Introduction to Community Health Practice

LECTURE SLIDE ON:
INTRODUCTION TO COMMUNITY
HEALTH PRACTICE
COURSE CODE: CHS 209
COURSE LECTURE: DR. DOTIMI DORIS
DEPART: COMMUNITY HEALTH

COURSE OUTLINE
 1) Community Health practice in Nigeria
 2) Community Health strategies used in the delivery of
primary health care services to community members.
 3) Types of health services delivered in the community
health practice in Nigeria
 4) Community Health Practice and the goal of health
for All in Nigeria
 5) History of community health practice in Nigeria

COURSE OUTLINE…2
 6) Why community health practice
 7) Community Health Practitioners Registration Board of
Nigeria (CHPRBN)
 8) The Legal Framework of community health practice in
Nigeria
 9) Functions of the Board
 10) Cadres of community health practitioners
 11) collective duties of various cadres of community health
practitioners

COMMUNITY HEALTH PRACTICE IN
NIGERIA
 Community health practice is a medical practice that has to do with the
provision of quality and efficient health care services to the people in a
particular geographical location where they live and work, using practical
approaches, scientifically sound, economically affordable and sustainable,
socially acceptable methods and technology by trained health professionals in
partnership with the community members who have seen the health care
services provided to them as their own responsibility to utilize, maintain and
sustain for the benefit of their own health and survival in other to lead
economically and socially productive lives.
 The health care services provided to the community by community health
practitioners ranges from promotive, preventive, curative and rehabilitative
health care services, which must be affordable, always available, accessible
and locally acceptable with respect to their culture and the local context.

COMMUNITY HEALTH PRACTICE IN NIG
CONT…………2
 There are some important points to be noted from the above definition of community
health. They are:
 - It is a branch of medicine
 - It deals with how the health of persons living together within a geographical area can be
studied to find out their health and health related needs within the community.
 - It deals with how their health can be improved.
 It deals with community involvement and participation in the planning and provision of
solutions to their identified health problems
 It deals with availability, affordability, acceptability and accessibility of health services

CONT….3
 Community health practice in Nigeria is mainly made up of the junior and senior community
health workers JCHEWs and CHEWs including The Community Health Officers ( CHOs) using
the rural communities as the hub of the practice.
 In Nigerian health system, the community health practitioners are the front line health
workers in the delivery of primary health care services to the sub hub communities across
the country.
 Where there are no doctors to render health care services due to unavailability of social
amenities, the community health practitioners are sent to such places to render promotive
health care services, preventive healthcare services, curative and rehabilitative health care
services using collaborated resources from Partners, NGOs, government and the
community through individual donations resulting from advocacy visits paid to opinion
leaders and other stakeholders in and outside the community.

CONT…4
 In Nigerian health system, the community health practitioners are the front
line health workers in the delivery of primary health care services to the sub
hub communities across the country.
 Where there are no doctors to render health care services due to
unavailability of social amenities, the community health practitioners are sent
to such places to render promotive health care services, preventive
healthcare services, curative and rehabilitative health care services using
collaborated resources from Partners, NGOs, government and the
community through individual donations resulting from advocacy visits paid
to opinion leaders and other stakeholders in and outside the community.

COMMUNITY HEALTH STRATEGIES/TOOLS FOR
THE DELIVERY OF PRIMARY HEALTH CARE
SERVICES TO COMMUNITY MEMBERS
 1) Community Diagnosis
 One of the key features or strategies of the community health practice is
community diagnosis which entails assessing the problems. According to
Abosade (2003)
 “to provide necessary health services for a community, health personnel must
be able to identify health problems and determine their priority.”
 Ibet-Iragunima (2006) defined community diagnosis “as an organized process
involving identified needs, resources, wants, constraints, problem, diseases
pattern, physical, social, cultural and demographic.”From the above you can
see that as a community health practitioner you must not only be able to
undertake community diagnosis, but must also regularly undertake it in order
to know the health needs, available resources and how to prevent prevailing
disease. The methods used in carrying out community diagnosis include the
following:
 - Observation (Ethnographic Survey)
 - Conducting interview
 - Review of existing data- Questionnaire

COMMUNITY HEALTH PRACTICE
STRATEGIES CONT….2
 2) Community Mobilization
 Another distinct feature of community health practice is community mobilization.
According to Ibet-Iragunimia (2006) community mobilization is a means of
encouraging, inspiring and arousing the interest of people to make them become
actively involved in finding solutions to their own health problems.
 Also, community mobilization can be said to be the process by which resources in a
given community are identified, pulled together and energized toward solving the
challenges within the community.

COMMUNITY HEALTH PRACTICE
STRATEGIES CONT….3
 3] ADVOCACY
 Advocacy is the process of visiting and meeting major stakeholders to be part
of to support in providing solutions to the identified health problems within
the community.
 The following persons can help in community mobilization activities.
 E.g: influential individuals, voluntary groups, local government chair-persons,
business groups, school groups, religious groups, political groups; pressure
groups and community leaders. These persons can provide support financially
and also enhance full community participation during health programmes in
the community.

TYPES OF SERVICES RENDERED IN THE
PRACTICE OF COMMUNITY HEALTH IN NIGERIA
 Promotive Health Services
 community health practice is concerned with promotive heath services which refers
to all those activities undertaken to enhance the quality of life. It is the process of
enabling people to increase control over, and to improve their health.
 Family planning services, health promotion, nutritional campaign, provision of
 safe water programmes.
 Increase access to healthy foods
 Physical activities like exercises
 Prevention of excessive alcohol use
 Helping people to quit smoking

PRACTICE OF COMMUNITY HEALTH…..2
 Preventive Health Services
 The other key feature of community Health is that it emphasis
preventive health care services which can be referred to those
activities involved in ensuring that all health or diseases do not
occur within the community. Some of these include;
 1) Proper disposal of refuses (solid, liquid and gaseous waste);
personal hygiene;
 2) immunization; health education; use of long lasting
insecticide nets (LLINs);
 3) clearing of bushes and cleaning of gutters

PRACTICE OF COMMUNITY HEALTH…3
 Curative health Care Services
 Although, community health deals more with prevention,
promotive and rehabilitative services; it also deals with curative
health care service which is referred to as the process of proper
diagnosis and management of health Problems or diseases
where they have occurred. What is involved here is that the
community health practitioners based on the signs and
symptoms of the illness obtain from history taking and
examination treat the patient with prescribed regimes of drugs
using the standing orders.

PRACTICE OF COMMUNITY HEALTH…..4
 Rehabilitative Health Services
 Again, rehabilitative health service is another aspect of community
health practice.
 This involves all those measures that are taken to ensure that person
who have had very severe illness or health condition are reintegrated
into society to lead a productive life. or are continually provided with
some form of health services that would prevent them from relapsing
into a severe state again. For example, the management of a person
who had being treated for mental illness or tuberculosis, hypertension,
diabetes, accident victims and other follow up cases from the
secondary or tertiary health care.

COMMUNITY HEALTH PRACTICE AND THE
GOAL OF HEALTH FOR ALL
 Millions of children and mothers across the world lack access to essential
health services.
 High costs and long distances to health facilities prevent families in many
rural communities from receiving care. Others may face barriers due to
conflict or insecurity.
 Community health programmes or services are essential for bringing critical
services to the hardest-to-reach children and Adults.
 As trusted members of society, community health workers help families make
informed decisions about their health and well-being, and educate them on
available health services to ensure that everyone has access to quality health
care irrespective of where they live and work.
 Community health practitioners resident in the communities provide a
critical channel for emergency response in critical cases through the referral
system.
 In Africa, especially in Nigeria, community health programmes and services
are grossly underfunded.

GOAL OF HEALTH FOR ALL cont….2
 The goal of Primary Health Care (PHC) was to provide accessible
health for all by the year 2000 and beyond. Unfortunately, this is
yet to be achieved in Nigeria and seems to be unrealistic in the
next decade if the basic essence of the Universal Health
Coverage – making health care accessible, available and
affordable to rural poor is ignored to whatever extent by not
enhancing and utilizing the practice of community health in the
rural communities.
 It is community health practitioners that move from house to
house informing the community and arousing their interest
towards utilization of available, accessibility and affordable
health services in the community.

GOAL OF HEALTH FOR ALL cont….3
The goal of "Health for All" is only
achievable if community health
practice becomes the top priority in
our primary health care services
delivery system as a country.


HISTORY OF COMMUNITY HEALTH PRACTICE
IN NIGERIA
 the practice of community health started in Nigeria about 1978 with Alma-
Ata declaration of primary health care and the need to have a cadre of health
professionals willing to man health facilities at the rural hard to reach places
in every country in Africa.
 According to RansomeKuti, Sorunghe, Oyegbite and Bamisaiye (1990) “in
1978 a new breed of primary health care workers was introduced to man the
primary health care services and these are community health officers,
supervisors, assistants and aides.
 Thus, the actual training of community health started effectively in 1978 and
to ensure the availability of adequate number especially at the higher level
existing health workers such as rural health workers, community midwives
and nurses as well as public health superintendent were allowed to train
either as community health officer or supervisor or assistants as the case may
be.

HISTORY OF COMMUNITY HEALTH PRACTICE
IN NIGERIA cont…..2
 It is also important to state that the community health aides were
trained for one year, the community health assistants trained for two
years The health supervisors where trained for
 two years after training as a community health assistant and the
community health officers trained for one year after training as a
community health supervisor or community midwife or public health
nurse or public health superintendent.
 However, today the Junior Community Health Extension Workers
(JCHEWs)
 are now trained for 2 years, while the Community Health Extension
Workers
 (CHEWs) are trained for 3 years and the Community Health Officers
(CHOs)
 are trained for 2 years.

WHY COMMUNITY HEALTH PRACTICE
IN NIGERIA
The need for community health practice in Nigeria became very important since
before 1978, but become more obvious in 1978 after the Alma-Ata declaration .
There were many obvious reasons that necessitated the birth of community health
practitioners to carry out community health practice in the Nigerian Health system at
the primary health care level. Such reasons are as follows:
 All attempts made to persuade doctors to serve in the disadvantaged areas of
the country have always failed due to the fact that their training does not equip them
with the necessary skills to work with the community for preventive health behaviours.
 Nurses and doctors were mal-distributed to serve only in the urban centers of the
country.
 Doctors and nurses find it difficult to adapt and work in communities without
social amenities such as pipe borne water, electricity and good road network.
 There was need for active community involvement and participation all over the
country in the provision and delivery of primary health care services. Thus, a new
breed of health workers was needed to man the PHC centers to motivate community
members to action in the provision and utilization of health services within the local
community and beyond

WHY COMMUNITY HEALTH PRACTICE
IN NIGERIA cont….2
 There was need to distribute health man power resource equitably to
everywhere in the Country irrespective of where the people live and
work. This need culminated into the establishment of the BASIC
HEALTH CARE SERVICES SCHEME in Nigeria which has to do with
providing health care at the Community level by trained personnel,
most of whom are the Community Health Practitioners. The Basic
Health Services Scheme (BHSS) was necessitated by the fact that the
previous system of health care was hospital based and comprised of
curative care.
 The scheme was therefore, based on the establishment of health
centres at the community level to work with the community members
to provide promotive, preventive, curative and rehabilitative health
services to reduce morbidity and mortality rates in the country
stemming mostly from the rural areas due to absence of quality and
appropriate health care personnel and services.

PRIMARY HEALTH CARE AND IT’S FUSION
WITH
COMMUNITY HEALTH PRACTICE NIGERIA
 Primary Health Care and its fusion with Community Health Practice cannot be made
clearly understandable without bringing to fore the historical perspective of Primary
Health Care. The concept of Primary Health Care started when the World Health
Assembly at a meeting of health professionals from all over the world at Alma-Ata in
U.S.S.R in September, 1978, wherein they propounded a new concept of health care
delivery called Primary Health Care. The outcome of the conference was the Alma-Ata
declaration, which is; “Health for all the world by the year 2000” through the
implementation of Primary Health Care as a cooperative international effort.
 The declaration emphasized the need to reallocate resources to achieve this aim and
emphasized the interrelation of health with economic and social development. It also
outlined the gross inequality in health status of the people of the developing and
developed countries and the contribution which an international effort can offer
towards rectifying this imbalance in achieving world peace.

WITH
COMMUNITY HEALTH PRACTICE NIGERIA cont..2
 Primary health care is the first level of contact of individuals, the
family and community with the national health system bringing health
care as close as possible to where people live and work and
constitutes the first element of continuing health care process.
 The concept of Primary Health Care is therefore explained in the
following perspective:1. It integrates preventive, promotive and
curative services using the type of technology the community will
accept at the level it can afford with an efficient and effective system
of supervision and referral.
 2. It involves in addition all health sectors, all health related sectors.
Any aspect of National and Community development in particular, the
agriculture, animal husbandry, food and industry, Education, Housing,
Public utility and work, Communications and other sectors and
demand the coordinated efforts of all these sectors.

WITH
COMMUNITY HEALTH PRACTICE NIGERIA cont…3
 3. It also involves a close partnership between the community and
government in the development of resources and health care.
 The obvious challenges at primary level in establishing a health care
system that will touch the lives of every citizen and tackle the
conditions that cause the highest mortality and morbidity make it
imperative, the bringing in of the concept of Community Health
Practice. This is because the system must be organized for the grass
root and woven into the fabrics of the community through the
processs of Community mobilization and Participation.
 Hence, community health practice becomes the vehicle through
which primary health care services are appropriately and adequately
delivered to members of the community who actively involved in all
the process of health service delivery within their community.

COMMUNITY HEALTH PRACTITIONERS
REGISTRATION BOARD OF NIGERIA (CHPRBN)
 The Community Health Practitioners Registration Board of Nigeria (CHPRBN)
was established by Decree 61 of 1992 and now in CAP C19, Laws of the
Federation of Nigeria 2004.
 The Decree was signed by the former President of Nigeria, General I.B.
Babangida on 24th of November 1992. Although the legal instrument
establishing the Board had been in existence since 1992, the Board was
constituted and inaugurated in December 2000.
 The establishment of the Board was informed by the need to regulate
Community Health Practice, which was consequent upon creation of a group
of Health Practitioners - Community Health Officers, Community Health
Extension Workers and Junior Community Health Extension Workers, whose
training started in 1978.

REGISTRATION BOARD OF NIGERIA (CHPRBN) cont.2
 Before the inauguration of the Board, the Basic Health Services
Scheme Coordinating Unit and Training and Manpower Development
Division, both of the Federal Ministry of Health had at one time or the
other performed both the training and regulatory functions of the
Board.
 The present Governing Board is composed of eleven (11) members
with Mr Sule Galadima Toma as Chairman and Alhaji Bashir Idris as
Registrar and Chief Executive.
 The Board’s Secretariat has five (5) Departments: Administration and
Finance; Education, Development and Standards; Registration and
Licensing; and Inspectorate/Accreditation of Institutions.

REGISTRATION BOARD OF NIGERIA (CHPRBN) cont.3
 Presently, the Board has its Head Office at
Plot 379, EFAB Estate Road, Gwarinpa I, by
Polaris Bank, Jabi District, Abuja, FCT.
There are six (6) Zonal Offices at Kano
(North West), Ilorin (North Central),
Maiduguri (North East), Akure (South West),
Umuahia (South East) and Port Harcourt
(South South).

CHPRBN- THE LEGAL FRAME WORK OF
THE COMM HEALTH PRACTICE
 The legal framework for Community Health Practice in Nigeria is the Community
Health Practitioners Registration Board of Nigeria Act CAP C19 LFN 2004
 This means every registered Community health practitioner in Nigeria is to practice
within the legal/ethical framework and guidelines for practice provided by community
health practitioners Registration Board of Nigeria.
 Any act of practice is that not in line with or against the legal framework of the
profession is considered to be professional misconduct and thus, must face the
disciplinary committee of the Board for trial and necessary disciplinary actions already
stated in the law guiding the community health practice in Nigeria.

FUNCTIONS OF THE BOARD
The Board serves as a regulatory body in:
 ( 1) The Training and retraining of community Practitioners in the country
including Approval of courses
 2) The board is responsible in the registration and licensing of community
health practitioners in the country
 3) It is responsible in the Regulation of Practice with licensing of community
health professionals and the giving of standing orders and the professional
codes of conduct.
 4) facilitates and promotes Research and Development undertakings in the
field of community health in Nigeria.
 Supervision of instruction and examinations leading to approved
qualifications.

FUNCTIONS OF THE BOARD
Establishment of the Disciplinary
Committee and the Investigating Panel
to handle cases of professional
misconduct and ensuring that
adequate disciplinary actions are taken
against registered Community health
practitioners that are found guilty.

CADRES OF COMMUNITY HEALTH
PRACTITIONERS
 Community Health Practitioners are “core” polyvalent workers and these have remaine
d the
core Primary Health Care Workers in Nigeria primary Health care system. It is a
family comprising:
 1) Primary Health Care Tutors,
 2) Community Health Officers,
 3) Community Health Supervisors which training was stopped in 1990,
 4) Community Health Assistants (now Community Health Extension Workers (CHEWs),
and
 5) Community Health Aides (now Junior Community Health Extension Workers (JCHEW

DUTIES OF A COMMUNITY HEALTH
PRACTITIONER
 Duty to the State
These duties are for all the cadres of community health practitioners.
They are duties a community health practitioner owe the government.
They include but no limited to the following:
 a)- Duty to uphold the law
 b) Duty to notify appropriate authorities of the existence of epidemics
 c) Duty not to advise or assist in procurement of abortion
 d) Duty not to advise or assist in volition of the Law.
 e) Duty to testify and give testimony before a tribunal or court
 f) Duty to probity and prudence
 g) Duty to identify community health needs and promote community
awareness
 and participation in health services.

PRACTITIONER cont..2
 Duty to the Profession
 A community Health practitioner by virtue of the professional code of
conduct is required to maintain a high standard of practice and shall
not engage in any conduct which is unbecoming of a community
health practitioner. The following are some of the duties of a
community health practitioner to the community health profession.
 a) Duty to use Standing Orders
 b) Duty to register
 C) Duty not to aid or procure illegal registration
 d) Duty not to advertise and solicit for patient
 e) Duty to dress properly
 f) Duty not to be involved in anti-professional act

PRACTITIONER cont..3
 DUTY TO CLIENT
In addition to the duty to the state and to the profession a community health practitioner
owe some duties to his/her clients who are often referred to as patients.
The duties of a Community Health Practitioner to client are not less important than his
duty to the state and the profession.
In fact, one would say the duty to client in our considered opinion is more important than
the first two earlier discussed. This is because a breach of any duty to a client could lead
to legal action. Some of the duty to a client includes:
a) Duty of care
 b) Duty to give candid and honest advice
 C) Duty to preserve confidentiality
 d) Duty to obtain informed consent
 e) Duty not to engage in extra-marital affairs with client and their relatives
 f) Duty to take full history and make proper diagnosis
 g) Duty not to covet
 h) Duty to accept client

PRACTITIONER cont…4
Duty to other Professionals
 A community Health practitioner does not work in isolation. He works with
other members of the health team which include doctors, nurses, laboratory
scientist and technician, pharmacists among others.
There is need for a harmonious and cordial working relationship among them
based on mutual respect and understanding. Thus, community health
practitioner owes other members of the team some duty as much as they owe
him. Some of the duties include:
 a) Duty of courtesy and respect
 b) Duty to keep promises
 c) Duty not to covet clients
 d) Duty to avoid ill-feeling among other health professionals

CHALLENGES OF COMMUNITY HEALTH
PRACTICE
 1. Though Primary Health Centres were established in both
rural and urban areas in Nigeria with the intention of equity
and easy access, regrettably, the rural populations in Nigeria
are seriously underserved when compared with their urban
counterparts.
 2. While most PHC facilities are in various state of disrepair,
with equipment and infrastructure being either absent or
obsolete, the referral system is almost non-existent.
 3. Poor political will in funding community health programme,
leading to donor driven health programme in Nigeria.
 4. Insufficient number of community oriented health team in
the public service as well as their uneven distribution.

CHALLENGES OF COMMUNITY HEALTH
PRACTICE cont..2
6. Lack of understanding of Primary Health Care among health
professionals and decision-makers resulting in poor quality
services.
7. Health workers poor attitude to work (frequent absence from
work).
 8) poor maintenance of the referral system in the health care
system of the country.
 9. Poor logistic system in reaching out to difficult-to-reach
communities/settlements

Introduction to Community Health Practice

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