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Introduction to Community Health Practice

This document provides an outline and overview of a lecture on community health practice in Nigeria. It discusses key topics like the definition of community health practice, the strategies and tools used, types of health services provided at the community level, and the history and importance of community health practice in Nigeria. The goal of community health is to provide primary healthcare services that are accessible, affordable and acceptable to local communities. Community health workers play an important role in promoting health, preventing diseases, and treating minor ailments at the grassroots level.

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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
COMMUNITY HEALTH PRACTICE IN NIG 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.
COMMUNITY HEALTH PRACTICE IN NIG 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
TYPES OF SERVICES RENDERED IN THE 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
TYPES OF SERVICES RENDERED IN THE 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.
TYPES OF SERVICES RENDERED IN THE 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.
COMMUNITY HEALTH PRACTICE AND THE 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.
COMMUNITY HEALTH PRACTICE AND THE 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.
PRIMARY HEALTH CARE AND IT’S FUSION 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.
PRIMARY HEALTH CARE AND IT’S FUSION 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.
COMMUNITY HEALTH PRACTITIONERS 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.
COMMUNITY HEALTH PRACTITIONERS 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.
DUTIES OF A COMMUNITY HEALTH 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
DUTIES OF A COMMUNITY HEALTH 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
DUTIES OF A COMMUNITY HEALTH 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
THANK YOU ALL FOR LISTENING

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Introduction to Community Health Practice

  • 1.
    LECTURE SLIDE ON: INTRODUCTIONTO COMMUNITY HEALTH PRACTICE COURSE CODE: CHS 209 COURSE LECTURE: DR. DOTIMI DORIS DEPART: COMMUNITY HEALTH
  • 2.
    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
  • 3.
    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
  • 4.
    COMMUNITY HEALTH PRACTICEIN 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.
  • 5.
    COMMUNITY HEALTH PRACTICEIN 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
  • 6.
    COMMUNITY HEALTH PRACTICEIN NIG 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.
  • 7.
    COMMUNITY HEALTH PRACTICEIN NIG 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.
  • 8.
    COMMUNITY HEALTH STRATEGIES/TOOLSFOR 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
  • 9.
    COMMUNITY HEALTH PRACTICE STRATEGIESCONT….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.
  • 10.
    COMMUNITY HEALTH PRACTICE STRATEGIESCONT….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.
  • 11.
    TYPES OF SERVICESRENDERED 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
  • 12.
    TYPES OF SERVICESRENDERED IN THE 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
  • 13.
    TYPES OF SERVICESRENDERED IN THE 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.
  • 14.
    TYPES OF SERVICESRENDERED IN THE 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.
  • 15.
    COMMUNITY HEALTH PRACTICEAND 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.
  • 16.
    COMMUNITY HEALTH PRACTICEAND THE 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.
  • 17.
    COMMUNITY HEALTH PRACTICEAND THE 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. 
  • 18.
    HISTORY OF COMMUNITYHEALTH 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.
  • 19.
    HISTORY OF COMMUNITYHEALTH 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.
  • 20.
    WHY COMMUNITY HEALTHPRACTICE 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
  • 21.
    WHY COMMUNITY HEALTHPRACTICE 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.
  • 22.
    PRIMARY HEALTH CAREAND 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.
  • 23.
    PRIMARY HEALTH CAREAND IT’S FUSION 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.
  • 24.
    PRIMARY HEALTH CAREAND IT’S FUSION 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.
  • 25.
    COMMUNITY HEALTH PRACTITIONERS REGISTRATIONBOARD 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.
  • 26.
    COMMUNITY HEALTH PRACTITIONERS REGISTRATIONBOARD 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.
  • 27.
    COMMUNITY HEALTH PRACTITIONERS REGISTRATIONBOARD 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).
  • 28.
    CHPRBN- THE LEGALFRAME 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.
  • 29.
    FUNCTIONS OF THEBOARD 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.
  • 30.
    FUNCTIONS OF THEBOARD 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.
  • 31.
    CADRES OF COMMUNITYHEALTH 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
  • 32.
    DUTIES OF ACOMMUNITY 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.
  • 33.
    DUTIES OF ACOMMUNITY HEALTH 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
  • 34.
    DUTIES OF ACOMMUNITY HEALTH 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
  • 35.
    DUTIES OF ACOMMUNITY HEALTH 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
  • 36.
    CHALLENGES OF COMMUNITYHEALTH 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.
  • 37.
    CHALLENGES OF COMMUNITYHEALTH 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
  • 38.