Community Health Promotion Notes

CONCEPTS IN HEALTH PROMOTION
HEALTH; It the state of being free from illness or injury:
WHO DEFINITION OF HEALTH

World Health Organization (WHO), defined Health as being “a state
of complete physical, mental, and social well-being and not merely
the absence of disease or infirmity” in 1948.
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TYPES OF HEALTH
1. PHYSICAL HEALTH
• This is concerned with anatomical integrity and
physiological functioning of the body. (proper
development and functioning of the body systems.
• It means the ability to perform routine tasks without

any physical restriction. E.g., Physical fitness is
needed to walk from place to place.
2. MENTAL HEALTH
•Refers to harmony in the personal life in
order to maintain relationships with the rest
•This is the ability to learn and think clearly

and coherently. E.g., a person who is not
mentally fit (retarded) cannot plearn
something new at a pace in which an
ordinary normal person learns.
3. SOCIAL HEALTH
•This is the ability to make and maintain

acceptable interaction with other people.
E.g. to celebrate during festivals; to
mourn when a close family member dies;
to create and maintain friendship and
intimacy, etc.
4. EMOTIONAL HEALTH
This is the ability of expressing emotions in the
appropriate way, for example to fear, to be happy,
and to be angry.
The response of the body should be congruent with
that of the stimuli. Emotional health is related to
mental health and includes feelings.
It also means maintaining one’s own integrity in the
presence of stressful situation such as tension,
depression and anxiety.
5. SPIRITUAL HEALTH
Some people relate health with

religion; for others it has to do with
personal values, beliefs, principles
and ways of achieving mental
satisfaction, in which all are related
to their spiritual wellbeing.
DETERMINANTS OF HEALTH
Health or ill health is the result of a combination of
different factors.
The health field concept;
According to the “Health field” concept. There are
four major determinants of health or ill health.
1.Genetic/hereditary
2.Individual and lifestyle
3.Environment
4. Health care organization
1. GENETIC/HEREDITARY
For instance;
a. During marriage parents can be made aware of their
genetic component in order to overcome some risks that
could arise. Giving birth to deformed children.
b. Genetic Engineering: may have a role in cases like

Breast cancer, prostate cancer.
2. ENVIRONMENTAL FACTORS:
• This is all that which is external to the individual human host.
• They are factors outside the human body.
• They include:
a. Life support factors; food, water, air etc.
b. Physical factors; climate, Rain fall
c. Biological factors: microorganisms, toxins, Biological waste,
d. Psycho-social and economic e.g. Crowding, income level,
access to health care
e. Chemical factors: industrial wastes, agricultural wastes, air
pollution.
3. INDIVIDUAL BEHAVIOR/LIFE STYLE
This is an action that has a specific frequency, duration, and purpose,
whether conscious or unconscious.
It is associated with practice. It is what we do and how we act.

Recently life style by itself received an increased amount of attention as a
major determinant of health.
Life style of individuals affects their health directly or indirectly.

For example:
• Cigarette smoking and alcohol use
• Drugs and Unsafe sexual practice
• Eating contaminated food
INDIVIDUAL FACTORS CONTI..
•Diet and physical activity.

•Exposure to the sun.
• use of seat belt or child car seat.
4. HEALTH CARE ORGANIZATION
Health care organizations in terms of their resource in;
• Human power,
• Equipments,
• Money and determine the health of people.
It is also concerned with;
a) Availability of health service
• People living in areas where there is no access to health
service are affected by health problems and have lower
health status than those with accessible health services
HEALTH CARE ORGANIZATION
CONTI…..
b) Scarcity of Health Services leads to inefficient health
service and resulting in poor quality of health status of
people.
c) Acceptability of the service by the community.
d) Accessibility : in terms of physical distance, finance
etc
e) Quality of care that mainly focuses on the
comprehensiveness, continuity and integration of the
health care.
PUBLIC HEALTH
• Defined as the science and art of preventing

diseases, prolonging life, promoting health through
organized community efforts. It is concerned with
the health of the whole population and the
prevention of disease from which it suffers.
PUBLIC HEALTH CONTI…..
•It is the combination of sciences, skills

and beliefs that is directed to the
maintenance and improvement of the
health of all the people through
collective social actions.
DISEASE PREVENTION
DISEASE; DEFINITION,
-Any abnormal condition of the body or part of it,
arising from any cause.
- An illness which affects people, animals, or plants,
for example one which is caused by bacteria or
infection
ILLNESS; The state of being unwell- a specific
condition that prevents your body or mind from
working normally : a sickness or disease.
LEVELS OF DISEASE PREVENTION
1.PRIMARY LEVEL;
These are Strategies taken to prevent the onset of diseases/illness,
Includes; Activities directed to the host and environment.
1. Immunization
2. Proper waste disposal
3. Avoid risky sexual behaviors
4. Use of mosquito nets
5. Child spacing
6. Chemoprophylaxis
7. Food hygiene
8. Safe water supplies
9. Avoid alcohol /drug use
2. SECONDARY LEVEL OF DISEASES PREVENTION
• Strategies taken to help shorten episodes of
diseases/illness and prevent prognosis of diseases
though ill health. Activities directed to the
host./individual;
• Involves early diagnosis and treatment of diseases to
prevent complications through;
1. Screening and disease management
2. Blood samples case finding
3. steps to isolate cases and treat or immunize contacts
to prevent further epidemic outbreaks
3.TERTIARY LEVEL OF DISEASE PREVENTION
• These are action taken after onset of
disease/injury.
• Involves activities directed at the host but also at
the environment in order to promote
rehabilitation, restoration, and maintenance of
maximum function after the disease and its
complications have stabilized. Providing of
wheelchairs, special toilets, mattresses
• They help to limit disability and manage complication
TERTIARY LEVEL CONTI…
• Through rehabilitation an managing of pain and reduce suffering.
• Rehabilitation is the process of restoring a person’s social identity
by repossession of his/her normal roles and functions in society.
• It involves the restoration and maintenance of a patient’s physical,
psychological, social, emotional, and vocational abilities
• Conducting a full assessment of people with disabilities and suitable
support systems
• Establishing a clear care plan
• Providing measures and services to deliver the care plan
COMMUNITY
• Is a city, town or village where we live.
• Communities can also be defined by common cultural heritage,
language, and beliefs or shared interests.
• A collection of people who share some important features of their lives,
they interact with one another and share common social interests that
form the basis for a sense of unity or belonging (togetherness).
• It can be a society of people holding common rights and privileges (eg,

citizens of a town).
COMMUNITY conti……
• Examples of communities include people living
in the same town, members of a church,
members of a sports team, a community of
farmers, living under the same laws and
regulations (eg, a prison community).
COMMUNITY HEALTH
This is a field of public health that focuses on; Studying,

Protecting and Improving health within a community.
• It does not focus on a group of people with the same
shared characteristics/interests, like age, gender or
diagnosis, but on all people within a geographical
location.
• Community health covers a wide range of healthcare interventions,
including;
1. Health Promotion
2. Disease prevention
3. Treatment.
4. It also involves management and administration of care by CHWS
Community health workers (CHWs) .
People trained to offer essential healthcare at the community level.
They are health professionals with knowledge of specific characteristics
and developments of the community.
They are often members of the community themselves and play an
important role in the functioning of community care.
FACTORS AFFECTING THE HEALTH OF A COMMUNITY
1. Physical Determinants – Are factors affecting the health of a
community include:
• The geography (e.g. high land versus low land),
• The environment (e.g. manmade or natural catastrophes) and
• The industrial development (e.g. pollution occupational hazards)
2. Socio – cultural determinants – The socio- cultural factors

affecting the health of a community include the beliefs, traditions,
and social customs in the community. It also involves the
economy, politics and religion in the community.
FACTORS AFFECTING THE HEALTH OF A COMMUNITY conti…..
3. Community organization - Community organization include the community

size, arrangement and distribution of resources (“relations of productions’) .
4. Behavioral determinants- The behavioral determinants affecting health include

individual behavior and life style affecting the health of an individual and the
community. E.g. smoking, alcoholism and promiscuity
FACTORS AFFECTING COMMUNITY HEALTH
HEALTH PROMOTION
HEALTH PROMOTION
• Its a process of enabling people to increase control over and improve their
health .
• It involves activities intended to enhance individual and community health
well-being.
• It seeks to increase involvement and control of the individual and the
community in their own health.
• Acts to improve health and social welfare, and to reduce specific
determinants of diseases and risk factors that adversely affect the health and
well-being of the people.
HEALTH PROMOTION CONTI…
•Hp is key element in PH and is applicable in
communities, clinics and hospitals in raising
awareness and informing people about health and
lifestyle factors that might put them at risk of
diseases.
WAYS OF ACHIEVING HP
1. Addressing the population in health related issues , as well as people at risk for
specific diseases:
2. Directing action to risk factors or causes of illness or death;
3. Undertaking activities that seek to prevent risk factors in the community that
adversely affect health;
4. Promoting factors that contribute to a better condition of health of the
population;
5. Initiating actions against health hazards ,including communication ,education,
legislation ,fiscal measures, organizational change ,community development ,
and spontaneous local activities ;
6. Involving public participation in defining problems ,deciding on action;
7. Advocating relevant environmental health and social policy ;
8. Encouraging
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health professionals’ participation
N. Kimonye
in health education and health
HEALTH PROMOTION AND ADVOCACY
STRATEGIES/ ways OF HP
1. Advocacy
2. Enablement
3. Mediation intervention
• Advocacy involves mobilizing essential resources to
support any health issue or policy that affect the health
of the community or the constituency.
• Can be thro mass media, direct political lobbying and
community mobilization.
ADVOCACY CONTI….
It’s a combination of individual and social actions designed to gain political
commitment, policy support, social acceptance and systems support for a
particular health goal or programme. Health professionals have a major
responsibility to act as advocates for health at all levels in society.
• lobbying for equitable distribution in provision health care services.
• Being a voice to the voiceless in matters of health.
• Advocating for education and behavior change in the individuals and

groups and reduce health inequalities.
ENABLING:
• Enabling means taking action in partnership with individuals or

groups to empower them, through mobilization of human and
material resources, to promote and protect their health.
• Provision of clean drinking water, community water tanks
• Drilling of wells
• Provision of seeds , seedlings,
• collective cleaning of the environment, draining stagnant
water, clearing bushes around homestead, encouraging kitchen
gardens
MEDIATION
• Is a process through which the different interests (personal, social,
economic) of individuals and communities, and different sectors
(public and private) are reconciled in ways that promote and
protect health.
• Producing change in people’s lifestyles and living conditions
produces conflicts between the different sectors and interests in a
population. Such conflicts includes;
• concerns about access to, use and distribution of resources, or
constraints on individual or organizational practices. Reconciling
such conflicts in ways which promote health may require
considerable input from health promotion practitioners, including
the application of skills in advocacy for health.
10 ways to make your community healthier
1. Grow healthy food
• Encourage garden-fresh fruits and vegetables that grow
naturally in your backyard with homemade compost and
without synthetic pesticides or fertilizers are more
nutritious than refrigerated produce shipped from long
distances.
2. Make your community more walkable and bikeable.
• make your community healthier and safer, advocate to
make it more walkable and bikeable. Work with local
officials to create pedestrian and bike zones.
3. Shop local
• Buying from businesses in your community doesn’t just help them
thrive, it also helps you and your neighbors in a number of health-
promoting ways.
• If stores are nearby you can walk or bike there, improving your
physical fitness and reducing car use.
4. Test tap water
• Water should be safe for drinking.
• All public water agencies are required by law to list contaminant
levels, including heavy metals and pathogens. If your community
relies on private wells, periodic testing is even more important
because well water isn’t regulated.
5. Reduce neighborhood waste
• Litter isn’t just unaesthetic, it’s also dangerous for kids, wildlife and
everybody else in your neighborhood.
• Improperly discarded cigarette butts, old tires, junk food wrappers,
plastic soda rings, beer cans, chemicals and other trash can hurt or kill
animals, start fires, promote harmful bacteria and clog stormwater drains
(which causes flooding and contaminates groundwater
• Pick up trash when you see it or organize regular neighborhood
cleanups.
• Start a compost pile in your yard instead of dumping food scraps and
yard waste in the garbage,
• Set up a community compost center. Composting not only transforms
waste into healthy nutrient-rich soil for your yard and garden.
6. Plant trees
• Besides absorbing air pollutants and carbon dioxide, protecting against climate
change and providing oxygen, trees add to the health of humans, wildlife and
neighborhoods
• Plant trees in your yard and encourage your neighbors to do the same
• Consider organizing a community tree-planting project
7. Encourage development of parks and outdoor spaces
• Nature, trees and undeveloped fields and forests are good for your body and mind,
• Team up with community leaders to preserve green spaces, create parks, develop
biking and walking paths, and establish more outdoor recreational areas. If you live
in an urban neighborhood without many green spots encourage nearby schools,
churches and community centers to open their playgrounds and other recreational
spaces to local residents when not in use. Ask about indoor gyms, play areas, pools
and even hallways for community use in bad weather.
8. Volunteer in your community
• Join a group that’s working to make your community
healthier whether providing nutritious meals to older
neighbors, fighting poverty or improving the environment
in your area.
• Attending municipal meetings, writing letters to
community leaders, getting appointed or elected to a town
board such as the planning commission, and even running
for city council or other local office.
• You will not only be directly involved in decision making
about your communities growth but u will also boost your
physical and mental health..
9. Clean up your energy use
• Installing solar panels in your homes allows you to generate
electricity without producing harmful greenhouse gas
emissions.
10. Be neighborly
• Research shows that connecting with people around you
makes you healthier and boosts your lifespan.
• Studies show that having a strong social network helps cut
stress levels that can harm your immune system, coronary
arteries and gut function, plus it elevates stress-busting
hormones.
• Introduce yourself to neighbors and stay in regular touch.
Principles and Approaches in Health and Development
COMMUNITY DEVELOPMENT
• Community development is a process where people come together
to take action on what's important to them in order to enhance the
community social, economic and environmental objectives/goals.
1. Community development is about community members taking
the lead and deciding how they want their community to be and
how to make it a better place to live in.
2. It is rooted in the belief that all people should have access to
health, wellbeing, wealth, justice and opportunity.
COMMUNITY DEVELOPMENT APPROACH CONTI….
3.It is a blend of ‘bottom up’ action that is driven by community.
4. It is about removing the barriers that prevent people from participating in

issues that affect their lives.
5. Helps to improves the ability of communities to collectively make better
decisions about the use of resources such as infrastructure, labor and knowledge.
6. A community development approach can be applied to many different areas

including; Health, education, employment, enterprise development,
infrastructure and town planning.
PRINCIPLES OF COMMUNITY DEVELOPMENT
1. Promote active and representative citizen participation.
2. Engage community members in issue identification.
3. Help community members understand economic, social,
political, environmental, and psychological effects.
4. Build upon community assets and emphasize shared
leadership.
5. Seek alternatives to any efforts that are likely to have
adverse impacts.
6. Increase leadership capacity, skills, confidence, and
aspirations in the community development process
STEPS IN COMMUNITY DEVELOPMENT PROBLEM
SOLVING
1. Identify the problem, e.g hunger, drought &famine,

flooding, poverty
2. Identify the stake holders, e.g gvt, ngos, cbos, fbos, amref
3. Identify strategies, providing relief food, digging wells,
building dams, building gabbions
4. Identify resources, human ,food ,unga, biscuits ,maize,
beans, oil
5. Implement
6. Monitor and evaluate
COMMUNITY STRATEGY
Communtiy – city, town, village where we live.
Strategy- a plan of action designed to achieve a long-term goal in the

community e.g increasing access to health services, reducing MCH
mortality and morbidity, drilling bore holes, planting tress, planting
grass along river banks, increasing immunization coverage, provide
seedlings
Community strategy
is a long-term plan for the economic, social and environmental well-
being of a local authority area.
GOALS OF COMMUNITY STRATEGY
• The overall goal of the community strategy is to enhance

community access to health care in order to improve
productivity in terms of;
1. Reducing poverty,
2. Reducing hunger,
3. Reducing Maternal and child deaths
4. Improving education performance across all the stages of the
life cycle.
• Non-governmental and community based organizations (CBOs)
have also been involved in the implementation of the strategy at
grass-root levels.
COMMUNITY STRATEGY CONTI…
•Communities are at the foundation of affordable,
equitable and effective health care. The
community represents level 1 in the Kenya
Essential Package for Health (KEPH) proposed in
the second National Health Sector Strategic Plan
2005–2010 (NHSSP II).
OBJECTIVES OF THE COMMUNITY STRATEGY GUIDELINES
1. To improve the health status of Kenyan communities through the
initiation and implementation of life-cycle focused health actions at
level 1.
2. Establishing community health service linkage structures through
effective decentralization and partnership for the implementation.
3. Launching and managing the Community Strategy.
4. Building the capacity of the community health extension workers
(CHEWs) and community health workers (CHWs) to provide services
at level 1.
5. Establishing a communication strategy that effectively improves
health seeking behaviour.
6. Providing level 1 services.
7. Establishing mechanisms for evidence-based dialogue informed by
community and facility based information systems.
COMMUNITY BASED KENYA ESSENTIAL PACKAGE FOR
HEALTH (KEPH)
Initiating kephs
Its the package of services that the government is providing or
is aspiring to provide to its citizens in an equitable manner.
Goals of essential package:
1. Improved efficiency,
2. Equity,
3. Political empowerment,
4. Accountability,
5. More effective health care.
LAUNCHING THE COMMUNITY STRATEGY – COMMUNITY ENTRY
• Steps in community entry
• 1: Create awareness. Awareness creation among district leaders is undertaken
through the existing structures and officials including the District Commissioner
(DC), the District Development Committee (DDC) and relevant line ministries.
• 2: Conduct situation analysis and household registration
• Activity 1: Review the history of the community over ten years – events,
achievements and challenges.
• Activity2: Carry out household registration and mapping, creating the village
register.
• Activity 3: Review community resources, assets, manpower, networks, etc.
Activity 4: Map the community health situation and the causes, thus summarizing
the community profile, based on the houeshold register (population structure,
environment, immunization, place of delivery, ITNs, use of family planning,
diseases,
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3: Plan actions for improving health status.
• Activity 5: Facilitate dialogue on the community health
situation (why, what has been done, what more can be done).
• Activity 6: Identify action options, select doable options.
• Activity 7: Outline actions by time frame for various groups
and individuals.
• Establish information systems to monitor change.

• Activity 8:Analyse the information gathered by the CHWs
and supporting task groups.
• Activity 9: Facilitate regular evidence-based dialogue and
community days.
• Activity 10: Disseminate analysed information for dialogue,
advocacy and social mobilization.
THE ESSENTIAL ELEMENTS OF THE COMMUNITY STRATEGY
LINKAGE MECHANISMS AND STRUCTURES

It is the members of households and families who are both the primary targets and the
primary implementers of level 1 services.
The NHSSP 11 recognizes that the health facilities at levels 2 and 3 will improve the
effectiveness of their service delivery if they work closely with their catchment
communities through various committees in the community strategy framework that
link to service delivery at the household level.
1. COMMUNITY UNIT - comprises of approximately 1,000 households or 5,000
people who live in the same geographical area, sharing resources and challenges.
- In most rural areas such a unit would be a sub-location, the lowest administrative unit.
- The number of households in a community unit will determine the number of
community health workers to be selected, so that 1 CHW serves approximately 20
households.
- The household level consists of individuals associated with and usually headed by the
household
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• They have contacts with the CHWs and the formal health system
where they seek and utilize health services.
• The household forms the first level of care that is universally
available.
• The community units are organized in villages and other interest
groups that are responsible for identifying and supporting the CHW.
• The CHWs report to the CHC through the CHEW who is the
secretary to the committee. All the villages within the community unit
should be represented on the CHC.
• The community level increases efficiency in improving health
outcomes. This includes nurturing economic empowerment and
transformation, enhancing access to the means of production and
marketing, and paying attention to the social determinants of health.
COMMUNITY STRATEGY LINKAGE STRUCTURE
2. THE WORK FORCE; CATEGORIES OF WORKERS AT
LEVEL 1
According to the NHSSP II there are two categories of

personnel promoting health at the community level.
1. These are community health workers (CHWs), who
work on a volunteer basis,
2. and community health extension workers (CHEWs),
who are MOH employees. The community health
committees (CHCs) manage the two.
COMMUNITY HEALTH WORKERS
Characteristics of CHWs;
• Mature, responsible and respected members of the community, men or women
chosen by the community to provide basic health care.
• They should be good communicators
• leaders who have shown signs of healthy practices as a parent or caregiver in their
own household.
• The Roles and Functions of CHWs / Resonsibilities
• Their main role is to promote good health by:
1. Teaching the community how to improve health and prevent illness by adopting
healthy practices.
2. Treating common ailments and minor injuries, as first aid, with the support and
guidance of the CHEW.
3. Tending the CHW kit with supplies provided through a revolving fund generated
from users.
4. Referring
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cases to the nearest health facilities.
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5. Promoting care seeking and compliance with treatment and
advice.
6. Visiting homes to determine the health situation and dialogue

with household members to undertake the necessary action for
improvement.
7.Promoting appropriate home care for the sick with the support of
the CHEWs and level 2 and 3 facilities.
8.Participating in monthly community unit health dialogue and action

days organized by CHEWs and CHCs.
9.Being available to the community to respond to questions and

provide advice.
10.Being an example and model of good health behaviour.
11.Motivating members of the community to adopt health
promoting practices.
12. Organizing, mobilizing and leading village health
activities.
13.Maintaining village registers and keeping records of
community health related events.
14. Reporting to the CHEW on the activities they have been
involved in and any specific health problems they have
encountered that need to be brought to the attention of higher
levels.
HOW A CHW IS SELECTED
1. Be a permanent resident in the area.
2. Able to read and write, and enthusiastic to learn
more.
3. Concerned about the welfare of the people.
4. Willing to volunteer.
5. Physically fit.
THE CHEWs
• Are trained health personnel with certification in nursing or public health. They
will supervise CHWs and will be Ministry of Health employees.
• The Roles and Functions of CHEWs
• Their function is to facilitate the provision of quality services by CHWs and to
ensure a smooth referral mechanism linking the community to level 2 and 3
facilities.
• The CHEWs’ main functions include:
1. Overseeing the selection of CHWs.
2. Organizing and facilitating CHW training.
3. Monitoring the management of the CHWs’ kit.
4. Supporting the CHWs in assigned tasks and coaching them to ensure
achievement of desired outputs and outcomes.
5. Collating information gathered by the CHWs to display
summaries at strategic sites to provide relevant feedback as
well as material for dialogue at household and community
levels.
6. Compiling reports from CHWs and forwarding to level 2
and 3 management committees.
7. Receiving feedback from level 2 and 3 facilities and passing
it on the CHCs and CHWs through dialogue and planning that
leads to actions to improve identified issues.
8. Following up and monitoring actions emerging from
dialogue and planning sessions to ensure implementation.
How a CHEW Is Selected
• The DHMT takes the lead in the recruitment of the
CHEWs with the support of level 3 management
committees. Community health committee (CHC)
members will be informed about the roles and
functions of CHEWs by the DHMT to enable them to
make informed decisions on the type of persons they
elect as CHEWs for their community
The CHEW should be received by the community at a
community unit meeting that is open to all members.
Characteristics of CHEW
1. Having suitable qualification in nursing or public health.
2. Being a mature and responsible person.
3. Being acceptable and respected by the whole community.
4. Being a good communicator.
5. Being able to work with people of diverse backgrounds.
6. Being willing to teach and mentor others.
7. Being able to be available to the service consumers
according to demand.
3.THE COMMUNITY HEALTH COMMITTEE (CHC)
• CHC is a group of people who are charged with the
responsibility of leading community health action at the
community unit level.
• Its the health governance structure closest to the community.
• The CHC should be elected at the Assistant Chief’s baraza
under the chair (a respected community member of the
assistant chief), secretary (the CHEW) and treasurer (a
CHW).
• Its elected in such a way that all the villages in the
community unit are represented.
• The committee is composed of 8–12 people selected from the
community. Membership must be sensitive to gender balance and
equal representation of villages and all interest groups in the
community.
• There should be nine additional members, to include

representatives of: youth, faith groups, women’s groups, NGOs,
people living with HIV and AIDS (PLWHAs), people with
disability (PWDs), and relevant others. At least one-third of the
committee members should be women.
• The CHC has regular meetings that relate to the 100-day

improvement cycle as well as community dialogue and action days.
ROLE AND FUNCTIONS OF CHC/ RESPONSIBILITIES
1. Identifying community health priorities through regular dialogue.
2. Planning community health actions.
3. Participating in community health actions
4. Monitoring and reporting on planned health actions.
5. Mobilizing resources for health action.
6. Coordinating CHW activities.
7. Organizing and implementing community health days.
8. Reporting to level 2 on priority diseases and other health
conditions.
9. Leading community outreach and campaign initiatives.
10.Advocating for good health in the community .
MEETINGS AND AGENDA FOR CHC
• The committee should meet at least monthly to receive reports from the villages
to enable the CHEW to compile monthly reports for level 2 or 3 management
committees.
• The standing agenda should include:
• Review of actions agreed on in the previous meeting and progress made in their
implementation.
• Review of the chalkboard records of key indicators by village (immunizations,
deliveries, cases of fever and diarrhoea in children, the chronically ill, use of
insecticide treated nets [ITNs], maternal and child mortality).
• Identification of and dialogue on areas needing improvement and planning
action to improve.
• Advocacy issues to be taken up to the next level.
• Recognition of the CHW of the month, based on data.
4. Providing structures for community action for health, emphasizing
key household health practices.
5. Providing a channel for external assistance to be continued where
necessary. 6. Providing a channel of communication with the levels 2
and 3 management committees, divisional health forum and the
district health stakeholder forum.
7. Facilitating community change by actively advocating the CHWs’
work, backing them up in their tasks.
8. Monitoring trends of key community health data and reporting to
level 2 and 3 management committees for quarterly dialogue, planning
and action.
9. Overseeing CHW activities and appraising CHWs in preparation
for recognition during community health days or forums at various
levels.
10. Seeking and mobilizing local human and financial resources for
health action, on the basis of priorities identified by available data.
HOW A CHC IS SELECTED
1. The selection of members to the CHC is led out by the
administrative head of the community unit, an Assistant Chief.
2. The respective level 3 management committee facilitates the
process by sending representatives to attend meetings organized
by the administrator for the purpose of selecting CHC members.
3. Ability to read and write.
4. Demonstrated leadership qualities.
5. Demonstrated role model in positive health practices.
Representative of a constituency in the community (village,
faith communities, youth, disabled, women, men , elderly etc.).
KEY HEALTH MESSAGES BY COHORTS FOR LEVEL 1
Communication messages
Effective communication is a two-way process
Sender Message Receiver
feedback
• Effective communication requires a message, the sender of the message, the

receiver of the message, and feedback from the receiver to the sender and back
again. There are many different ways of communicating, whether you are
working person-to-person within a community, advocating with political leaders
or developing messages to be publicized in the mass media,
Basic principles when conveying a health message;
1. Know who needs the information and find out about their living conditions,
language, customs and level of knowledge.
2. When adapting or translating the messages, use language that people
understand.
4. Make sure the audience understands the information and knows how to put it
into practice
5. Make the message relevant to people’s lives, Find ways to make the messages
interesting and meaningful to each household and community, such as by
illustrating them with local examples and stories.
6. Select the communication channels and media that are most effective at
reaching the target audience , use a mix of channels and media so that the
audience receives the message repeatedly and in many variations.
7. Repeat the information to reinforce it.
THE SIX LIFE CYCLE COHORTS
• The Kenya Essential Package for Health defines six life-cycle
cohorts namely;
1. Pregnancy, delivery and the newborn (first 2 weeks of life)

2. Early childhood (2 weeks to 5 years)
3. Late childhood (6 to 12 years)
4. Adolescence (13-24 years)
5. Adult (25-59 years)
6. Elderly (over 60 years)
KEY HEALTH MESSAGES BY COHORTS FOR LEVEL 1
COHORT 1: Pregnancy, Delivery and Newborn
1. Know the warning signs during pregnancy and childbirth and have plans and
resources for getting immediate skilled help.
2. Remind community members that physical abuse of women for any reason is
dangerous and unacceptable.
3. Encourage pregnant women to attend at least four ANC visits before delivery.
4. Encourage all pregnant mothers to sleep under insecticide treated nets (ITNs) to
prevent malaria.
5. Help a pregnant woman prepare a birth plan, that is, what to do when the time
comes.
6. Encourage all pregnant women to deliver with the assistance of skilled medical
personnel.
7. Recognize the following risk factors in pregnancy:
An interval of less than two years since an earlier birth.
• Girls who are under 18 and women who are over 35 with first pregnancy
are at risk.
• A girl who is under 18 or a woman who is over 35 years of age with first
pregnancy.
• The woman has already had four or more deliveries.
• The woman has had a previous premature birth or baby weighing less than 2
kilograms at birth.
• The woman has had a previous difficult or Caesarean birth.
• The woman has had a previous miscarriage or stillbirth.
• Those who smoke, drink alcohol
7. Recognize the following warning/danger signs during pregnancy
and take action:
• Anaemia, paleness inside the eyelids, or being tired or easily out-
of-breath. Swelling of legs, arms or face.
• The foetus moves very little or not at all.
• Spotting or bleeding from the vagina during pregnancy (or profuse
or persistent bleeding after delivery).
• Severe headaches or abdominal pains.
• Severe or persistent vomiting.
• High fever.
• The water breaks before due time for delivery.
• Convulsions.
• Prolonged labour.
8. Encourage mothers to get immunized against tetanus.
9. Immunize all newborn children against the preventable diseases.
10 Ensure all births are notified and registered.
11. Remember that the child health card is an important document
that must be kept safely to monitor growth and immunization and
other services to the child.
12. Wash hands before feeding or breastfeeding, after cleaning the
baby’s faeces, and after using the toilet.
13. Breastfeed your baby within an hour of birth.
14. Follow instructions given at the health facility FOR EACH SERVICE.
15. Involve fathers in the reproductive health of the family.
COHORT 2; : EARLY CHILDHOOD (2 WEEKS TO 5 YEARS
1. Immunize all children during the first year of life to protect against diseases.
2. Give all children Vitamin A supplementation.
3. Monitor the child’s growth every month from birth to age two, and thereafter
when a child has a health problem.
4. Recognize warning signs showing that the child’s growth and development are
faltering.
5. Give the child proper mix of foods in three meals a day.
6. Provide stimulation and affection to ensure social, physical and intellectual
development.
7. Provide exclusive breastfeeding to the infant for the first six months.
8. Introduce weaning foods to infants from the age of six months, but continue
breastfeeding through the child’s second year and beyond.
9. Keep the child health card safe. It is an important document that
has all the information about child immunization and growth.
10. Incase the child has diarrhoea, give the child extra fluids as well
as regular foods.
11. Give the child an extra meal a day for at least two weeks while
recovering from diarrhoea.
12. To prevent diarrhoea, wash hands thoroughly with soap or ash
and water after contact with faeces and before touching food or
feeding children.
13. Keep a child with cough or cold warm and continue normal
feeding and drinking.
14. Ensure children sleep under ITNs to prevent malaria.
15. Have a child with a fever examined immediately by a
trained health worker and receive an appropriate anti-
malaria treatment as soon as possible.
16. Watch young children when playing and keep their
environment safe to avoid accidents.
17. Do not use drinking bottles to store poisons,
medicines, bleach, acid or liquid fuels such as paraffin.
All such liquids and materials should be kept in clearly
marked containers out of children’s sight and reach.
18. Involve fathers in the care of their children.
COHORT 3: LATE CHILDHOOD (6—12 YEARS)
1. Ensure all children attend primary school.
2. Ensure children receive an adequate balanced diet, three meals a day.
3. Respond to child’s need for care by playing, talking with and providing
a stimulating environment to promote mental and psychological
development. Seek health care as soon as an illness appears or is
suspected.
4. Insist that children sleep under ITNs to prevent malaria.
5. Treat all drinking water at the point of use.
6. Wash hands after visiting toilets and before eating in school and at
home. Introduce sexuality education at focal points (home, church and
school).
7. Follow the instructions given at the health facility for each service.
COHORT 4: Adolescence and Youth (13—24 Years)
1. Seek health care as soon as an illness appears or is suspected.
2. Sleep under ITNs to prevent malaria.
3. Treat water at point of use.
4. Remember that abstinence is the safest way to prevent STDs and HIV
infection.
5. Delay sexual activity as long as possible.
6. Use protection during sex if one must have sex.
7. Follow all the instructions given at the health facility for each service.
8. Avoid the use of alcohol, cigarettes and drugs.
9. Involve both parents in the care of their adolescents and in reproductive
health of the family.
10. Encourage parents to discuss sexuality issues with their adolescent children.
11. Prevent unwanted pregnancy through family planning.
COHORT 5: ADULTS 25—59 YEARS
1. Remember that all people are at risk of HIV/ AIDS; use condoms to
reduce this risk.
2. If you suspect that you might be infected with HIV, contact a health
worker or a VCT centre to receive confidential counselling and
testing.
3. Reduce the risk of getting HIV through sex by not having sex at all
or by being faithful to one partner, whose only partner is you.(apply
the ABC principle)
4. Parents and teachers, help young people protect themselves from
HIV/AIDS by talking with them about how to avoid getting and
spreading the disease.
5. Discuss sexuality and HIV/AIDS with children early enough.
6. Get information on lifestyle related illnesses.
7. Check regularly for non-communicable illnesses like

diabetes, hypertension,
8. Seek health care as soon as illness appears or is
suspected.
9. Sleep under ITNs to prevent malaria.
10. Treat drinking water at the point of use

COHORT 6: Elderly Persons (over 60 Years)
1. Seek health care as soon as illness appears or is
suspected.
2. Use ITNs when sleeping to prevent malaria.
3. Treat drinking water at point of use.
4. Follow instructions given at the health facility for any
service.
5. Take regular exercise to the extent of ability.
6. Go for regular medical check u
SERVICE DELIVERY AT LEVEL 1
• NHSSP II organizes health services into six levels of delivery

recognizing the Kenya Essential Package for Health (KEPH) over
the six stages in the life cycle of human development.
• The five key policy objectives of the strategy highlight equity,
access, effectiveness, efficiency, partnerships and resource
mobilization as the pillars of improved health care.
• At the community level, level 1, the main focus is to promote
positive health behaviours and to create demand for health
services that are provided at other levels of health care.
LEVELS OF SERVICE DELIVERY
Teaching and referral hospitals Level 6
County hospitals Level 5
Sub county hospitals Level 4
Health centres/maternity/nursing homes Level 3
Dispensary Level 2
Community Level 1
Specialized services from level 1 to level 6
KEY COMPONENTS OF KEPH AT LEVEL 1
1. Reproductive Health
• Maternal mortality remains unacceptably high in Kenya
(414 maternal deaths per 100,000 live births), with almost
all of the deaths being the result of well-known and
preventable causes such as haemorrhage, eclampsia,
obstructed labour and puerperal sepsis.
• These common causes of maternal and neonatal deaths
have been observed to be ;
1. due to unsafe traditional practices during delivery.
• Such practices need to be checked to ensure that clean
hands, clean delivery and clean instruments for cutting the
cord are maintained in order to minimize complications.
THE OTHER CONTRIBUTING FACTORS ARE THE
THREE DELAYS:
2. Delay by the pregnant mother in deciding to seek
care for pregnancy related.
3. Delay in actually reaching the care facility, which is
usually caused by lack of transport or unfavourable
infrastructure.
4. Delay in being examined and receiving appropriate
definitive treatment once at the health facility. This is
one of the most tragic issues in maternal mortality
2. HIV/AIDS PREVENTION AND CARE
• At the community level the major obstacle to effective

HIV/AIDS care and control is lack of access to different
services, e.g., voluntary counselling and testing (VCT),
laboratory services and anti-retroviral therapy (ART
Services are restricted to major hospitals and big urban
health institutions.).
• The standard care in ART requires laboratory

monitoring of response, yet these tests are expensive
and available only at a limited number of health
facilities.
• Services to prevent mother-to-child transmission (PMTCT) of
HIV are being systematically integrated into maternal and
child health (MCH) and family planning services, and thus
guided by standards of care that have been developed,
including codes and ethics of practice, clinical guidelines, and
guidelines for operational procedures.
• The goal of the PMTCT programme is to increase access to
PMTCT by developing capacity of health workers, expanding
facilities, encouraging utilization of services, and
strengthening information and reporting systems
• These objectives will not be achieved without adequate
information, education and communication (IEC) at
household and community levels.
•MCH/FP programmes are in a unique position to
assist in HIV/AIDS control as well as care. There
is long experience within MCH/FP programmes
dealing with such matters as sexuality,
counselling, contraception methods, care during
pregnancy and childbirth, and breastfeeding, all of
which are closely related to risk and prevention of
HIV transmission.
3. MALARIA
• The greatest burden of malarial disease and death lies with
the poor, who also have the least access to interventions
against malaria.
• Effective interventions against malaria are available, yet the
burden persists, because most people at risk of malaria have
little or no access to them for reasons including those of
distance and affordability.
• Poor access to public health facilities is a recognized
constraint to the provision of early treatment. A large
proportion of people who are ill with malaria are treated at
home, with medicines from shops – often inappropriate
medicines.
4. TUBERCULOSIS
• It is estimated that 35% of the Kenyan population is infected with
the TB bacillus (Mycobacterium tuberculosis), the causative
agent of TB. The majority of these people will never develop
disease because their immune (defence) systems are able to
prevent the bacillus from multiplying and causing disease.
• Tuberculosis is a disease that usually attacks the lungs (80%), but
can affect almost any part of the body except the hair and the
nails.
• TB is curable even in people living with HIV, as long as the
diagnosis is made early and treatment is prescribed and taken
adequately.
5.COMMUNITY IMCI
• The community component is well developed in the concept of
integrated management of childhood illness (IMCI). The households
are engaged in the 20 key care practices that have been identified and
agreed upon and hence introduced to the households through dialogue
with CHWs. The households are thus strengthened to improve the
health status of their children, mostly those in the second cohort. The
critical components include:
• disease prevention,
• care of the sick child,
• care seeking and compliance, and
• promotion of early childhood growth and development.
COMMUNITY BASED PRIMARY HEALTH CARE(PHC)
• Healthcare system - an organized plan of health

services. Or the
organization of people, institutions, and resources that
deliver health care services to meet the health needs of
target populations.
• Community-based health care is care for people of all
ages who need health care assistance at home.
Community care services include home support,
nursing, physiotherapy and other rehabilitation services.
e.g -A nurse visits an elderly person at home to help with
medication.
-A home support worker helps a child in a wheel chair with
personal care, such as bathing.
PRIMARY HEALTH CARE
•Is the essential health care made universally

accessible and acceptable to individuals through
full participation and at a cost the Community and
country can afford.
•It is an approach to health beyond the traditional
health care system that focuses on health equity-
producing social policy.
ALMA ATA DECLARATION (1978)
• The Alma-Ata Declaration,USSR of 1978 at a conference
on PHC emerged as a major milestone of the twentieth
century in the field of public health, and it identified PHC
as the key to the attainment of the goal of Health for All by
the year 2000.
• It defined 8 key elements for attaining health for all;
• These elements were : education, food supply, safe water,
maternal and child health (including family planning),
immunization, prevention and control of endemic diseases,
appropriate treatment of common diseases and injuries, and
provision of essential drugs.
Essential Elements of Primary Health Care (PHC):
There are 8 elements of primary-health care (PHC).
• E– Education concerning prevailing health problems and the methods of
identifying, preventing and controlling them.
• L– Locally endemic disease prevention and control.
• E– Expanded programme of immunization against major
infectious diseases.
• M– Maternal and child health care including family planning.
• E– Essential drugs supplies
• N– Nutritional food supplement, an adequate supply of safe and basic
nutrition.
• T– Treatment of communicable and non-communicable disease and
promotion of mental health.
• S– Safe water and sanitation.
Extended Elements in 21st Century:
1. Expended options of immunizations.
2. Reproductive health needs.
3. Provision of essential technologies for health.
4. Health promotion.
5. Prevention and control of non-communicable diseases.
6. Food safety and provision of selected food supplements
PRINCIPLES/OBJECTIVES OF PHC
Basic objectives that should be formulated in national policies in order
to launch and sustain PHC as part of a comprehensive health system
and coordination with other sectors.
1. Improvement in the level of health care of the community.
2. Favorable population growth structure.
3. Reduction in the prevalence of preventable, communicable
and other disease.
4. Reduction in morbidity and mortality rates especially among
infants and children.
5. Extension of essential health services with priority given to the
undeserved sectors.
6. Improvement in basic sanitation.
7. Development of the capability of the community aimed at self-
reliance.
8. Maximizing the contribution of the other sectors for the social and
economic development of the community.
9. Equitable distribution of health care–primary care and other
services to meet the main health problems in a community must be
provided equally to all individuals irrespective of their gender, age, and
caste, urban/rural and social class.
10. Community participation-comprehensive healthcare relies on
adequate number and distribution of trained physicians, nurses, allied
health professions, community health workers and others working as a
health team and supported at the local and referral levels.
11. Multi-sectional approach-recognition that health cannot be
improved by intervention within just the formal health sector;
other sectors are equally important in promoting the health
and self- reliance of communities.
12. Use of appropriate technology- medical technology should

be provided that accessible, affordable, feasible and culturally
acceptable to the community.
Communication
• Communication is the act of sharing information from one
person to another or group of people.
• Also defined as the process by which people share ideas,
experience, knowledge and feelings through the transmission
of symbolic messages
• communication is absolutely necessary when building
relationships, sharing ideas, delegating responsibilities,
managing a team and much more.
• For health workers there is need to communicate effectively
with the patient otherwise the message, no matter how good,
will not be heard or heeded.
MOST COMMON WAYS OF COMMUNICATING
1. Spoken word
2. Written word
3. Drawing
4. Pointing/using hands
5. Using equipments, comp, phone etc
6. Eye conduct
7. Facial expression
8. Body language
9. Touch
Types of Communication
1. Downwards Communication : Highly Directive, from Senior to
subordinates, to assign duties, give instructions, to inform to offer
feed back, approval to highlight problems etc.
2. Upwards Communications : It is non directive in nature from

down below, to give feedback, to inform about progress/problems,
seeking approvals.
3. Lateral or Horizontal Communication: Among colleagues,

peers at same level for information sharing for coordination, to save
time
CHANNELS OF COMMUNICATION
• These the means by which the message reaches its
audience.
• The means of communication are usually spoken or
written words, pictures or symbols.
• But we also give information through body language,
gestures, and looks, facial expressions can show how
we feel and what we think about an issue or another
person.
EXAMPLES OF CHANNELS OF COMMUNICATION
1. Face to face or inter personal communication

2. Broadcast media communication
3. Mobile communications
4. Electronic communication channels.
5. written methods of communication. (news paper, journals,
billboard etc.
1. FACE TO FACE /INTERPERSONAL COMMUNICATION
• Is one of the richest channels of communication that can be used to

pass messages between people, within an organization or community
• Is a person to person, two-way, verbal and non verbal interaction that

includes the sharing of information and feelings between individuals
or in small groups that establish trusting relationships.
• Interpersonal communication can be in the form of lecture, role play,

group discussion, drama, meetings, counseling.
• In addition, visual aids, such as posters, charts, flyers, pamphlets, and

audio visual aids such as, video, films, radio, taped messages. These
can be used to reinforce IPC.
INTERPERSONAL COMMUNICATION CONTI…..
• IPC in health care settings takes place between service

providers and their clients and members of the
community and is a key element in maximizing access to
quality care.
• IPC includes the process of education, motivation and
counseling
• Examples can be community outreach events, visiting target
audience members in their homes, talking to clients in health
care setting
1. Education
This is the process of providing factual information and
clarification about a topic to an individual or group.
2. Counseling is the act of helping a client to make her or his
own decision, by providing unbiased information and asking
questions about what the client wants and what the client thinks
that he or she can do.
It is a confidential dialogue between a medical provider and a
client that helps a client to define his or her feelings and to cope
with stress. Usually people need training to be a good
counselor.
CCCs of effective counselling
1. Client-centered
2. Interactive
3. Private and confident
4. Individualized
APPLICATION OF IPC IN HEALTH CARE SETTING
1. History taking: Each intervention begins with a thorough

analysis of the existing situation in a given field.
2. Channeling: The objective of channeling is to motivate

community to utilize the preventive and curative health
services offered.
This is carried out through one-to-one communication and
group education sessions.
4. Counseling:
The objectives of counseling are:
• To share information about the disease and treatment options
• To promote compliance through negotiation with the client over
positive treatment and behavior changes.
• To help clients make informed decisions
4. Dialogue with Patients/clients:

the objective of dialogue is to:
• Determine what services are needed by the clients and what the
best way to provide those services is.
• Management of diseases, conditions and rehabilitation of patients
and clients when they go to health institutions.
5- Overall Socio-Emotional Communication:
The objectives of effective socio-emotional
communication are:
• To establish and maintain a positive rapport with the

patient throughout the encounter.
• To enhance patients to open up and comply. Socio-

emotional skills include the ability to use statements to
show empathy, concern, positive regards, and to give
reassurance.
2. BROADCAST MEDIA COMMUNICATIONS
Audio visual communication by use of TV, radio, and
loud speakers all fall within the broadcast media
communication channel. These types of media should be
used when addressing a mass audience. Passing health
messages. Going for VCT, FP methods, use of Condoms,
behavioral changes to reduce lifestyle diseases,
screening for cancers, immunization coverage
3. MOBILE COMMUNICATIONS CHANNELS
• A mobile communication channel e.g use of phone should
be used when a private or more complex message needs to
be relayed to an individual or small group.
• A mobile channel allows for an interactive exchange and
gives the recipient the added benefit of interpreting the
speaker's tone along with the message.
• Some people may opt to use this channel versus a face-to-
face channel to save on the time and effort it would take to
coordinate a face-to-face meeting.
4. ELECTRONIC COMMUNICATIONS CHANNELS
• This includes email, Internet, intranet and social media
platforms. This channel can be used for one-on-one,
group or mass communication. It is a less personal
method of communication but more efficient. When
using this channel, care must be taken to create
messages with clarity and to avoid the use of sarcasm
and innuendo.
5. WRITTEN METHODS OF COMMUNICATION
• Written communication should be used when a message that
does not require interaction needs to be communicated to a
person or group. letters, pamphlets, memos, manuals, notices
and announcements are all messages that work well for this
channel. Recipients may follow up through an electronic or
face-to-face channel if questions arise about a written
message.
Skills in communication
•The basic communication skills necessary for
effective communication in any environment
include;
1. Reading
2. writing
3. speaking and
4. listening
1. Speaking
• Uttering words with the ordinary voice/talking.
• to express thoughts, opinions, or feelings orally.
• to extend a greeting.
• to be friendly enough to engage in conversation
• we can also categorize the non-verbal, non-written
expressions as forms of speaking like music or dance
in this category.
• this category includes anything that has to do with you
expressing yourself in ways other than through written
words or imagery.
2. Writing
• To form (characters, symbols, etc.) on a surface with an
instrument (such as a pen).
• This category will include all written verbal communication
skills. So written letters, signs, stories, plays, screenplays,
novels and much more are accounted for.
• But it also includes graphics of any kind. Logos, icons,
drawings, pictures and so on all help us express ourselves in
ways that do not involve speaking.
3 Listening
• Also referred to as “understanding” and “listening.”
•Its the ability to comprehend someone else’s non-
written communication. This includes knowing
what the words they utter mean and also factoring
in how their non-verbal communication and their
particular personal and social characteristics shed
light on that meaning.
4. Reading
• This is the ability to make sense of written
communications of any kind.
• It involves not only recognizing the words, but being
able to extract their meaning so as to attain
comprehension.
• It could also be applied to the ability to appreciate and
analyze graphical artistic works such as those
mentioned under the category of “Writing.”
KEY ELEMENTS OF COMMUNICATION
1. Message
2. Source (sender)
3. Channel
4. Receiver
5. Feedback
The Communication Process
Medium
Barrier
SENDER RECEIVER
(encodes) (decodes)
Barrier
Feedback/Response
BARRIERS TO EFFECTIVE COMMUNICATION
A communication barrier is anything that prevents us from

receiving and understanding the messages.
1. Values and beliefs/culture
2. Sex/gender and age
3. Economic status
4. Educational level
5. Physical barriers
6. Attitude
7. Timing
8. Understanding of message
9. Trust
OVERCOMING BARRIERS TO COMMUNICATION
1. Learn to use feedback well.

2. Be sensitive to receiver’s point of view.
3. Listen to UNDERSTAND!
4. Use direct, simple language, or at least use language
appropriate to the receiver.
5. Use proper channel(s). Learn to use channels well.
6. Learn to use supportive communication, not defensive
communication.
CHARACTERISTICS OF EFFECTIVE COMMUNICATIONS
The message should be:
1. Clear and concise
2. Accurate
3. Relevant to the needs of the receiver
4. Timely
5. Meaningful
6. Applicable to the situation
CCCs of effective communications
The receiver should:
•Be aware, interested, and willing to accept the
message
•Listen attentively
•Understand the value of the message
•Provide feedback
CCCs of effective communications conti….
The sender should :
1. Know the subject well

2. Be interested in the subject
3. Know the audience members and establish a
rapport with them
4. Speak at the level of the receiver
5. Choose an appropriate communication channel
CHARACTERISTICS OF EFFECTIVE COMMUNICATOR
An effective verbal An effective nonverbal

communicator: communicator:
1. Clarifies 1. Relaxes
2. Listens 2. Opens up
3. Encourages empathically 3. Leans toward the other
4. Acknowledges person
5. Restates/repeats 4. Establishes eye contact
5. Shows appropriate facial
expressions
COMMUNICATION PROGRAMME DESIGN/STRATEGY
Strategy- A plan of action designed to achieve a vision.

CPS- A detailed plan for achieving success in situations, such as behaviour
change, increase utilization of health services.
7cs of communication.
1. Clear
2. Concise
3. Concrete
4. Correct
5. Coherent
6. Complete
7. courteous
Clear - be clear about your goal /message, what is your purpose in
communicating.
Make sure your message is short and easy to understand.
2. Concise – stick to the point and keep it brief.
• your audience doesn’t need to read six sentences when u can make them
three.
• Delete unnecessary sentences, check for any repeatition.
3. Concrete – clear picture of the message, giving details and facts about the
message
4. Correct – Correct message fits your audience.
• Use technical terms that fits your audience level of education.
• Check for any grammatical errors.
• Make sure all names and titles are spelled correctly.
5. Coherent – Being logical.
• make sure all points are connected and relevant to the main topic and
the tone and flow of text is consistent.
6. Complete - The audience has everything they need informed. If applicable
take action.
7. Courteous – Be friendly ,open and honest.
• To develop a plan for communication of any sort, you have to
consider some basic questions:
• Why do you want to communicate with the community? (What’s your

purpose?)
• Whom do you want to communicate it to? (Who’s your audience?)
• What do you want to communicate? (What’s your message?)
• How do you want to communicate it? (What communication
channels will you use?)
• Whom should you contact and what should you do in order to use those
channels? (How will you actually distribute your message
Communication Action plan
Eight step process
1. Identify goal and objectives of your communication.
2. Identify your target audiences.
3. Plan and Design your key messages.
4. Select your communication channels, plan for two-way
communication.
5. Establish your time frame.
6. Draft a budget- consider the resources . Plan for obstacles and
emergencies and Strategize how you’ll connect with the media and
others who can help you spread your message
7. Implement the action plan. Monitor the results and look for ways
to improve.
8. Evaluate - Decide how you’ll evaluate your plan and adjust it,
based on the results of carrying it out
Goal versas Objective
Goal- are general guidelines that explain what you want to achieve in
your community.
• They are usually long-term and represent global visions such as
“protect public health and safety, “health for all by 2000 “
• A goal may not specify when things will happen
Objective - Refers to the specific steps that a person or organization
will take to achieve a desired goal/ result within a time frame and with
available resources.
• They are more specific and easier to measure than goals.
• Unlike goals objectives are more specific and outline the “who, what,
when, where, and how” of reaching the goals
• ‘goals and objectives.’ my goal is what I want to become, while my
objective is how I plan to get there.
OBJECTIVES
• Objectives should be SMART
• Specific
• Measurable
• Appropriate
• Realistic
• Time bound
1. Specific: Objectives should provide the “who” and “what.”

2. Measurable: The focus is on “how much” change is expected.
The amount of change expected. The objective provides a reference
point from which a change in the target population can clearly be
measured (e.g., over the next 12 months).
3. Achievable: Objectives should be attainable within a given
time frame and with available community resources.
4. Realistic: Objectives are most useful when they accurately
address the scope of the problem and action steps that can be
implemented within a specific time frame.
5. Time-phased: Objectives should provide a time frame
indicating when the objective will be measured or a time by
which the objective will be met. Including a time frame in the
objectives helps to plan and evaluate.
A SMART objective:
• to increase the percentage of homes that are smoke-free by
10 percentage points by 2020
• increase percentage of adults engaging in recommended
physical activity from 57% to 67% By December 2020
EXAMPLES OF A GOAL AND OBJECVTIVES
Goal- healthy People by 2022
1. Nutrition Objectives -Increase the proportion of persons
aged 2 years and older who consume at least two daily servings
of fruit.
- Increase the proportion of persons aged 2 years and older who
consume at least three daily servings of vegetables, with at
least one-third being dark green or orange vegetables.
- Increase the proportion of children and adolescents aged 6 to
19 years whose intake of meals and snacks at schools
contributes to good overall dietary quality
• Increase the proportion of worksites that offer nutrition or weight
management classes or counseling
Goal - Healthy People by 2022
2. Physical Activity Objectives
• Increase the proportion of adults who engage regularly, preferably
daily, in moderate physical activity for at least 30 minutes per day.
• Increase the proportion of adolescents who engage in moderate
physical activity for at least 30 minutes on 5 or more of the previous 7
days.
• Increase the proportion of adolescents who engage in vigorous
physical activity that promotes cardio-respiratory fitness 3 or more
days per week for 20 or more minutes per session
2. IDENTIFY YOUR AUDIENCE
• Demographics. Demographics are simply basic statistical information about people,

such as gender, age, ethnic and racial background, income, etc.
• Geography. You might want to focus on a whole town or region, on one or more
neighborhoods, or on people who live near a particular geographic or man-made
feature.
• Employment. You may be interested in people in a particular line of work, or in
people who are unemployed.
• Health. Your concern might be with people at risk for or experiencing a particular
condition – high blood pressure, perhaps, or diabetes – or you might be leveling a
health promotion effort – “Eat healthy, exercise regularly” – at the whole community.
• Behavior. You may be targeting your message to smokers, for example, or to youth
engaged in violence.
• Attitudes. Are you trying to change people’s minds, or bring them to the next level of
understanding?
3. Message
When creating your message, consider;
content, mood, language, and design.
Consider what emotions you want to appeal to.
The mood of your message will do a good deal to determine how
people react to it. If the mood is too extreme – too negative, too
frightening, trying to make your audience feel too guilty – people won’t
pay much attention to it.
Keeping your tone positive will usually reach more people than
evoking negative feelings such as fear or anger.
language
- one is the actual language – English/ Kiswahili that your intended audience speaks;
• the other is the kind of language you use – formal or informal, simple or complex, referring to
popular figures and ideas or to obscure ones.
• Channels of communication
• Posters, Brochures with good health issues put in supermarkets for nutrition, doctors office.
• Newsletters
• Promotional materials - Items such as caps, T-shirts, and mugs can serve as effective channels
for your message.
• Comic books or other reading material
• Internet sites - In addition to your organization's website, interactive sites like Facebook,
Twitter, and YouTube are effective mediums for communication
• Letters to the Editor
• News stories, columns, and reports
• Press releases and press conferences
• Presentations or presence at local events and local and national conferences, fairs, and other
gatherings
• Community
30-Jan-21
outreach N. Kimonye
• Public demonstrations
• Word of mouth
• Music
• Exhibits and public art - The AIDS quilt, a huge quilt with squares made
by thousands of people, commemorating victims of the HIV epidemic, is a
prime example.
• Movies - Since the beginnings of the film industry, movies have carried
messages about race, the status of women, adult literacy, homosexuality,
mental illness, AIDS, and numerous other social issues.
• TV - TV can both carry straightforward messages – ads and Public Service
Announcements (PSAs) – and present news and entertainment programs
that deal with your issue or profile your organization.
• Theater and interactive theater - A play or skit, especially one written by
people who have experienced what it illustrates, can be a powerful way to
present an issue, or to underline the need for services or change.
4. RESOURCES.
• Your plan should include careful determinations of how much you can spend
and how much staff and volunteer time it’s reasonable to use. You may also be
able to get materials, air time, and other goods and services from individuals,
businesses, other organizations, and institutions.
5. ANTICIPATE OBSTACLES AND EMERGENCIES.

• Any number of things can happen in the course of a communication effort.
Someone can forget to e-mail a press release, or forget to include a phone
number or e-mail address. A crucial word on your posters or in your brochure
can be misspelled, or a reporter might get important information wrong. Worse,
you might have to deal with a real disaster involving the organization that has
the potential to discredit everything you do.
6. STRATEGIZE HOW YOU’LL CONNECT WITH THE MEDIA AND OTHERS TO
SPREAD YOUR MESSAGE.
You have to make personal contacts, give the media and others reasons
to want to help you, and follow through over time to sustain those
relationships in order to keep communication channels open.
The individuals that can help you spread your message can vary from
formal community leaders – elected officials,
CEOs of important local, businesses, clergy, etc. –
to community activists and ordinary citizens.
Institutions and organizations, such as colleges, hospitals, service
clubs, faith communities, and other health and community
organizations all have access to groups of community members who
might need to hear your message.
7. IMPLEMENT THE ACTION AND MONITOR
Implement the action plan and monitor the results and look for ways to improve
it.
If you evaluate your communication plan in terms of both how well you carry it
out and how well it works, you’ll be able to make changes to improve it. It will
keep getting more effective each time you implement it.
And finally, you'll evaluate your effort so that you can continue to make it better.
8. EVALUATION
Finally, you'll evaluate your effort so that you can continue to make it better.
Communication strategy Recap
• A good communication strategy includes:
• Implementation plan
• How will the campaign work
• What will be done
• When will it be done
• Who will do it
• How will it be phased, placed, orchestrated, and managed
• Monitoring and evaluation
• How to measure impact (process/outcome)
• Budget
• Less is more
implementing comm.. action plan
Identify AREAS OF OPPORTUNITY THROUGH COMMUNITY FOCUS GROUP
DISCUSSION
1. Access to Health Services*

2. Cancer*
3. Chronic Kidney Disease
4. Dementias, Including Alzheimer’s
Disease
5. Heart Disease & Stroke*
6. Injury & Violence* Bold items were identified as a top concern in focus groups.
7. Infant Health & Family Planning * Denotes issues identified as Areas of Opportunity in 2010
as well.
8. Mental Health & Mental Disorders* Underlined-identified in 2014 Community Forum
9. Nutrition, Physical Activity &
Weight*
10. Respiratory Diseases*
11. Substance Abuse*
12. Tobacco Use
Identified Community Priorities,, separate doc in words
1. Access to Health Services
2. Mental Health & Mental Disorders,
3. Substance Abuse
4. Nutrition, Physical Activity & Weight
HOW TO DEVELOP THE ACTION PLAN

1. Health problem to be addressed
2. Objectives
3. Action to be taken
4. Who will do it?
5. Time scale
6. Evaluation measures
Resources and Support Communication Plan for
Action Steps By Whom By When Potential Barriers or Resistance
Available/Needed Implementation
What individuals and

What needs to be done? By what date will the action be Resources Needed (financial, What individuals and organizations should be informed
Who will take actions? Resources Available
done? human, political, and other) organizations might resist? How? about/involved with these
actions?
Step 1: anayse the situation
Step 2:
Bdevelop message__________
Step 3:
identify channels to use
Step 4: implement then

monitor and evaluate
IMPLEMENTATION MONITORING AND EVALUATION
• Monitoring and evaluation are essential management tools
which help to ensure that health activities are implemented as
planned and to assess whether desired results are being
achieved.
• M&E framework show whether a service/program is
accomplishing its goals. It identifies program weaknesses and
strengths, areas of the program that need revision, and areas of
the program that meet or exceed expectations
Monitoring:
A process of measuring, recording, collecting and analyzing data on
actual implementation of the programme and communicating it to the
programme managers.
Importance of monitoring
1. It helps in measuring level of performance and provide progress of
activities.
2. Helps to identify the problems in the project implementation. Incase
any deviation from the planned operations are detected, diagnosis for
causes of deviation is carried out.
3.To take suitable corrective action.
4. Ensure that programmes are implemented as planned.
5. Helps in Preparation of action plan, which should specify what needs to be
done, who is going to do it, and when it is to be done , Inadequacy in planning
will result in inadequacy in monitoring
Different levels of Monitoring
• Managers at top level
• They have to develop health plans based on objectives, goals, devise
strategy and allocate necessary resources
• Managers at the middle level
• They are more concerned with whether they are getting desired output
from the inputs that are being utilized
• Managers at the operational level
• They have to supervise actual operations and to ensure that planned
activities are being carried out as per schedule
EVALUATION-
• is a systematic process to understand what a program does and how well
the program does it.
Evaluation results can be used to maintain or improve program quality and
to ensure that future planning can be more evidence-based.
• Reasons for carrying out an Evaluation
1. To review the implementation of and services provided by health programmes
so as to identify problems and recommend necessary revisions of the
programme.
2. To assess progress towards desired health status at national or state levels and
identify reasons for gap, if any
3. To contribute towards better health planning.
4. To document results achieved by a project funded by donor agencies.
5. To know whether desired health outcomes are being achieved and identify
remedial measures.
6. To improve health programmes and the health infrastructure
7. Allocation of resources in current and future programme
8. To render health activities more relevant, more efficient and more effective
• TOOLS OF EVALUATION
• Review of Records
• Monitoring
• Case studies
• Qualitative studies
• Controlled experiments and intervention studies
• Sample surveys
• Basic steps of Evaluation
• Establishing standards and criteria

• Planning and methodology
• Collecting data
• Analyzing the data
• Taking action
• Re-evaluation
Who is performing Evaluation?
• The planner
• The research group
• Those responsible for health development
• Those responsible for implementation
• By the Community
• Basic steps of Evaluation
• Establishing standards and criteria

• Planning and methodology
• Collecting data
• Analyzing the data
• Taking action
• Re-evaluation
Difference Btn Monitoring and evaluation
Examples of existing programmes
• National Anti Malaria Programme
• Revised National TB control programme
• National AIDS control programme
• National programme for control of Blindness
• Nutritional Surveillance
• National Diabetes control programme
• National Surveillance programme for Communicable Disease
• National Polio surveillance programme
• Reproductive child health programme
EXAMPLE OF M AND E FRAMEWORK- goal, objectives, process and
outcome
TERMILOGIES USED IN M& E
1. Input- the financial, human, and material resources used in a
program/intervention
• Input indicators
• These indicators refer to the resources needed for the implementation of an
activity or intervention. Policies, human resources,vehicles, materials,
financial resources are examples of input indicators. Example: inputs to
conduct a training course may include facilitators, training materials, funds.
2.Activities - actions associated with delivering project goals.
- what the personnel/employees do in order to achieve the aims of the project.
E.g In a HIV and AIDS project, for example, activities would include things like
conducting community meetings to sensitize the public on prevention
measures, installing condom dispensers at hot-spots, collecting periodic data to
monitor project progress among others.
3. Outputs- These are the first level of results associated with a project
- are the direct immediate short term results associated with a project after
implementing an activity.
. In other words, they are usually what the project has achieved in the short
term.
- For example, project outputs in a HIV and AIDS project would be: the number
of community awareness meetings that were done,
- the number of condom dispensers installed,
- number of HIV and AIDS infected persons referred for ARTs among others.
4. Impacts are the broader /long term changes that occur within the community,
organization, society, or environment as a result of program
5. Outcome: is a change that occurred because of a program implementation.
• This is the second level of results associated with a project and refers to the
medium term consequences of the project.
• Outcomes usually relate to the project goal or aim.
• For example, Goal safe water project, an outcome would be “the percentage
of households that are using chlorinated drinking water”.
• Another outcome could be “ reduction in the percentage of children suffering
from diarrhea.”, outcomes should clearly link to project goals.
Outcome-.
1. Process evaluation
2. Impact evaluation
3. Outcome evaluation
5. Impact:
• It is the third level of project results, and is the long term consequence of a
project.
An example
• Reduced poverty rates,
• reduced child mortality rates among others.
• In the case of the Safe Water project, an increase in the number of
households using treated water would directly impact on fewer cases of
people suffering from diarrhea, meaning that there will be a reduced number
of lost man-hours. This has a direct impact on poverty reduction.
• Also, the number of children suffering from diarrhea may reduce, meaning that
the cases of child deaths are reduced.
Common types of evaluations
1. Formative evaluation - ensures that a program or program activity is feasible,
appropriate, and acceptable before it is fully implemented. It is usually
conducted when a new program or activity is being developed or when an
existing one is being adapted or modified.
2. Process/implementation evaluation- determines whether program activities
have been implemented as intended. Can be done periodically within a program.
3. Outcome/effectiveness evaluation - measures program effects in the target
population by assessing the progress in the outcomes or outcome objectives that
the program is to achieve.
3. Impact evaluation - assesses program effectiveness in achieving its ultimate
goals

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CONCEPTS IN HEALTH PROMOTION

HEALTH; It the state of being free from illness or injury:

WHO DEFINITION OF HEALTH

• It means the ability to perform routine tasks without

•This is the ability to learn and think clearly

•This is the ability to make and maintain

Some people relate health with

b. Genetic Engineering: may have a role in cases like

It is associated with practice. It is what we do and how we act.

Life style of individuals affects their health directly or indirectly.

•Diet and physical activity.

• Defined as the science and art of preventing

•It is the combination of sciences, skills

• It can be a society of people holding common rights and privileges (eg,

This is a field of public health that focuses on; Studying,

2. Socio – cultural determinants – The socio- cultural factors

3. Community organization - Community organization include the community

4. Behavioral determinants- The behavioral determinants affecting health include

• lobbying for equitable distribution in provision health care services.

• Being a voice to the voiceless in matters of health.

• Advocating for education and behavior change in the individuals and

• Enabling means taking action in partnership with individuals or

4. It is about removing the barriers that prevent people from participating in

6. A community development approach can be applied to many different areas

1. Identify the problem, e.g hunger, drought &famine,

Communtiy – city, town, village where we live.

Strategy- a plan of action designed to achieve a long-term goal in the

• The overall goal of the community strategy is to enhance

• Establish information systems to monitor change.

LINKAGE MECHANISMS AND STRUCTURES

According to the NHSSP II there are two categories of

6. Visiting homes to determine the health situation and dialogue

8.Participating in monthly community unit health dialogue and action

9.Being available to the community to respond to questions and

• There should be nine additional members, to include

• The CHC has regular meetings that relate to the 100-day

• Effective communication requires a message, the sender of the message, the

1. Pregnancy, delivery and the newborn (first 2 weeks of life)

7. Check regularly for non-communicable illnesses like

9. Sleep under ITNs to prevent malaria.

10. Treat drinking water at the point of use

• NHSSP II organizes health services into six levels of delivery

County hospitals Level 5

Sub county hospitals Level 4

Health centres/maternity/nursing homes Level 3

• At the community level the major obstacle to effective

• The standard care in ART requires laboratory

• Healthcare system - an organized plan of health

•Is the essential health care made universally

12. Use of appropriate technology- medical technology should

2. Upwards Communications : It is non directive in nature from

3. Lateral or Horizontal Communication: Among colleagues,

1. Face to face or inter personal communication

• Is one of the richest channels of communication that can be used to

• Is a person to person, two-way, verbal and non verbal interaction that

• Interpersonal communication can be in the form of lecture, role play,

• In addition, visual aids, such as posters, charts, flyers, pamphlets, and

• IPC in health care settings takes place between service

1. History taking: Each intervention begins with a thorough

2. Channeling: The objective of channeling is to motivate

4. Dialogue with Patients/clients:

• To establish and maintain a positive rapport with the

• To enhance patients to open up and comply. Socio-