vision
 Conduct a needs assessment
 Create a needs assessment
 Create a strategic plan
 Implement mutually reinforcing strategies
 Create a fundraising strategy
 Establish effective channels for internal communication
 Educate the community
 Conduct process and outcome evaluations
 Evaluate the community mobilization effort separately

Stages of Community Mobilization

 conduct initial preparation

 organize the community for action
 explore the health issues
 set priorities
 plan
 act and evaluate
 scale up

Community Engagement

Community engagement is the process of collaboratively working with groups of

people affiliated by geographical proximity, special interest or similar situations to

31
address issues affecting their wellbeing to foster environmental and behavioural
changes for positive health.

Community engagement differs from community participation because community

engagement requires an active, intentional dialogue between people and stakeholders
or policy makers while community participation can be intrinsically aroused by the
people by stirring up interest to participate in community programmes. There are three
types of community engagement. They are informative participation, preparatory and
planning participation and decision-making participation community engagement is
otherwise referred to as community consultation, community empowerment,
community collaboration or stakeholder engagement civic or public engagement.

Community Engagement Tools and Techniques

These are tools and techniques that can be used to undertake effective and positive
community engagement. These include:

1. Stakeholders workshop 2. Focused group discussions 3. Planning forum

4. World café 5. Door knocking/surveys 6. Newsletter

7. E-voting 8. Roundtable network event 9. Conferences

10. Opinion survey 11. Ideas competition 12. Planning for real

13. Mapping event 14. Process mapping 15. Activity event

16. Community conference and survey 17. Street stall 18. Advertising

19. Open house events 19. Videography 20. Drop in sessions

21. Paper based questionnaire 22. Special interest group discussion 23. Interview

24. Motorized campaign 25. Social media: Twitter, Facebook, blogs

Community Health Diagnosis (Community Assessment)

32
Community health diagnosis can be viewed from social medicine; which includes
social anatomy, social physiology, social pathology, social diagnosis and social
therapy. Social therapy refers to a community health action as solution to health needs
of the community identified through community diagnosis.

Community Health Diagnosis is defined as a way of determining the pattern of health

problems in a community, including factors which influence the pattern. It is an
important concept of public health that identify the disease pattern of a population,
identify the basic health needs and current problems as felt by the community, its
analysis and priority for community health action, its planning, implementation and
the evaluation of the community based health activities.

Community diagnosis is a comprehensive assessment of health status of a community

in relation to its social, physical and biological environment. It is a means of
identification of health problems and needs. Community diagnosis employs
community analysis. Community analysis is the process of examining data to define
needs, strengths, barriers, opportunities, readiness and resources.

The product of analysis is the “community profile”. Health indicators are the tool used
in performing community diagnosis. Health indicators are variables used for the
assessment of community health. These indicators must be valid, reliable, sensitive,
specific, feasible and relevant.

These health indicators are classified as:

1. Mortality indicators 2. Morbidity indicators 3. Disability rates

[Link] care delivery indicators

4. Nutritional status indicators 5. Health care delivery indicators

6. Utilization rates 7. Indicators of social and mental health

8. Environmental indicator 9. Socio-economic indicators

10. Health policy indicators 11. Quality of life indicators

33
The WHO (2009) defines community health diagnosis as a quantitative and qualitative
description of the health of citizens and the factors that influence their health. It
identifies problems, proposes areas for improvement and stimulate actions.

Community health diagnosis is a dynamic process that must be conducted at a regular

interval to promote positive health behaviour change in the [Link] tool
of community diagnosis is the Baseline Survey.

Stages of community health diagnosis

The process of community diagnosis involves 4 stages:

1. Initiation
2. Data collection and analysis
3. Diagnosis
4. Dissemination

Types of Community Health Diagnosis

1. Comprehensive community diagnosis

2. Problem oriented community diagnosis

Levels of Community Diagnosis

There are three distinct levels of community health diagnosis. These are:

1. Descriptive level
2. Analytical level
3. Action level

Characteristics of Community Diagnosis

 It identify community problems

 It identify targeted health events
 It reflects changes in distribution of events over time, place and occurrence in
people
 It is participatory

34
 It is uncomplicated
 It is on-going and dynamic
 It is sensitive and timely
 It is cheap

Steps in Planning Community Health Diagnosis

Planning – Baseline survey to obtain information about the community.

 Use the GPS – Global positioning system to locate community

 Prepare map of the community to locate the geographical boundaries, important
roads, streets, housing patterns, community hall, religious institutions, educational
institutions, water sources, drainages, dumping areas, refuse area, waste disposal
channels etc.
 Identify community problems and needs
 define the problem and needs

A problem is a difficulty or obstacle observed to exist between a present situations and

desired future objection. Problems or needs must be defined in the words of the
community members, they may define problem as a perceived gap between what is
and what should be. Needs may be perceived or felt.

 Find out all possible causes and measures to reduce or solve the problem
 Prioritize the health problems and needs listed
 Implement the comprehensive community health action.

Steps in Community Health Diagnosis

1. Establish the assessment team

2. Identify and secure resources
3. Identify and engage community partners
4. Collect, analyze and present data
5. Set health priorities

35
6. Clarify the issue
7. Set goals and measure progress
8. Choose strategy
9. Develop the community health assessment document
10. Manage and sustain the process.

Community Assessment for Health Problems and Health Programmes

The component of a Community Health Needs Assessment (CHNA) are policy

change, systems change and environmental change. A community health assessment
gives organizations comprehensive information about the community’s current health
status, needs and issues.

Community Health Needs Assessment

Need is a state of wantedness or deficiency. Community Health Needs Assessment

(CHNA) is a systematic process involving the community’s ability to identify and
analyze the community health gaps (needs) of any given population.

Types of Needs

Bradshan (2011) identifies four main categories of need as:

1. Normative needs: Needs identified according to a norm or set standard. These

norms are generally set by experts

2. Comparative needs: these needs are concern with other who are not in need e.g.
the comparison of social problems in different areas in order to determine
which areas are most deprived.

3. Felt need: need which people feel i.e. need from the perspective of the people
who have it. These are wants, changes deemed necessary by people to correct
the problems they perceived in their community.

4. Expressed need is the need which people say they have. People can feel need
which they do not express and they can express needs they do not feel.

36
Other categorization of needs are real needs, perceived needs, and unfelt needs.

Real Needs: refer to the real qualities and effort a person needs to develop or utilize
that leads to desired results.

Perceived Needs: an individual’s judgment of benefits of a particular health service

Unfelt Needs: the need of people in a community which they are not aware of at
present. It is also called unrecognized needs

Steps in Community Needs Assessment

 Plan for a community needs assessment

 Identify community for assessment
 Identify and assemble a diverse community team
 State required information
 Select method of gathering data
 Develop questionnaire for data collection
 Train data collectors
 Arrange for a sample representative of the community
 Conduct need assessment
 Record and rate data
 Tabulate and analyses data
 Record and review consolidated data
 Identify needs suggested by data
 Develop a community action plan.

The stages of health assessment are:

 Assessment
 Diagnosis
 Planning
 Implementation

37
  Evaluation

Community Health Planning

Community health planning is a deliberate effort to involve the members of a

geographically defined community in an open public process designed to improve the
availability, accessibility, and quality of healthcare services in their community as a
means towards improving their health status.

It allows the identification of community needs, assess capacity to meet those needs,
allocate resources and resolve conflicts. Community Health Planning makes
healthcare system more accountable to average resident in their communities. It brings
private-public interests together to form collaborative partnership to delivery of
healthcare services.

Community health assessment and planning cycle

Assess – community health assessment

Prioritize: priority for health issues

Plan – community health improvement plan

Implement – monitor, revise community health improvement plan.

Stages of Healthcare Planning

 Situational analysis
 Problem identification and prioritization
 Objective setting
 Strategic formulation
 Sequence of activities
 Resource allocation
 Action planning
 Monitoring and control
 Evaluation

38
THE HEALTH PLANNING PROCESS

DEVELOPMENT OF HEALTH PROMOTION-PREVENTION PLAN

The steps in the development of health promotion – prevention plan actively

involve both the community and health planning team. The steps are:

 Review and summarize data from assessment

 Reinforce strengths and competencies of the client

 Identify health goals and related behavioural-change options

 Identify behavioural or health outcomes that will indicate that the plan has
been successful from the community’s perspective.

 Develop a behaviour-change plan based on the community’s preferences

on the stages of change and on “state-of-the-science” knowledge about
effective interventions.

 Reiterate benefits of change and identify incentives for change from the
client’s perspective

 Address environmental and interpersonal facilitation and barriers to

behaviour change

 Determine a time frame for implementation

 Commit to behaviour-change goals and the support needed to accomplish

them.

39
 Model for Health Promotion-Prevention Plan

Individual/Community Health Promotion-Prevention Plan form

Individual (Name):…………………………………..MobileNumber……………

Office number: ……………………

Community (Name of settlement) ………………...…

Address:………………………………….. Date of Birth:

………………………………..

Occupation: ……………………………………… Date of Initial Plan:

………………

Cultural Identification: ………………………………………………

Individual/Community Strength: ……………………………………………

Major risk factors:

………………………………………………………………………

Desired behavioural & health outcomes:

………………………………………………

Personal Selected Stage of Strategies Times frame

Health Goals behaviour to change intervention
(start from accomplish for change
highest goals
priority)

40
SOCIAL BEHAVIOUR IN THE COMMUNITY

Social behaviour is the way people interact with and influence other individuals. An
individual’s social behaviour impacts, not only the way other people respond to the
current situation but also their future decision. Social Behaviour can be positive or
negative. Social behaviour are caused by characteristics and actions of others,
cognitive processes, culture, environmental variables, and biological causes. Social
behaviour is all behaviour that influences or is influenced by other members of the
same community. It covers all sexual or reproductive activities and all behaviours that
tends to bring individuals together as well as all forms of aggressive behaviour.

It qualifies, modifies or alters the act of another individual. Examples are connecting
with other people by conveying information to others through verbal and non-verbal
cues.

Types of Social Behaviours

1. Emotional 2. Aggressive 3. Cooperative 4. Compliant 5. Mutualistic

6. Altruistic 7. Public 8. Anonymous 9. Parental 10. Dire

11. Prosocial: proactive, reactive, altruistic

Positive Social Behaviour

Positive social behaviour is the willingness to share not only the other’s goal strivings
but also their pain, frustration and sorrow. It includes prosocial behaviour that benefits
others and the community as a whole.

41
Examples: friendliness, kindness, getting along with peers, being well liked, being
generous and thoughtful, being perceptive about other’s feelings and perspective,
harmonious relationship, helping others, sharing, donating, obeying rules,
volunteering time.

Negative Social Behaviour

Negative social behaviours are self-oriented, being concerned neither with the
pleasure nor the welfare of the other person. They are unacceptable by the society and
can cause harm to the image and wellbeing of the society.

Examples: Rudeness, lateness, bullying, lack of discretion, having nothing positive to

say, not responding well to criticism, resistance to working with others, dishonesty,
examination malpractice, laziness.

Social Act

Social behaviour is any act which has been influenced by the society and also
influences the society. A social behaviour is a behaviour in which the responses either
serve as social stimuli or are evoked by social stimuli.

Example laughter

Factors Influencing Social Behaviour

 Culture; language
 Social influence of primary group e.g. family
 Environment

Culture: Is the sum total of behaviour patterns, attitudes and values, shared and
transmitted by the members of a given society.

42
Development of Social Behaviour

Social Behaviour are developed through social organization

Social organization

The 4 basic roots for social organization are:

 Contactual behaviour
 Reproduction
 Protection of the young
 Cohabiting, feeding and play

Kinds of Social Behaviour

1. Overt
2. Symbolic

Controlling and self-adopting social behaviour

Self-adopting social behaviour is when an individual in a society tries to adopt

himself within his social environment. E.g. relationship between a father and a son,
parenting styles, setting rules, instilling values and the child’s obedience.

Controlling Social Behaviour is when an individual who is controlled in one

situation may show controlling behaviour in another situation. E.g. relationship
between a father and a son, where the child teaches the father surfing for information
on the internet.

THE COMMUNITY HEALTH EDUCATOR

The Community Health Educator

A community health educator is someone who is skilled in teaching and promotion of

health and wellness of a community through various health programs.

Characteristics of a Community Health Educator

 Good interpersonal skills

 Good observer
43
 Leadership skill
 Active listener
 Knowledgeable
 Enthusiastic
 Professionalism
 Goal settings
 Ability to advocate
 Decision making
 Analytical skill
 Information technology oriented
 Effective communication skill
 Teaching skills
 Language skills
 Problem-solving skills
 Presentation skills
 Patience
 Creativity skill

Roles of Community Health Educator

Adviser, Advocate, promoter, team manager, case finder, counsellor, consultant,

coordinator, collaborator, educator, epidemiologist, good observer, identifier, assessor
promoter of health, manager of resources, planner, role model

 Ensure holistic learning in a prepared environment

 Provides opportunities for people to learn how to identify and analyze health and
health related problems
 Teaches people how to set their own targets and priorities
 Makes health and health-related information easily accessible to the community
 Indicate to the people alternative solutions for solving the health and health-related
problems identified

44
 Ensures people have access to proven preventives measures
 Teach functional and essential knowledge
 Shapes personal values and beliefs that support healthy behaviour.
 Shapes group norms that value a healthy lifestyle
 Develop, the essential health skills necessary to adopt, practice and maintain
health-enhancing behaviour
 Encourage ongoing learning and self-development
 Gather and analyze data to identify community’s needs
 Liase with internal and external partners to develop health programs
 Create and distribute health education materials and aids like pamphlets, posters,
notices, video clips, audio clips, images, posters, skits, voice notes and jingles
 Plan health promotion program activities
 Answer to health inquiries
 Provide health information and advice.

Kathryn Stolle 12 dimensions of wellness

12 Dimensions of wellness: this is the role wellness play in human lives in having a
better and healthy life style. Wellness for Change is the slogan of Kathryn's Stolle and
it’s about choosing wellness to change human life. Kathryn researched into how our
organization contributes towards a healthy community. Wellness is an integrated
system of 12 dimensions that make up our human needs. Living healthy is a daily
choice made throughout the day to move towards being well. The energy in it
transforms human then release this energy into the environment. Inappropriateness in
this transformation may results in "disease" These everyday choices is about being
mindful and not constantly living in the past or living the future. It is the integration
of mind/body/spirit. Wellness is not the absence of disease but it is about what we do,
how we do it, and how we interact in society.

45
Dr. John Tranvis (grandfather of the wellness movement) created the "wellness
continuum" which illustrates how you can move towards a high level of wellness even
if you are unwell. A physical disability does not prevent someone from creating a
spiritual and mental well-being that off-sets the physical challenges you may have.
The continuum includes:

1. Self-responsibility & Love;

2. Breathing;

3. Sensing;

4. Eating;

5. Moving;

6. Feeling;

7. Thinking;

8. Playing & Working;

9. Communicating;

10. Intimacy;

11. Finding Meaning;

12. Transcending.

These dimensions can be measured through an assessment tool that can be applied to
people to determine whether a person is content with what they are experiencing on
these factors and what they would like to change. Stress contributes to an unwell state
and causes a significant increase in risk to a person's health including infections, heart
disease, mental disorders, substance abuse and injury. Wellness improvements at the
workplace include the physical work environment; social-psycho work environment
and work-place/life balance. Working and playing are part of the same dimension and
when properly managed provides a healthy environment for employees.

46
Source

Kathryn Stolle 12 dimensions of wellness. She is a Certified Wellness Coach with

extensive experience in spas and wellness, is president of SLK Wellness Concepts, an
independent wellness resource for individuals, spas and organizations across North
America

References

47
Beierle, T. C. & Cayford, J. (2002). Democracy in practice: public participation in
environmental decisions. RFF press, Resources for the future, Washington.

Feindt, P. H. (2001). Guidance or public participation in relation to the water

framework directive. Active involvement, consultation and public access to
information.

Hare, M. & Kryinkon, J. (2005). Participatory processes for the design of water
storage area. Inception report of the Trust project (interreg 111b). Season Report
1/2005.

Pretty, J. N. (1995). Regenerating Agriculture policies and practice to sustainability

and self-reliance. Earthsian, London: National Academy Press Washington.

48