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Community and environmnetal hygiene

The document provides information on primary health care (PHC), including its definition, important terms, historical development, principles, components, approaches, characteristics, essential elements, obstacles to implementation, and the nursing process as applied to community health. Some key points: - PHC is based on practical, scientifically sound methods that are universally accessible and affordable. - Its goal is to provide the highest level of health for all people. - Principles include equity, intersectoral collaboration, community involvement, and decentralization. - Approaches include selective PHC focusing on a few diseases and comprehensive PHC addressing all health elements. - The nursing process—assessment, diagnosis, planning, implementation, and

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Ahmad Guelleh BScN
PRIMARY HEALTH CARE (PHC) PHC is an essential health care based on practical, scientifically sound and socially acceptable methods and technologically made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self confidence and self development.
Important terms in the definition Primary: First in order of its importance Essential: basic and necessary and vital. Practical: Applicable or Appropriate Scientifically sound: The strategy we use in implementing PHC should be scientifically explainable and understood.
Socially acceptable methods: Should be accepted by the local community. Universally accessible: To bring health care as close as possible to where people live and work  Mawel1233A  Berberashop2017
Historical Development of PHC The World Health organisation (WHO), which was established in 1948, has always had as a major objective the achievement or ability by all people of the highest possible level of health." WHO definition”
However due to political and socio-economic factors the various health care approaches implemented in different countries between 1948 and 1978 did not enable WHO to meet the stated objective.
 Thus -the magnitude of health problems and inadequate distribution of health resources called for a new approach and the concept of PHC was born.
 In 1977 the WHO set a goal of providing "Health for All by the year 2000" which aims at achieving a level of health that enables every citizen of the world to lead a socially and economically productive life.
 The strategy to meet this goal was later defined in the 1978 WHO/UNICEF joint meeting at Alma-Ata USSR. In this meeting it was declared that the primary health care strategy (PHC) is the key to meet the goal of "health for all by the year 2000".
Principles of primary health care Equity Intersectoral collaboration Community involvement Appropriate technology Emphasis to promotion and prevention Decentralization
I. Equity Providing equal health care to all groups of people according to their needs giving highest priority to those with greatest health needs Services should be physically, socially, and financially accessible to everyone
II. Intersectoral collaboration  It means a joint concern and responsibility of sectors (Organizations)  It is important to:-  Save resources (effective use of resources)  Identify community needs together  It can be promoted through  Forming bodies from relevant agencies and elders at different levels, starting from the community
III. Community involvement The communities should be actively involved in: The assessment of the situation Definition of the problems Setting of priorities
Planning, Implementation Monitoring Evaluation Management of development programs
Advantages of community involvement Extended service (coverage) Programs are affordable and acceptable Promote self-reliance and confidence Success has a multiplying effect Create sense of responsibility
Consideration of real needs Promote local community’s initiatives and technologies Reduce dependency on technical personnel Builds the community’s capacity to deal with problems. Helps to choose correct strategy
IV. Appropriate Technology Methods- procedures - techniques, equipments are Scientifically valid Adapted to local needs Acceptable by the professional Acceptable by the community
Criteria of Appropriateness Effective Culturally acceptable and valuable Affordable Sustainable Locally Evolutionary capacity
Environmentally Accountable Measurable Politically Responsible
V. Emphasis on health promotion and prevention  Promotive: addresses basic causes of ill health at the level of society.  Preventive: reduces the incidence of disease by addressing the immediate and underlying causes at the individual level.
 Curative: reduces the prevalence of disease by stopping the progression of disease.  Rehabilitative: reduces the long-term effects or complications of a health problem.
VI. Decentralization Bringing decision making away from the national or central level closer to the local communities served and to field level providers of services.
The components of PHC at alma-ata declaration Health education Promotion of food supply and proper nutrition adequate supply of safe water and basic sanitation Maternal and child health care, including family planning
Immunization Prevention and control of locally endemic diseases treatment of common diseases and injuries Provision of essential drugs
Components added after Alma Ata Declaration  Mental health  Dental health (oral health)  Control of ARI (Acute respiratory tract infections)  Control of HIV/AIDS and other STDS  Occupational health  The use of traditional medicine
Approaches to PHC The two main approaches are:- Selective PHC (sPHC) Comprehensive PHC (cPHC)
Selective PHC (sPHC) It is the low cost strategy to treat and prevent few selected diseases which have great impact to mortality
Advantage of sPHC approach  Easy to plan and implement  Decision making is easier  Results are achieved faster  It gives more satisfaction  Requires limited resources
Disadvantages of sPHC Limited scope of activities The approach is disease oriented. The approach doesn't address the general health problems of the community
It doesn't address priorities of the community Top to down decision making It doesn't recognize contribution and co-operation by other sectors
Comprehensive PHC (cPHC) It defines Health in its holistic sense, in its complete form.
Advantage of the cPHC approach It looks at health holistically Development oriented It promotes equity It advocates multi- sectoral collaborations It deals with priorities of the community Covers all elements of PHC
Disadvantages of the cPHC approach It is expensive initially to set up an infrastructure Requires conscious planning Results are gradual It is a long process It is a complex process
Characteristics of primary health care from Alma Ata declaration  Evolves from the economic conditions and sociocultural and political characteristics of a country and its communities  Is based on the application of social, biomedical, and health services research and public health experience  Involves all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, and industry
 Requires maximum community and individual self- reliance and participation in the planning, organization, operation, and control of services  Develops the ability of communities to participate through education
 Should be sustained by integrated, functional, and mutually supportive referral systems, leading to better comprehensive health care for all, giving priority to those most in need  Relies on health workers, including physicians, nurses, midwives, auxiliaries, and community workers as well as traditional practitioners, trained to work as a team and respond to community’s expressed health needs
Essential components of effective primary health care o Well trained, multidisciplinary workforce o Properly equipped and maintained premises or buildings o Appropriate technology, including essential drugs o Capacity to offer comprehensive preventive and curative services at community level
o Sound management and governance systems o Sustainable funding streams aiming at universal coverage o Functional information management and technology o Community participation in the planning and evaluation of services provided
o Collaboration across different sectors—for example, education, agriculture o Continuity of care o Equitable or fair distribution of resources
Obstacles to implementation of PHC strategies  Misconception of PHC  Selective PHC strategy  Resistance to change  Lack of political
 Centralized planning and management Of infrastructure  Inequitable and insufficient recourse allocation  Poor organization of health services and ineffective referral system  Inequitable distribution of health professionals
o Unsatisfactory working conditions of health workers: low salaries, poor living conditions and inadequate career structures. o Inappropriate use of medical technology o Limited intersectoral cooperation for health development o Weakness of health information systems to measure performance and make decisions
THE NURSING PROCESS IN COMMUNITY HEALTH NURSING  A community usually is defined by boundaries which may be geographic, such as those defined as city, state or nation.  The nursing process is a systematic, purposeful act of nursing actions that includes assessment, diagnoses, planning, implementation and evaluation.  Nursing process can be applied to community as it is applied to individual patients.
Establish Rapport: Nurse - client interaction (rapport) is often an implied or indirect element in the process. Rapport is called the act of respectful informality that helps build client trust in the nurse.
Important elements in establishing rapport: Respect fullness  Courtesy or politeness  Objectivity  Caring and warmth  Concern for client's welfare  Interest and attention
Nursing Assessment The first step in the nursing process is assessment which involves collection of data.
Sources of data 1. Primary data is the data that are directly obtained from clients. It offers the most accurate insights and comprehensive information. 2. Secondary sources of data are data obtained from people who know the client: family, friends, neighbors, and workmates pending clients' permission.
Additional secondary sources include:- o Clients' records o Community health statistics o Census bureau data o Research report o Police o Insurance records However, secondary data may need augmentation or further validation.
Data collection Techniques  Observation  Interviewing  Listening  Measuring  Survey study  Record review
Nursing Diagnosis It is a statement describing client's healthy and unhealthy responses that can be influenced or changed by nursing intervention. A nursing diagnosis is often called a problem statement when writing nursing diagnosis for wellness response or deficit response.
Planning  The purpose of the planning phase is to determine how to satisfy clients' needs. Planning is a logical, decision making, designing an orderly, detailed program of action to accomplish specific goals and objectives.
Planning involves:  Establishing priority  Establishing goals and objectives  Identifying intervention activities that will accomplish objectives
Criteria for priority: Severity  Feasibility  Magnitude  Community concern  Political concern
Establishing goals and objective:  Specific  Measurable  Achievable  Reliable  Time targeted
Implementation Implementation is putting the plan into action. Implementation is often referred to as the action phase of the nursing process. In community health nursing implementation is not nursing action or intervention but it is a collaborative implementation by the clients.
The nurse and clients should have a clear idea of who, what, why, when, where and how. Example: What are each person's responsibilities? Do they know when and where activities will occur?
Evaluation It is the final component of the nursing process. The nursing process is not complete until evaluation takes place. Evaluation is an act of appraisal in which one judges value in relation to a standard and a set of criteria.
 Ask how effective the service was?  Whether client's needs truly met?  If not, why not?
Community Assessment Community assessment is a key element in the nursing process. When the community is thought of as the client, the goal is to identify groups of people who are at increased risk for health problems.
The community assessment process 1. Define the community that is the focus of the assessment process. 2. Describe the people socio- demographic elements that help describe the population of the community, e.g. Sex  Age Income Education, etc.
3. Describe the structures that organize the community: Family structures Voluntary structures Informal power structures 4. Identify health risk factors
5. Risk factors in the community can be made using vital statistics, clinic records, and reports of communicable diseases. 6. Identify resources for dealing with risk factors, Resources include the health department, NGOs, social organizations, and other voluntary agencies.
Community Nursing Diagnosis The community nursing diagnosis has a different starting point. It uses the list of health risk factors and converts them to a nursing diagnosis.
Some of the community nursing diagnosis include:- High rate of infants with low birth weights and related factors Low levels of participation in prenatal clinics, etc. High teenage pregnancy rates related to poor sex education programs in the community.
Poor prenatal nutrition related to cultural practices High school dropout among school girls related to unplanned pregnancy Poor nutritional status of under five children Knowledge deficits regarding weaning diet.
Planning Planning involves thinking on what will be done to prevent and manage the health problems. In all phases of Community activities we should involve community.
 The process includes a survey of the resources identified in the assessment phase, a discussion of the actual availability of the resources and a plan to gain access to them.
Implementation: - Implementation is put the planning into action, monitoring the activities.
Evaluation Evaluation is the process by which the impact of the program is assessed.  Process evaluation: The way in which the various processes of a program are carried and evaluated by comparing with a predetermined standard.  Outcome evaluation - This is concerned with the end results.
There are many benefits to conducting a community assessment. The following are ways an assessment can benefit your community; you can work with other organizations in your community to identify additional benefits. There is increased understanding within the community about its needs, why they exist, and why it is important for the needs to be addressed. Community members have the opportunity to share how the needs impact the quality of life for the larger community.
Community appointment is increased because members from different parts of the community are included in discussions about needs, assets, and the community’s response. The community’s strengths and weaknesses are identified. There is a record of the resources currently available within the community that can be leveraged to improve the quality of life for community members.
Communities identify the asset gaps that exist in their communities. Community members have an increased awareness of how they can contribute to their community’s assets. Community organizations can use the information about community needs to assess their service delivery priorities.
There is data for making decisions about the actions that can be taken to address community needs and how to use the available assets. Data can be used to inform strategic planning, priority setting, program outcomes, and program improvements.
There are six steps to conducting a community assessment. The six recommended steps in the process of planning and conducting a community assessment are: 1. Step 1: Define the Scope 2. Step 2: Go Solo or Collaborate 3. Step 3: Collect Data 4. Step 4: Determine Key Findings 5. Step 5: Set Priorities and Create an Action Plan 6. Step 6: Share your Findings
Needs and Assets Before you can begin the six steps of conducting a community assessment, it is important to understand the terms "community needs" and "community assets. “The Work Group for Community Health and Development defines community needs as "the gap between what a situation is and what it should be."
They define community assets as "those things that can be used to improve quality of life." Understanding these terms will help you get started on your quest to assess what your community needs and what its assets are.
Community needs are the gaps between what a situation is and what it should be. One goal of a community assessment is to develop an informed understanding of the gaps or needs that exist within a community and their impacts upon the community’s members. Low high school graduation rates mean that there is need to find effective ways to keep kids in school.
Community needs can affect a large or small number of a community’s members. This may include families, individuals, youth, seniors, parents, businesses, community organizations, and faith-based organizations – essentially, anyone who claims membership in the community. .
If community needs affect a large number of community members, there will likely be more support for addressing the needs. Sometimes community needs are referred to as “community problems.”
Community assets are those things that can be used to improve quality of life. Another goal of a community assessment is to develop a detailed analysis of community assets, or resources, that currently exist in the community and can be used to help meet community needs.
Community assets include organizations, people, partnerships, facilities, funding, policies, regulations, and a community’s collective experience. Any positive aspect of the community is an asset that can be leveraged to develop effective solutions.
Two approaches can be used to identify community assets: 1. Identify the assets that are already known for supporting the community need. This includes community organizations and individuals that currently provide services to community members or have provided financial support to address the need. Organizations that provide after-school programs to help youth graduate on time would be included in a community assessment focused on keeping kids in school.
Clinics that offer free medical services to low-income seniors should be identified in a community assessment of seniors who need medical financial assistance.
2. Build upon the experiences of other communities to highlight resources that may be available. The community assessment can identify communities with similar demographics that have successfully addressed similar needs and can be used as a blueprint (first planning) for identifying assets.