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Dynamics of communication health and development for submission

  1. 1. Republic of the Philippines Bicol University Graduate School, Gubat Campus Master of Arts in Nursing Gubat, Sorsogon Name: Ynneb Reine H. Manginsay, R.N. Topic: Community Organizing and COPAR Subject: MAN 212: Dynamics of Communication Health and Development Professor: Mr. Gaspar Santos, R.N., M.N. Term: 2nd Semester, S.Y. 2012-2013 COMMUNITY ORGANIZING Healthy Community (WHO 1998) -It is a social group determined by: Geographical boundaries Common values and interests Members know and interact with each other Creates norms, values and social institutions (Jimenez)  Not only the absence of disease in individuals  It is a state of physical, social and mental well-being  People are aware of political, religious, economic and cultural factors that affect their health  Could act to prevent illness and promote health Classification of Communities Urban Rural Rurban Characteristics of Community (Reyes and Layug) 1. Environment – physical, socio-cultural, educational and employment milieu 2. Population – Behavior/lifestyle, self responsibility, self care competency 3. Human Biology – Genetic characteristics of a population 4. Systems of Health Care – Prevention, promotion, cure and rehabilitation
  2. 2. Characteristics of a Healthy Community (Hunt and Zurek, 1997:12) 1. Awareness that “we are a community” 2. Uses and conserves its natural resources 3. Recognition of and respect for the existence of subgroups and welcomes their participation in community affairs 4. Prepared to meet crises 5. Has open channels of communication 6. Resources available to all 7. Settling of disputes through legitimate mechanisms 8. Encourages maximum citizen participation in decision making 9. Promotes high level wellness among all its members Components of Community 1. The PEOPLE – core 2. Subsystems of Community  Housing  Education  Fire and Safety  Politics and Government  Health  Communication  Economics  Recreation Factors Affecting Community Health Political factors – way of leadership Socio – cultural factors– Composed of beliefs and practices of the members of the community Economic factors – refers to the production, distribution and consumption of goods and how these affect health and development Environment – The sum total of all conditions and elements that make up the surroundings Approaches in Community Development 1. Welfare Approach (Traditional Approach) 2. Modernization Approach 3. Transformative/Participatory Approach Community Organizing Definitions:
  3. 3. (Maglaya) -Process whereby community members develop the capability: To assess their health needs and problems Plan and implement actions to solve these problems Put up and sustain organizational structures Support and monitor implementation of health initiatives by the people Keyword: EMPOWERMENT (Human Resource Development Program (HRDP III))  A continuous and sustained process of educating the people  It is working with the people collectively and efficiently, discover their immediate and long term problems and mobilizing the people to develop their capabilities and readiness to respond and take action on their immediate needs toward the solution of their long term problems. (Jimenez) - It is the people who organize themselves into a working team who can effectively solve their own health problems  As applied to Primary Health Care – it is defined as the process and structures through which people are tapped to become organized to participate in health care and community development activities  As a process – is the sequence of steps whereby the members of the community work together to critically assess, evaluate and improve its condition  As a structure – refers to the particular group of community members that work together for common health and health- related problems (Wikipedia)  Assumes social change involves conflict and social struggle  Core goal is to generate durable power (collective power) allowing it to influence key decision makers on the range of issues overtime (Mike Miller)  Is a developmental strategy for building people’s capabilities towards self determination and self reliance  A method and a process of educating, organizing and mobilizing people which leads to their own development.  2 things to rectify the problem of power of imbalance:  Builds a permanent base of power – dominant institutional power can be challenged
  4. 4.  Transforms individuals and communities – aims to transform the apathetic, individualistic, voiceless poor into a dynamic, participatory and politically responsive community. Objectives of Community Organizing (as identified by PHC) 1. To make people aware of social realities 2. To form structures that hold the people’s basic interests 3. To initiate the responsible actions History of Community Organizing in the Philippines September 21, 1972 –Marcos declaration of martial rule led to:  Elimination of social movements and groups  Church-based programs functioned as NGOs and started community organizing  Urban and rural Missionaries of the Philippines  Taskforce detainees of the Phil.  Episcopal Commission on Tribal Filipinos  Share and Care Apostolate for poor Settlers and PEACE  NGOs followed and resumed grassroots activities discretely  Political formations saw the need to set up NGOs in order to pursue their own interest Positive side vs. Negative side December 1972- Developmental institutions saw the need for more coordinated activities from 10 foundations to 40 by 1976.  Association of Foundations 1977- Repression continued, human rights violation increased -Advocacy was used to organize mass movement -NGOs recognized the need to band together into networks for purposes of linkaging, synchronization of activities and cooperative exchange of experiences and resources. 1983- Assassination of Benigno Aquino led to:  Widespread street protests  Attracted cooperation of unpoliticized sectors of society (businesses and church)  Coalitions were formed  Major organizations among the ranks of the peasant, fisherfolks and indigenous people were organized  Other venues of developmental work were explored Elements of Community Organizing
  5. 5. (Joan Minieri, Paul Getsos and Chardon Press, Tools for Radical Democracy) 1. Power Ability to make something happen Getting people understand the source of problem, devise solutions, strategies, take on leadership and move to action thru campaigns that win concrete changes 2. Relationship Building People are accountable to one another for their activities on behalf of the group 2 kinds 1. One on one 2. Public relationships 3. Leadership Development must build a base of members, get them to see the root of the problem and get them involved to develop them into leaders 4. Political Education Form of training whether formally or informally about issues, social movements and history of the organization 5. Strategy Overall approach to achieving objectives Way that a community uses its power to win what it wants by:  Campaigns  Research  Collaboration and alliances 6. Mobilization Essential process of moving people to action 7. Action A public showing of an organization’s power Takes place during campaigns 8. Winning Organizing focuses on winning Unless the organization wins concrete, measurable benefits for those who participate, it will not last long.  They must see a potential for either benefit or harm to themselves if the group succeeds or fails  Their personal involvement has an impact on the whole effort. 9. Movement Building Groups engage in broader social justice activities that are not solely connected to winnable campaigns or self interest of community 10. Evaluation Monitors and improves performance (Action-reflection-action) Continuous process of assessing actions whether the goals are met or not
  6. 6. Principles of Community Organizing 1. People are motivated by self-interest 2. Community Organizing is a dynamic process 3. Learn to deal with conflict and confrontation 4. Take into account the fundamental definition of an issue 5. Tactics should be within the experience of the people and outside the experience of the target 6. Man learns more effectively from his own actual experiences 7. Man needs to deepen and widen his horizon 8. People must make their own decisions Types of Community Organizing Grassroots FBCO Coalitions Strengths of Community Organizing (Miller) Builds self-reliant, creative grass root organizations Openness to experiment Rooted in the community Generates immediate success Empowers people – simple and can be learned by anyone Emphases of Community Organizing in Primary Health Care (Jimenez) 1. The community works to solve their own problems 2. The direction is internal rather than external 3. The development of the capacity to establish a project is more important than the project 4. There is a consciousness-raising to perceive health and medical care within the total structure of society. Characteristics of Consolidated and Viable Organization (Miller) 1. Ability to facilitate, lead and effectively carry out policies, etc. with maximum participation of members in decision making 2. Ability to achieve desired objectives through maximizing their planning and implementing skills. 3. Capable of effecting institutional and development changes within the organization that would accrue to the welfare of the members 4. Consciousness content: organizational matter Characteristics of Stable Organization (Miller)
  7. 7. 1. Keeps and maintains self-reliance and self-sufficiency 2. Capable of effecting institutional and development changes that would increase the benefit of the people 3. Seeks meaningful participation in policy making bodies where some sectors are not represented at all but which decision affect them 4. Conscious content, community or regional matters affecting the whole population Phases of Community Organizing (Maglaya) A. PREPARATORY PHASE 1. Area Selection 2. Community Profiling 3. Entry in the Community and Integration with the People Guidelines:  Recognize the role and position of local authorities  Adopt a lifestyle in keeping with that of the community  Choose a modest dwelling  Avoid raising expectations of the people  Participate directly in production process and social activities  Make house calls  Seek out people where they usually gather B. ORGANIZATIONAL PHASE 1. Social Preparation 2. Spotting and developing potential leaders 3. Core Group formation - Represented by different sectors of the community The core group serves as training ground for developing potential leaders in:  Democratic and collective leadership  Planning and assuming tasks for the formation of a community wide organization  Handling and resolving group conflicts  Critical thinking and decision making process 4. Setting up the Community Organization C. EDUCATION AND TRAINING PHASE 1. Conducting Community Diagnosis 2. Training of Community Health Workers 3. Health Services and Mobilization 4. Leadership Formation Activities D. INTERSECTORAL COLLABORATION PHASE As the organization grows, its needs also grow Assistance and support can be achieved through collaboration with other organizations and communities
  8. 8. E. PHASE OUT Turn-over of work Monitoring and subsequent follow up of activities until the community is ready for full disengagement Basic Community Organizing Process (Jimenez) I. ENTRY TO THE COMMUNITY The decision to enter a community and establish a helping/working relationship should consider the ff: A. Clarity of purpose of the relationship between the agency/community organizer and the people B. Existence of social problems and needs C. Community’s desire and willingness to work for change II. INTEGRATION WITH THE PEOPLE - Is establishing rapport with the people in a continuing effort to imbibe in their community life - Immerses himself/herself in the community to know and respect the culture, history, economy, leaders, and lifestyle of people - Facilitates social investigation and vice versa III. SOCIAL INVESTIGATION/COMMUNITY STUDY - Is the process of systematically learning and analyzing the various structures and force in the community study – economic, political and socio-cultural - Comes at the beginning and as a process. It is continuous. “no community study is ever complete” Objectives: 1. To gather data 2. To identify the classes and sectors present 3. To determine the correct approach and method of organizing 4. To provide a basis of planning and programming of organizing activities General methodology and guidelines in social investigation: A. Interview B. Observations C. Examination/Review of Secondary Data - Assumes that much of the initial information needed is already available - Major data to be gathered: a. Geographic and demographic data b. Economy system/type of economic production c. Political system/decision-making structure/s d. Socio-political system
  9. 9. IV. PARTICIPATORY APPROACH IN SOCIAL INVESTIGATION - Peoples participation should be observed Participatory Data Gathering – the process of involving the community residents in the collection and consolidation of data or information Knowing the answers to the ff: 1. Why data are gathered 2. What data to gather 3. How data are to be gathered (tools to be used) 4. Where data are to be gathered (sources) It is important in CO because it provides: 1. Demographic profile 2. Inventory of community resources 3. Identification of community trends and issues 4. Picture of network of service and organization in the area 5. Opportunity for raising the level of consciousness Aids the community organizer in: 1. Identifying the situation he/she is entering 2. Initial view of the social problems 3. Specifying his role face to face with the people 4. Setting relevant objectives and effective programs 5. Evaluating the community’s progress V. PROBLEMS/ISSUES IDENTIFICATION AND ANALYSIS Problem Identification – process of defining, analyzing and ranking community problems and needs - Helping communities perceive and analyze their situation from a more comprehensive and analytical viewpoint Guide in Problem Identification: 1. Scope/degree of the problem 2. Past change efforts 3. Origin of the problem 4. Factors that maintain/increase or eliminate the problems 5. Consequence analysis 6. Problem on organization VI. PLANNING AND STRATEGIZING Planning – process of translating goals/objectives into specific activities to meet community needs or solve community problems
  10. 10. Planning process involves: A. Identification of perceived problems and needs B. Identification of existing resources C. Study on the block to the utilization of their resources D. Formulation of the possible solutions E. Setting Plans of Actions - Plans are further broken down into strategies and tactics - Strategy – general/over-all direction that organizing process will take course (long range goal) - Tactics – a specific action/goal within a strategy Guidelines for forming strategies: a. Principal issue/ problem b. Solution to the problem c. Strengths and weaknesses d. Other secondary issues e. Larger outside issues VII.CORE GROUP FORMATION - Identification of potential leaders Criteria:  Belongs to poor sectors and classes –engaged in production  Well-respected and has relatively wide influence  Willing to work for change  Can find time, conscientious and resourceful  Must be able to communicate effectively Functions of a core group: Training ground for democratic and collective leadership Builds people’s potential and self-confidence Helps gather data, spotting other potential leaders and members for a community wide organization Helps in laying out plans and tasks for the formation and maintenance of the organization VIII. ORGANIZATION DEVELOPMENT - Forming a community-wide organization after formation of the core group Techniques to recruit members: A. Ground Work – to go around and motivate people on a one-on-one basis (agitation) B. The Meeting – the people collectively ratify what they already have decided individually
  11. 11. - Gives a sense of collective power and confidence - creation of working committees and tasks C. Organizational structure – formal setting up of the community organization where constitution and organizational plans are ratified and approved - Organizing process results in consolidating a viable people’s organization D. Leadership Training and development – revolves on indigenous leaders who will eventually take over the role of community organizer - Promotes collective or shared leadership - May be done formally or informally Principles and Concepts of Leadership training 1. Leadership as service 2. Corporate/collective leadership 3. Delegation of Authority 4. Eliciting Participation 5. Problem Solving Activities in informal leadership training:  Groundwork  Continuous exposure to and active participation to mobilization activities  Action-reflection and criticism-self criticism Activities in Formal leadership training  Seminars  Workshops  Structured study Sessions IX. MOBILIZATION - Refers to the activities undertaken by the community to solve problems - Builds and strengthens people’s self-confidence and collective spirit - Actual experience of the people confronting the powerful and the actual exercise of people power Steps and guidelines in preparing Conflict Mobilization: A. Issue(s) spotting and analysis B. Target Analysis C. Planning D. Role playing X. REFLECTION AND EVALUATION Reflection – analyzing the finished mass action, its good and weak points identified. - Relates practice to theory and creates an awareness of global issues
  12. 12. Continual self analysis – necessary to maintain and consolidate a cooperative and participatory spirit to ensure that no oppressor-oppressed relationship emerge within the group Evaluation - Process of discovering the way it has been accomplished, what has been left out and what remains to be done - People’s participation in evaluation is as important Guidelines for evaluating a community: PART I. QUANTITATIVE ANALYSIS A. General Description B. Listing of activities 1. People’s issues handled, completed, on-going and potential 2. Mobilization/Negotiation taken 3. Meeting/Reflection sessions held 4. Seminars and Conventions PART II. QUALITATIVE ANALYSIS A. Area Description B. Issues C. Organization/Groups 1. Knowledge gained 2. Involvement and outlook of people 3. Attitudinal changes XI. TURN OVER AND PHASE OUT - After some time, community organizers become dispensable and the people’s organization takes over. Turn-over of the organizing process is done if the ff. are satisfactory achieved: High level of sociopolitical awareness Sustained membership participation Trained pool of leaders Well set up community structures and linkages Delineated goals, directions, plans of actions are clear - Organizers may assume a supportive role monitoring, consultant, and evaluator Five Stages of Organizing: A Community Health Promotion Model (Public Health Nursing in the Philippines, 10th edition) STAGE 1: COMMUNITY ANALYSIS Five Components:
  13. 13. Demographic, social and economic profile from secondary data Health risk profile Health/Wellness outcomes profile Survey of current health promotion programs Studies in certain target groups Steps: 1. Define the community 2. Collect data 3. Assess community capacity 4. Assess community barriers 5. Assess readiness for change 6. Synthesis data and set priorities STAGE 2: DESIGN AND INITIATION a. Establish a core planning group and local organizer b. Choose an Organizational structure c. Identify, select and recruit organizational members d. Define the organization mission and goals e. Clarify roles and responsibilities of the people f. Provide training and recognition STAGE 3: IMPLEMENTATION a. Generate broad citizen participation b. Develop a sequential work plan c. Use comprehensive, integrated strategies d. Integrate community values into the programs, materials and messages STAGE 4: PROGRAM MAINTENANCE – CONSOLIDATION a. Integrate intervention activities into community networks b. Establish a positive organizational culture c. Establish an ongoing recruitment plan d. Disseminate results STAGE 5: DISSEMINATION – REASSESSMENT a. Update the community analysis b. Assess effectiveness of interventions/programs c. Chart future directories and modifications d. Summarize and disseminate results
  14. 14. COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) PARTICIPATORY ACTION RESEARCH (Jimenez) An investigation on problems and issues concerning life and environment of the underprivileged by way of research collaboration with the underprivileged whose representatives participate in the actual research as researchers themselves, doing research of their own problem A community-directed process of gathering and analyzing information or an issue for the process of taking actions and making changes PARTICIPATION – main element  The beneficiaries of the research are the main actors of the research process  Involves research, education and actions to empower people to determine the cause of their problems, analyze these problems and act by themselves in responding to their own problem CHARACTERISTICS OF TRADITIONAL AND PARTICIPATORY ACTION RESEARCH Traditional PAR 1. Purpose: to identify and meet individual needs within existing social systems 1. Purpose: Social Transformation 2. Community problems or needs are defined by experts 2. Research problems are defined by the community 3. Research problems is studied by the researchers 3. The community undertakes the research process. External researchers work alongside 4. Recommendations are based on the researcher’s findings and analysis 4. Community formulates recommendations and an action plan based on research outcome PARTICIPANTS IN PAR There is an outside researcher, a professional one who through immersion and integration on the community becomes a committed participant and learner in the community The local researchers are trained in the process of research and are made aware of the needs of their people
  15. 15. COPAR Definition:  Is a social development approach that aims to transform the apathetic, individualistic and voiceless poor into a dynamic, participatory and politically responsive community  is a continuous and a sustained process of: 1. Educating the people - to understand and develop their critical consciousness 2. Working with people - to work collectively and effectively on their immediate and long term problems 3. Mobilizing with people - develop their capability and readiness to respond, take action on their immediate needs towards solving the long term problems  It is a process and a structure through which the members of the community are tapped to become organized for participation in health care and community development activities  A strategy used by the HRDP III in implementing the Primary Health Care delivery in depressed and underserved communities to become self-reliant Process: The sequence of steps whereby members of the community come together to critically assess to evaluate community conditions and work together to improve those conditions Structure: Refers to a particular group of community members that work together for a common health and health related goals Emphasis of COPAR 1. Community working to solve its own problem 2. Direction is established internally and externally 3. Development and implementation of a specific project less important than the development of the capacity of the community to establish the project 4. Consciousness raising involves perceiving health and medical care within the total structure of society Importance of COPAR 1. COPAR is an important tool for community development and people empowerment 2. COPAR prepares people/clients to eventually take over the management of a development programs in the future. 3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.
  16. 16. PRINCIPLES 1. People especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change. 2. COPAR should be based on the interest of the poorest sector of the community. 3. COPAR should lead to a self-reliant community and society. Process/Methods Used in COPAR A Progressive Cycle of Action Reflection Action – begins with small, local and concrete issue identified by the people and the evaluation and reflection of and on the action taken by them Consciousness – Raising – through experiential learning is central to the COPAR process because it places emphasis on learning that emerges from concrete action and which encircles succeeding action COPAR is Participatory and Mass-Based – because it is primarily directed towards and biased in favor of the poor, the powerless and the oppressed COPAR is Group Centered- not leader centered. Leaders are identified, emerged and are tested through action rather than appointed or selected by some force or entity CRITICAL STEPS (ACTIVITIES) IN COPAR 1. Integration – the health worker becomes one with the people in order to: a) Immerse in the community b) Understand deeply the culture, economy, leaders, history, rhythms and lifestyle in the community 2. Social Investigation (Community Study) - Systematic process of collecting, collating, analyzing data to draw a clear picture of the community - Must remember the following: a) Use of survey questionnaires is discouraged b) Community leaders can be trained to initially assist in the social investigation c) Secondary data should be thoroughly examined d) Social investigation is facilitated if the health worker is properly integrated and has acquired the trust of the people e) Confirmation and validation of community should be regularly done 3. Tentative Program Planning – CO to choose one issue to work on in order to begin organizing people 4. Groundwork – going around and motivating the people on a one on one basis to do something on the issue that has been chosen 5. The meeting – people collectively ratify what they have decided individually - Gives collective power and confidence - Problems and issues are discussed
  17. 17. 6. Role Play – acting out the meeting that will take place between the leaders of the people and the government representatives - way of training people to anticipate what will happen and prepare them for such eventually 7. Mobilization or action – actual experience of the people in confronting the powerful and the actual exercise of people power. 8. Evaluation – the people reviewing the steps 1-7 so as to determine they were successful or not in their objectives 9. Reflection – dealing with deeper, ongoing concerns to look at the positive values CO is trying to build in the organization - Gives people time to reflect on the stark reality of life compared to the ideal 10. Organization – the people’s organization is the result of many successive and similar actions of the people. - a final organizational structure is set up with elected officers and supporting members COPAR Process 1. Pre-entry Phase Organizers look for communities to serve/help. It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it Preparation of the Institution o Train faculty and students in COPAR. o Formulate plans for institutionalizing COPAR. o Revise/enrich curriculum and immersion program. o Coordinate participants of other departments. Site Selection o Initial networking with local government. o Conduct preliminary investigation. Criteria for Initial Site Selection Economically depressed. Health services are inaccessible/ inadequate Poor community health status Acceptance of the program by community. No serious peace and order problem. No similar group or organization holding the same program. o Do final networking and consultation with local government and NGOs o Generate secondary data. o Make long/short list of potential communities. o Do ocular survey of listed communities.
  18. 18. Choosing Final Barangay/Site o Conduct interviews with barangay officials and key informants to choose project site. o Discuss suitability of project site o Coordinate with local government and NGOs for assistance of the program’s implementation in the future. o Develop community profiles from secondary data. o Develop survey tools. After site selection o Pay courtesy call to community leaders. o Conduct Community Assembly o Create a working committee o Conduct baseline study o Conduct Staff planning, strategizing for entry phase 2. Entry Phase (social preparation phase) crucial in determining which strategies for organizing would suit the chosen community Success of the activities depend on how much the community organizers has integrated with the community Guidelines for Entry o Recognize the role of local authorities by paying them visits to inform their presence and activities. o Her appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role model. o Avoid raising the consciousness of the community residents; adopt a low-key profile. Activities in the Entry Phase 1. Integration - establishing rapport with the people in continuing effort to imbibe community life.  living with the community  seek out to converse with people where they usually congregate  lend a hand in household chores  avoid gambling and drinking 2. Deepening social investigation/community study  verification and enrichment of data collected from initial survey  a previous investigation was done but this time it is needed to better view how the community and its people perform in general  conduct baseline survey by students results relayed through community assembly Core Group Formation Leader spotting through sociogram.
  19. 19. Key persons - approached by most people Opinion leader - approach by key persons Isolates - never or hardly consulted define roles and functions of the core group  prepare community for health and development work  organize research team  set-up community health organization The staff can assist the community leaders and core group in creating a project:  Management of health programs and to ensure the collective participation of the residents  establish networks and linkages  Generate resources  Raising consciousness of the community in health and other issues  Mobilize residents to act  identification of possible community worker  scrutinize and mobilize residents Conduct team building activities and informal education of the group Train community researchers 3. Community Study/ Diagnosis Phase (Research Phase) Is a comprehensive documentation of the data about the community gathered through social investigation Components of the study: 1. Physical and geographical data 2. Demographic data 3. Economic Condition 4. Mortality and morbidity data 5. Food Supply and Nutrition 6. Cultural Patterns 7. Health Services and Facilities 8. Education 9. Community Leadership and organization 10. Development agencies 11. Community Problems and Needs Activities 1. clustering of household and spot mapping 2. selection of the research team 3. training on data collection methods and techniques/ Capability building (data collection tools) 4. Planning for the actual gathering of data 5. data gathering
  20. 20. 6. Training on data validation (tabulation and preliminary analysis of data 7. Community Validation 8. Presentation of the community study/ diagnosis and recommendations 9. Prioritization of community needs/ problems for action 4. Community Organization and Capability Building Phase Activities 1. draw up guidelines for the organization of Community Health organization 2. Election and induction of officers 3. Development of management systems and procedures 4. team building activities 5. Action-reflection-action session (ARAS) 6. Working out legal requirements of CHO 7. Organization of the working committees 8. Training of CHO officers and members 5. Community Action Phase Activities 1. Organization and Training of Community Health Workers: a. development of selection criteria of CHW’s b. selection of CHWs – each zone of group of families will select from their members c.training of CHWs 2. setting up linkages, network and referral systems 3. Project implementation, monitoring and evaluation (PIME) of health services, intervention schemes and community development projects 4. Initial identification and implementation of resource mobilization schemes 6. Sustenance and strengthening Phase 1. Develop financial and management systems 2. Identification and development of secondary leaders 3. Formulation and ratification of the constitution and by-laws of the CHO 4. Work for the registration of CHD with the securities and exchange Commission 5. Formalize and institutionalize linkages, networks and referral systems 6. Development and implementation of viable management systems and procedures, committees, continuing education/training of leaders, CHWs, community residents 7. Continuing Education and upgrading of community leaders, CHWs and CHO members 8. development of medium and long term community health and development plans