COMMUNITY HEALTH CARE DEVELOPMENT

Approaches to Development

1. Welfare Approach - assumes that poverty is

God-given and that poverty is destined.

- believes that poverty is caused by bad luck.

2. Modernization Approach

- when the community began to accept and utilize technology and industrialization

- assumes that development can be attained by abandoning the traditional methods/practices and adopt the technology of industrial countries.

- poverty is due to lack of education, resources and technology.

3. Transformatory/Participatory Approach

- focused on empowering the poor and oppressed sectors of society so that they can pursue a just and human society.

- poverty is not God-given: rather it is rooted in the historical past and is maintained by the oppressive structures in the society.

Health Resource Development Program (HRDP)

Program initiated by the Population center Foundation as its contribution to the development of alternative health care system in the Philippines.

Based on a belief that potential health manpower exists in the form of students, faculty, and hospital/clinic staff who can be mobilized to work with people to act on their own health problem.

A model for PHC

HRDP Goals and objectives:

- It seeks to develop health personnel at two levels:

A. NGO or Institution level – staff, faculty and students

B. Community level – community leaders and residents

Result: a more responsive health care system in the community

Objectives:1. Expansion of health services delivered by

privates institutions2. Capability building of institutions to increase

the involvement of partner communities3. To develop schemes for innovative services

and make it a part of the curriculum4. To support initial community efforts in

seeking ways to sustain health service delivery

5. To review and evaluate the efforts and institutionalize those that work

6. To develop the capability of partner communities toward self reliance in health

Community Organizing A promising tool for achieving the PHC goals

of self-reliance and self-determination A continuous and sustained process of

educating the people to understand and develop their critical awareness of their existing conditions, working with people collectively and efficiently on their immediate and long term problems, and mobilizing the people to develop the capability and readiness to respond and take action on their immediate needs toward solving their long-term problems

Objectives:

1. To make people aware of the social realities toward the development of local initiative and strengthening people's capabilities

2. To form structures that uphold the people’s basic interests

3. To initiate responsible actions to address the community health and social problems

Emphasis of CO in PHC:

1. Community working to solve its own problems

2. Direction is established internally rather than externally

3. Process of capability building is more important than output

4. Consciousness-raising is facilitated

Principles:

1. People especially the most oppressed, exploited and deprived sectors are open to change.

2. Based on the interest of the poorest sectors of society

3. Leads to a self-reliant community and society

Participatory Action Research (PAR) An investigation of the problems and issues

concerning the life and environment of the underprivileged in society by way of a research collaboration with the underprivileged, whose representatives participate in the actual research process as equal partners in studying their own problem.

Central Element:Participation – is an active process whereby

the expected beneficiaries of the research are the main actors in the research process

Objectives:

1. Encourages consciousness of their suffering and develop competence in changing their situation

2. Help in organization-building by harnessing both human and material resources in responding to community needs

3. Enhances the knowledge of the researchers and the community on the social reality before them

PAR Process:

I. Preparatory Phase A. Immersion with the community B. Stages: 1. Preliminary observation of study

areas

2. Selection of the research team/ group 3. Choice and definition of the theme 4. Training of the local researchersII. Operational Phase – data gatheringIII. Collective data synthesis and analysisIV. Dissemination and Research Utilization

COPAR (Community Organizing

Participatory Action Research)

Definition:

is a social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.

Is a collective, participatory, transformative, liberative, sustained and systematic process of building people’s organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effective change in their existing oppressive and exploitative conditions (1994 National Rural CO Conference)

A process by which a community identify its needs and objectives, develops confidence to take action in respect to them and in doing so, it extends and develops cooperative and collaborative attitudes and practices un the community.

A continuous and sustained process of sensitizing the people to understand and develop their critical awareness of their existing conditions, working with the people collectively and efficiently, concerning immediate and long term problems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs toward solving their long term problems

Processes/Methods Used in COPAR

1. Progressive Cycle of Action-Reflection-Action-Session.

Begins with small, local and concrete issues identified by the people, make an action about it and then they will have the evaluation and reflection of the action taken by them.

2. Consciousness Raising

an experimental learning where emphasis on the learning that emerges from concrete action and which enriches succeeding action

3. Participatory and Mass based

it is primarily directed towards and biased in favor of the poor, the powerless and the oppressed sector of the community.

4. Group-centered and not Leader-oriented

Leaders are identified, emerged and are tested through action rather than appointed or selected by some external force or entity.

Critical Steps (activities) in COPAR1. Integration- the health-care worker

becomes one with the people in order to: Immerse him/herself in the

community. Understand deeply the culture,

economy, leaders, history, rhythms, and lifestyle in the community.

Methods: participation in direct production activities of the people

house-house visits Participation in activities like birthdays, fiestas, wakes, etc.

conversing with the people where they usually gather such as in stores, water wells, washing streams, or in churchyards.

helping out in households chores like cooking, washing dishes, etc.

2. Social Investigation

A systematic process of collecting, analyzing, collating data to draw a clear picture of the community. Use of survey questionnaires is discouraged Secondary data should be thoroughly examined

because much of the information might already be available

Social investigation is facilitated if the health worker is properly integrated and has acquired the trust of the people

Confirmation and validation of community should be done regularly.

3. Tentative Program Planning CO should choose one issue to work on in

order to begin organizing the people.

4. Groundwork Going around and motivating the people on

a one on one basis to do something on the issue that has been chosen

- People collectively ratify what they have already decided individually. The meeting gives the people the collective power and confidence. Problems and issues are discussed.

5. The Meeting

6. Role Play Means acting out the meeting that will

take place between the leaders of the people and the government representatives. It is a way of training the people to anticipate what will happen and prepare them for such eventuality.

7. Mobilization Actual experience of the people in confronting the powerful and the actual exercise of people power.

8. Evaluation

The people reviewing the steps 1-7 so as to determine whether they were successfully or not in their objectives

9. Reflection

- Dealing with the deeper, on going concerns to look at the positive values CO is trying to build in the organization. It gives the people time to reflect on the stark reality of life compared to the ideal.

10. Organization

The people’s organization is the result of many successive and similar actions of the people. A final organizational structure is set up with elected officers and supporting members.

Community Health Worker

One who provides basic community health care services for promotion of health prevention of illness, simple treatment and rehabilitation.

Qualities/Traits of a health worker

Open Tactful Objective Good listener Good communicator Systematic knowledgeable

Efficient Flexible Critical thinker Keen observer Creative and

resourceful With sense of

humor

Functions of a Health Care Worker

A. Documenter/Reporter Records- refer to forms on which

information pertaining the client is noted Reports- refers to periodic summaries of

the services/activities of an organization/unit or the analysis of certain phases of its work.

Purposes of Records and Reports

1. Measure services/program directed to the clients

2. Provide basis for future planning.3. Interpret the work to the public and

other agencies, or community.4. Aid in studying the conditions of the

community.5. Contributes to client care.

B. Community Health Service Provider

Carries out health services Appraise health needs and concerns

of clients (existing or potential).

C. Facilitator◦ helps plan a comprehensive program with the people.

◦Provides continuing guidance and supervisory assistance.

D. Health Counselor - provides health counselling including

emotional support to individuals, family, group and community.

E. Health Educator◦ Information- provision of knowledge

◦ Education- change in knowledge, attitude and skills.

◦ Communication- exchange of information

Phases of the HRDP-COPAR process

I. Pre-entry PhaseII. Entry PhaseIII. Organization-Building and Capability Building PhaseIV. Sustenance and Strengthening Phase

Pre-Entry Phase

- the preparatory phase of the HRDP-COPAR process

- simplest phase in terms of actual outputs and strategies

- it takes only 1 to 2 months to complete- done usually at the institutional level- students participation is minimal

Site Selection

- entails the sequential implementation of sub-activities to ensure that the project sites will be responsive to whatever health and development interventions initiated

- important in determining the working relationship as well as the need for the project

Criteria in Site Selection

1. Depressed, poor community2. Inaccessibility or inadequacy of health

services3. Poor health status of the community4. With no serious peace and order

problem5. No strong resistance from the

community regarding the model utilized6. No similar agencies or programs

currently in the community

Preliminary Social Investigation

- initial gathering of data about potential sites, focusing on the data necessary to determine the site that best conforms with the criteria set

Social Investigation- a systematic and scientific process of collecting, collating, synthesizing and analyzing data to draw a clear picture of the community

Methods of Data Collection:

1. Use of secondary data from various government offices

2. Use of secondary data from other community-based health programs

3. Coordination with extension workers from both the government and non-government agencies

4. Conduct of ocular observations

Guidelines for Choosing the Final barangay

1. Conduct of ocular survey2. Conduct of informal interviews with key

persons and informants3. Assess whether our services are in fact

needed in the area4. Validate the secondary collected

* It is essential to inform concerned authorities so that project endorsement and support to the program can be secured

Identification of Host Family

- community work becomes more effective if we live in the area

- Ensures round-the-clock integration and experiencing the community

Criteria in Choosing Host Family

1. Should be strategically located in the barangay

2. Should belong to the majority of the group in the community (poor sector)

3. Should be respected by both the formal and informal leaders

4. Should have a house where neighbors, especially the poor are welcome

5. No member of the host family will be displaced

Entry Phase

- sometimes called the social preparation phase

- crucial in determining which strategies for organizing would suit best the community

- lays the foundation of the organizing work as well as determines the relationship of the people to the organizers

Guidelines for Entry in the Community

1. Recognize the role of the authorities2. Appearance, speech, behavior and

lifestyle should be in keeping with those of the community residents

3. Avoid passing expectations off the community residents

* There are five interrelated and simultaneous activities that can be carried out in the entry phase

Integration with the Community

Integration – the process of establishing rapport with the people in a continuing effort to imbibe community life by living with them and undergoing the same experience, sharing their hopes, aspirations and hardships towards building mutual trust and cooperation (Ferrer, 1982).

The success of activities in the latter parts of the organizing process greatly depend on how much the community organizer has integrated with the community.

Methods of Integration

a. Participation in direct production activitiesb. Participation in social activitiesc. Conversing with people where they usually

gatherd. Doing household chores

Identification of Potential Leaders or Core Group Formation

- a process of selecting and training the core group which is considered critical in community organizing

Potential leaders – considered the future CO’s and possible partners in the management and in the delivery of basic health services

Core Group – group of individuals who possess leadership potentials to be formed/ organized into a cohesive working group

Organization-Building Phase- begins when the community starts to

study their own problems- usually starts with the formation of

research team- phase where the community leaders

develop their full potential as leaders of the community

- characterized by the formation of working groups and the capability building activities provided by the team.

Research Team Formation

- the team who are charged with the conduct of Participatory Action Research

- the first working group that is formed in the formal organization that is being formed in the community

- initiated by the Core Group and when the community people starts verbalizing about the need to look deeper into the problems of the community

Sustenance and Strengthening Phase

Consolation and expansion Networking and establishing Implementation of livelihood projects Developing secondary leaders