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Community Health Management 1

Focus: facilitating community empowerment to act on community health
problems by using the community health process and the philosophy of
Community Health Nursing

Ultimate goal: to improve the quality of health of the citizenry

It is geared to help communities and families cope with health problems and
have them assent to health services
1. Establishing a good working relationship
Initial attempts to communicate the intention to help members of the
community and inform them of its nature are vital to the success
Vital step – development of a mutually trusting and egalitarian (open)
relationship
1.1Identifying key community officials
Community health manager must possess the ability to effectively influence
and negotiate with people from both ends of the social spectrum

the most important activities of the community health manager : Directly

influencing executive and legislative officials and governing agencies for
health and development are

First step in initiating a smooth relationship: to learn the correct full name
and designation of key community officials
BARANGAY OFFICIALS
___________________________________________
(Name of Barangay, City, Town, or Province)

NAME DESIGNATION ADDRESS/TEL. NO. COMMITTEE

1.2. Establish a good working relationship with the community

Using COPAR: the client assumes the role of partner in both health related
activities and health development
Frequent consultation with the client is required to arrive at a decision that is
desirable to both and advantageous to working with partners
Activities to help establish a good working relationship with
community officials
Initiating contact through home or offical visits to the ocmmunity leaders or
attending official meetings of community leaders
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Introducing yourself and your agency
Activities to help establish a good working relationship with
community officials
Communicating interest in the community’s welfare
Maintaining a 2-way communication with the community leaders
Expressing/showing willingness to help with the community’s expressed
needs
1.3. Conducting a community organization meeting
Attaining health for all requires expanding participation in health and health
related programs
major goal for community health management: Empowering community to
make decisions on its own health

Arcaina (1999) reiterates that meetings give people collective power and
confidence by discussing their problems and issues

Gathering people is one of the effective strategies especially if a decision

that needs the consensus of the body has to be made
People are also given a chance to work with one another and thus promotes
cohesiveness with proper motivation

With effective and regular meetings, the morale of the community residents
improves
By keeping them informed, providing guidance in decision-making,
persuading, motivating, they are led and trained on how to attain group
goals
Steps in organizing a community health action
Gain entry into the community and accomplish the following:
Gather information about the community form other members of the
RHU or from records and reports
Identify persons to contact for a courtesy call
Schedule and make your courtesy calls
Introduce yourself, your role, your functions and your initial plans
as a representative of the agency
Steps in organizing a community health action
Arrange first meeting with identified key community leaders.
Have barangay officials sign invitation for a meeting
Prepare an agenda for the first meeting
Integrate with the people in the community

2. Community assessment

The health status of the community is influenced by various interacting

elements such:
Population
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Physical and topographical characteristics
Socio-economic and cultural factors
Health and basic social services
Manpower structure in the community

The interrelationship of these elements will explain the health and illness
pattern of the community

2.1. Preparing a community spot map

Conduct a preliminary ocular survey
Draw a spot map of your assigned community
A community spot map with the aid of community residents can also be a
chance to acquaint yourself with the people and places in the
community
Old maps may be reviewed

2.2. Relating the history of the barangay

Barangay history may be legendary or in folklore or may also be official
Its history will give an insight on the nature of its people and their tendency
to act in certain ways

Sources:
Community residents, and officials
Pertinent write-ups about the baranagay

2.3. Constructing and consolidating community profile

Barangay Profile – a consolidation of important data gathered about the
barangay
It could be a basis for approximating the magnitude of the task at hand or
the problems being faced; like:
Resourses needed
Resources available
Projects and programs

2.4.Gathering community demographic data

Essential in administering and performing activities in every project
Accurate and timely information is necessary in all aspects of health
development, thus its availability should be ensured through the
identification, collection processing and analysis of necessary data to
allow evaluation of the various aspects of community health situation

Gathering community demographic data (Continuation)

Accurate and timely information is necessary in all aspects of health
development, thus its availability should be ensured through the
identification, collection processing and analysis of necessary data to
allow evaluation of the various aspects of community health situation
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Assessnment of the human, material and other resources of the community
will greatly help to come up with a rational and systematic health
program responsive to the community needs
Demography (Encyclopedia Britanicca) – statistical study of human
population specifically with reference to size, destiny and distribution

Demographic features
Population
Population density
Power supply
Communication services
Land use

Physical infrastructure
roadworks
Transportation
Water supply

Social features
Health status
Vital statistics
Health facilities and services
Toilet facilities
Garbage collection and disposal
reduction

2.5. Presenting Vital Statistics and Epidemiology Data

Community vital statistics or biostatistics:
Data on age and sex distribution
Growth rate
Birth and death rates
A brief explanation of figures trough legends should be included
A simple graph may eloquently describe causes and effects of
community health problems

2.6. identifying community health problems

Types:
Health status problems such as increased morbidity, mortality or
fertility
Health resource problems suchas lack or absence of manpower,
money, or materials/institutions necessary to solve the existing
health problems
2.6. identifying community health problem (continuation)
Health related problems such as the presence of social, economic,
environmental or potential factors that aggravate illness, which
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may cause a potential health situation in the community
Barangay: __________________________________________

Health status problems

1.
2.
3.
4.
Health resources problems
1.
2.
3.
4.
Health related problems
1.
2.
3.
4.

2.7. analyzing problems and determining resources needed

Community, and health manager must analyze why the health problem
exists while also recognizing resources available in the community that
would help address the said problems
Example
problem: increased cases of malnutrition
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3. Community health care planning

Planning is: (Mercado, 1993)
futuristics
change-oriented
Continuous and dynamic process
Flexible
Systematic process
3.1.identifying priority health problems
Compute for the score for each problem and list them according to priority
Identify possible/available resources to solve these problems
Guide for prioritizing problems
Community problem _________________________________________________________

HIGHEST
CRITERIA SCORE POSSIBLE WEIGHT ACTUAL SCORE
SCORE

NATURE OF THE PROBLEM 3

• Health status 2
3 1
• Health resources 1

• Health related

MAGNITUDE OF THE 4 4 3
PROBLEM
3
• 75-100% affected
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• 50-74% affected 2

• 25-49% affected 1

• Less than 25%

affected

MODIFIABILITY OF THE 3
PROBLEM
2
• High
1
3 4
• Moderate
0
• Low

• Nonmodifiable

PREVENTIVE POTENTIAL 3

• High 2
3 1
• Moderate 1

• Low

SOCIAL CONCERN 2

• Urgent community 1
concern
0
• Recognized problem 2 1
but does not need
urgent attention

• Not a community
concern

Final score

Actual score = score/(highest possible score x weight)

3.2. list of community problems according to priority

Arrange the list of community problems according to priority
The one with the highest score will have the topmost rank
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List of community problems according to priority

Proble Problems Scores

m
No.
1
2
3
4
5
6
7
8
9
10

3.3. preparing a community health action plan

Formulate a community health action plan for the top 5 priority community
problems together with a community health action group
Action plan
Problems Solutions projects Goals/ Responsible
objectives persons/
signatures

1.

2.

3.

4.

5.

Example: Action plan

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Responsible
Goals/
Problems Solutions projects persons/
objectives
signatures

1.Malnutriti Additional food supply Feeding program Reduce the

on among number of 2nd
0 to 6 y/o Educate mothers on Mother classes degree
children proper feeding malnourished
children ages
Monitor weight Operation timbang 0 to 6 years
old within 3
months

3.4. working out details of the plan together with the community
action group
PROJECT PLAN

Project : _______________________________________

ACTIVITIES RESOURCES TIME ALLOTED PERSON/S RESPONSIBLE

NEEDED

1.

2.

3.

4.

5.

6.

7.

Example: project plan

PROJECT PLAN
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Project :feeding program

ACTIVITIES RESOURCES TIME ALLOTED PERSON/S

NEEDED RESPONSIBLE

1.Meeting with Result of OPT venue 1 day

mothers of
malnourished children

2.decide/implement 1 week
fund raising activity

3.Acquisition of food 1 day

supplements /
supplies

4.Enroll priority List of supplies 1 day

children in feeding needed, fare
programs

5.Schedule mothers 1 day

in food preparations/
feeding activities

6.Make schedule of Logbook, pen 1 day

feeding and weighing
activities

7.Feeding proper Cooking/feeding Daily for 3 months

venue, cooking
utensils, stove,
eating utensils,
soap, water

4. Community health care implementation

All strategies in building people’s organization should be considered

Community should be active participant in all the activities that will be
implemented
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Implementation phase: refers to the actual implementation of the plan, the
mobilizaiton of resources to meet objectives, and the active participation
of the people
To meet the objectives, the following activities should be employed:
Home visits
Schedule a conference or a demonstration
Deliver basic health care services
Disseminate information or health education
Mobilize all indigenous resources
4.1. health education and training/information communication
campaign
Facilitating a class discussion
Rules to enable the group to learn quickly:
Have a very clear idea concerning the topic to be discussed and the
activities that the group will take part in before the session begins
Supervise the discussion

Direct the discussion

Provide feedback
Be diplomatic and tactful
Encourage group spirit
Effective educator
One must answer the ff questions
Can they clearly hear and understand what you are saying and red what you
are writing?
Do you use simple language?
Do you use visual aids?
Do to summarize the main points?
Methods of teaching skills
Describing a skill or task analysis
Demonstrating a skill
Practicing
Role playing
Project completion
Simulation
Case study
Job experience
Methods of teaching knowledge:
Teach only the facts that the clients need to know
Carefully plan activities for the clients where they can apply what they
have just learned. Do not limit yourself to lectures
Encourage them to learn more from their own experiences, from books,
from role models and from each other
Use visual aids and handouts
Methods of teaching attitudes
Attitude is the tendency to behave in a certain way.
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Attitudes are not easily developed
Attitudes are shaped by:
Providing relevant background information
Providing models or examples
Providing experience
Encouraging discussion among cleints
Role playing activities
Teaching plan
Topic: ________________________________

Teaching Attracting client

activities evaluation
objectives interests

4.2. Intra/inter agency coordination

Health activities undertaken outside the health sector have impact on health
that is possibly greater than those undertaken within it.
All health efforts should be unified within the heath organization itself, as
well ass all other sectors concerned
Other sectors closely related to health:
Agriculture
Education
Public works
Local government
Social welfare
Private sector

Make a directory of key government and nongovernment agencies in the

community, including:
Heads
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Services
Possible resources
4.3. community mobilization
Successful implementation of a community health care programs can be
ensured b using Participatory Action Research
Relies on effective facilitation when working with people
Effective facilitation ensures that the groups achieve their aims
and reach their goals
COPAR:
Uses a progressive cycle of ACTION-REFLECTION-ACTION
Raises consciousness through experimental learning
Is participatory and biased towards the masses
Is group-centered and not leader-oriented
Critical activities in building people’s organization:
Integration or living with the people
Tentative program planning
Ground-working
Meetings
Role play
Social investigation
Mobilization or action
Continuation: Critical activities in building people’s organization:
Evaluation
Reflection
Organization

4.4. Rural Health Programs

Provision of basic health services through participation in the RHU programs
is a major responsibility of the Community Health Manager

Nursing students are expected to help in the improvement of health service

delivery system especially in rural areas while delivering new insights
from experiences of working with the people in the community
community health care evaluation
Program/ Project Evaluation
Output – refers to the products or services which an activity is expected to
produce
Example: number of children weighed
Effect – refers to the outcome of the utilized project outputs
Example: number of malnourished children
Impact – refers to the outcome of the program/project effects

Impact evaluation – assess the impact of care administered of the impact of

implemented project/program on the client by comparing the conditions
of the quality of life
Examples: mortality or death rates, average life expectancy
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Cost effectiveness analysis – can be done to compare alternative

projects/care intervention in terms of the cost of producing a given
output