Community Health Nursing Practice Utilizing COPAR
Dr. Alberto Romualdez, former DOH secretary described the Philippine health status as “ on continuing shift towards positive change despite age-old problems..” Some infectious degenerative diseases are on the rise Correlation of poor health with low socio-economic status is well documented Filipinos are still living in the remote areas, where it is difficult to deliver the health services they need Scarcity and exodus of MD’s, RN’s and RM’s add to the poor delivery of the health care to the poor and deprived who comprise the majority of the country’s 80 million or so total population
INDICATORS MALE FEMALE BOTH SEXESPopulation 41, 612, 133 41, 015,428 82, 663,561Life Expectancy 72.78 years 67.53 yearsCrude Birth Rate 24.63Per 1000populationCrude Death Rate 5.66; 4.8 in 1998per 1000populationInfant Mortality 29 per 1000 liveRate birthsMaternal 138 per 1000 liveMortality Rate birthsTotal Fertility Rate 3.5
Cause Number Rate Percent TOTAL 1,732 1.0 100.01. Complicationsrelated to pregnancyoccurring in the course 819 0.5 47.3of labor, deliveryand puerperium2. Hypertensioncomplicatingpregnancy, 510 0.3 29.4childbirth andpuerperium3. Postpartum 263 0.2 15.2hemorrhage4. Pregnancy with 138 0.1 8.0abortive outcome5. Hemorrhage in 2 0.0 0.1early pregnancy
Cause Number Rate Percent1. Bacterial sepsis of newborn 3,161 1.9 14.62. Respiratory distress of newborn 2,298 1.4 10.63. Pneumonia 2,013 1.2 9.34. Disorders related to short gestation and low birth weight, not elsewhere 1,610 1.0 7.4classified5. Congenital Pneumonia 1,510 0.9 7.06. Congenital malformation of the heart 1,444 0.9 6.77. Neonatal aspiration syndrome 1,146 0.7 5.38. Other congenital malformation 1,012 0.6 4.79. Intrauterine hypoxia and birth 971 0.6 4.5asphyxia10.Diarrhea and gastro-enterities of 900 0.5 4.2presumed infectious origin Infant Mortality: Ten (10) Leading Causes Number & Rate/1000 Live births & Percentage Distribution Philippines, 2005
5 Year Average 2005* Cause (2000-2004) Number Rate No. Rate1. Diseases of the Heart 66,412 83.3 77,060 90.42. Diseases of the Vascular 50,886 63.9 54,372 63.8system3. Malignant Neoplasm 38,578 48.4 41,697 48.94. Pneumonia 32,989 41.4 36,510 42.85. Accidents 33,455 42.0 33,327 39.16. Tuberculosis, all forms 27,211 34.2 26,588 31.27. Chronic lower respiratory 18,015 22.6 20,951 24.6diseases8.Diabetes Mellitus 13,584 17.0 18,441 21.69. Certain conditionsoriginating in the perinatal 14,477 18.2 12,368 14.5period10. Nephritis, nephrotic 9.166 11.5 11,056 3.6syndrome and nephrosis
Cause No. Rate1. Diseases of the Heart 43,809 102.12. Diseases of the Vascular system 30,531 71.23. Accidents 27,281 63.64. Malignant Neoplasms 21,993 51.35. Tuberculosis, all forms 18,229 42.56. Pneumonia 18,145 42.37. Chronic lower respiratory diseases 14,450 33.78. Diabetes Mellitus 8,912 20.89. Certain conditions originating in the 7,385 17.2perinatal period10. Nephritis, nephrotic syndrome and 6,548 15.3nephrosis
Cause No. Rate1. Diseases of the Heart 33,251 78.52. Diseases of the Vascular system 23,841 56.33. Malignant Neoplasms 19,704 46.54. Pneumonia 18,365 43.35. Diabetes Mellitus 9,529 22.56. Tuberculosis, All Forms 8,359 19.77. Chronic lower respiratory diseases 6,501 15.38. Accidents 6,046 14.39. Certain conditions originating in the 4,983 11.8perinatal period10. Nephritis, nephrotic syndrome and 4,508 10.6nephrosis
Based on these statistics what are the challenges that nurses, doctors or midwives and other health agencies face in relation to health profile and growth rate of the Philippine population? What preventive measures can be done? What can be done to promote and restore health? What health education can be administered by the community health workers, doctors, nurses, midwives, etc.? How can we improve the health care deliver system? How can increase the number of health workers? What can be done for people in the far flung areas to prevent the occurrence of diseases and health hazards?
Was developed and sponsored by the Philippine Center for Population and Development (PCPD) To make health services available and accessible to depressed and underserved communities in the Philippines PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutions and agencies through programs and projects geared toward the social human development of rural and urban communities Formerly known as The Population Center Foundation
HRDP I Trained the faculty, medical/nursing students to provide health care services to the far flung barrios because of lack of man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health The PCPD provides seed money for the income generating projects The CO uses his/her own strategy or method in developing the community Short-term service
HRDP II The 2nd cycle uses the same strategy but the program could not be sustained by the schools or hospitals and the income-generating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects Both HRDP I and HRDP II have brought about some changes in the community life of the people Established basic health infrastructure; basic health services were increased; there were trained workers and organized health groups to take care of the needs of the community
HRDP III PCPD refined the program and resulted to what is now called HRDP III, which has these unique features: Comprehensive training of the staff and faculty of the participating agency in which the community work was initiated Periodic training program and regular assistance to the participating agency were provided to strengthen the health outreach program to become community oriented PHC as the approach with which all nursing/medical students, their CI’s and indigenous health workers are trained for community health work and around which all other project inputs will revolve
Community organizing as the main strategy to be employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the community health programs Organizing work in the communities were done in 3 phases PAR as fascinating strategy for maximum community involvement through collective identification and analysis of community health problems and collective health action Available funds to finance community initiated projects
Since Management Leadership and Jurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts as leaders of the different levels of the students who were involved in COPAR Principles of management were applied in carrying out primary health care The community members, CHW’s and leaders were empowered to manage their own health projects Conducted seminars and trainings as well as health education and services needed by community(exposure and immersion 6-8 weeks)
A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.
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 effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference)
A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967)
A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term problems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual of experience, PCPD)
1. COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities. 2. COPAR prepares people/clients to eventually take over the management of a development programs in the future. 3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.
People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change. COPAR should be based on the interest of the poorest sectors of society COPAR should lead to a self-reliant community and society.
A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them. Consciousness- raising through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed. COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity.
Pre- entry Phase is the initial phase of organizing process where the community/organizer looks for communities to serve/help It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it Activities include Community consultations/dialogues Setting of issues/ considerations related to site selection Development of criteria for site selection Site selection Preliminary social investigation (PSI) Networking with LGU’s, NGO’s and other departments
Entry Phase Social preparation phase Activities done here includes: Integration with the community Sensitization of the community; information campaigns Continuing social investigation Core group formation: Development of criteria for the selection of CG members Defining the roles/functions/tasks of the CG Coordination /dialogue/consultation with other community organizations Self-awareness and Leadership training (SALT), action, planning This phase signals the actual entry of the community worker/organizer into the community
Community Study/Diagnosis Phase (Research Phase) Selection of the research team Training on the data collection methods and techniques; capability-building (includes development of data collection tools) Planning for the actual gathering of the data Data gathering Training on data validation (includes tabulation and preliminary analysis of data) Community validation Presentation of the community study/diagnosis/recommendations Prioritization of community needs/problems for action
Community meetings to draw up guidelines for the organizations of the CHO Election of officers Development of management systems and procedures, including delineation of the roles, functions and task of officers and members of the CHO Team building/Action-Reflect Action (ARA) Working out legal requirements for the establishment of the CHO Organization of the working committees and task groups(e.g. education and training, membership of committees) Training of the CHO officers/community leaders
Community Action Phase Organization and training of the community health workers (CHW’s) Development of criteria for the selection of CHW’s Selection of CHW’s Training of CHW’s Setting up of linkages/network referral systems Initial identification and implementation of resource mobilization schemes
Sustenance and strengthening phase Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings Strategies used may include: Education and training Networking and linkages Conduct of mobilization on health and development concerns Implementation of livelihood projects Developing secondary leaders
A CO becoming a par with the people in order to: Immerse himself in the poor community Understand deeply the culture, leaders, history, rhythms and lifestyle in the community Methods of Integration includes: Participation in direct production activities of the people Conduct of house visits Participation in activities like birthdays, fiestas, wakes, etc Conversing with people where they usually gather such as stores, water, walls, washing streams, or churchyards Helping out in the household chores like cooking, washing the dishes, etc
A systematic process of collecting, collating, analyzing data to draw a clear picture of the community Also known as the COMMUNITY STUDY Pointers for the conduct of SOCIAL INVESTIGATION Use of survey or questionnaires is discouraged Community leaders can be trained to initially assist the community worker/organizer in SI Data can be more effectively and efficiently collected through informal methods-house visits, participating in conversations in jeepneys and others Secondary data should be thoroughly examined because much of the information might already be available SI is facilitated if the CO/ community worker is properly integrated and has acquired the trust of the people Confirmation and validation of community data should be done regularly
CO choose one issue to work in order to begin organizing the people
Going around and motivating the people on an one on one basis to do something on the issue that has been chosen
People collectively ratifying what they have already decided individually The meeting gives the people the collective power and confidence Problems and issues are discussed
Means to act out the meeting that will take place between the leaders of the people and government representatives It is a way of training the people to participate what will happen and prepare themselves for such eventually
Actual experience of the people in confronting the powerful and the actual exercise of the people power
The people reviewing the steps 1-7 so to determine whether they were successful or not in their objectives
Dealing with 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
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