Module 01

MODULE
01
Principles and Practices of

Community Health
Development
Module Name 00
FINAL module 01 PAGE 01

COMPLETE LIST OF TITLES, COMMUNITY HEALTH DEVELOPMENT PACKAGE:
• Community Health Development Package Handbook
• MODULE 1. Principles and Practices of Community Health Development
• MODULE 2. Building Partnerships
• MODULE 3. Gender Sensitivity Training
• MODULE 4. Orientation to Reproductive Health
• MODULE 5a. The P.R.A. Approach (A Participatory Planning Process)
• MODULE 5b. Community Health Planning
• MODULE 6a. Reproductive Health Training (Part One)
• MODULE 6b. Reproductive Health Training (Part Two)
• MODULE 6c. Reproductive Health Training (Part Three)
• MODULE 7. Community Organizing and Community Development for Health
• MODULE 8a. Community Based Health Referral System
• MODULE 8b. Savings for Health
• MODULE 9. Community Based Project Management (An Introduction to Management for Communities)
• MODULE 10. Organizational Development
• MODULE 11. Locally-Driven Information, Education and Communication
• MODULE 12. The Community Health Development Package (Monitoring and Evaluation)
• MODULE 13. Community Based Monitoring
• MODULE 14. Sustainability Through Transition
• MODULE 15a. Child-to-Child: A Life Skills Approach 1
• MODULE 15b. Child-to-Child: A Life Skills Approach 2 (Training of Trainers)
• MODULE 15c. Child-to-Child: A Life Skills Approach 3 (Working with Children Facilitators)
• MODULE 15d. Child-to-Child: A Life Skills Approach 4 (Working Out Sensitive Issues)
• MODULE 16. Advocacy for Quality Health Services
• MODULE 17. Men’s Health and Well Being
• MODULE 18. Functional Literacy
• MODULE 19. Agri-Health Integration
• MODULE 20. Community Based Responses to Violence Against Women and Children
Published by:
Women’s Health & Safe Motherhood Project-Partnerships Component

A Project of the Filipino People
financed through
a Partnership between the Government of the Philippines and the European Union
Any part of this publication may be reproduced with appropriate acknowledgement, provided parts copied are distributed free
or at cost—not for profit. For commercial reproduction, permission must be obtained from the Bureau of Local Health Development,
Department of Health, and the Delegation of the European Commission to the Philippines.
The opinions expressed herein are solely those of the WHSMP-PC and do not necessarily reflect the views of the EU.
00
PAGE 02 module 01 FINAL

TABLE OF CONTENTS
Introduction 05
Training Design 07
Orientation Workshop on Community Health Development
Principles and Practices 07
I. National and International Agreements Affecting Health Care

The Alma Ata Declaration and Primary Health Care (PHC) 11
Conventions on Gender and Development
II. Concerns/Issues of Importance in Women’s Health

in the Philippines 17
III. Community Health Development: Principles and Practices 19

Community Organising
Primary Health Care: The Philippine Experience
Mainstreaming Gender in Health
Partnerships Building
IV. Program Components 36

Improved Health Services
Health, Gender and Development
LGU Incentives and Support
Glossary 40
Bibliography 42
Acknowledgements 43
Principles and Practices of Community Health DevelopmenA 03

INTRODUCTION
“Principles and Practices of Community Health Development ” is one of twenty modules
that make up the Community Health Development Package. It is the crystallization of
the experience of the Women’s Health and Safe Motherhood Project – Partnerships
Component, gained through working with women and their communities, utilizing
women’s health focused, health oriented community development models, approaches and
techniques. Thus, the Package and its Modules reflect the knowledge, experience and
lessons learned through working with Partners, as well as with women and their
communities over the six years of the Project’s implementation, which concluded in
December 2003.
Background
Community Health Development (CHD), as practised in the WHSMP-PC pilot sites, reflects
changing notions of health care worldwide. It draws its concepts and practices from
international agreements and from empirical experience of the country in rural development.
CHD veers away from largely Western ideas of health and medicine. The aim is to make
health care more accessible to the vast majority, in a manner appropriate to the socio-
economic and cultural contexts of a developing country like the Philippines. The turning
point occurred with the World Health Organization's advocacy of Primary Health Care in
the '70's.
In addition to the movement to democratize health care, efforts to mainstream gender

concerns in health and development took off in the last decade. The country's rich experience
in community organizing and development is a building bloc in the development of CHD
principles and practices. Devolution of health functions to local government units reinforced
the value of forging partnerships with all concerned.
Principles and Practices of Community Health Development 05

Training Design
ORIENTATION-WORKSHOP ON COMMUNITY HEALTH DEVELOPMENT

PRINCIPLES AND PRACTICES
Rationale
This training design works on the proposition that partnerships among all concerned sectors
best address women’s health and gender issues. It is essential for partners to have a common
orientation on the project’s basic principles and practices.
This is a one-day orientation on the key concepts of the Community Health Development
Principles and Practices. To provide participants with examples of CHD implementation,
workshop organizers may discuss experiences of the pilot sites of the Women’s Health and Safe
Motherhood Project-Partnership Component.
Training Objectives
Participants are briefed on Community Health Development principles and strategies.
The orientation shall fulfill the following objectives:
1. Participants are briefed on the CHD's fundamental concepts and principles

2. Participants contribute to the formulation of health and gender analysis framework for the
area
Workshop Outputs
1. Participants internalize CHD concepts, principles and strategies.

2. Participants prepare localized gender and health analysis framework
Requirements
Visual aid is important in the discussion of every topic and must be prepared beforehand.
The boxed materials and tables may be useful for discussion purposes.

Methodology
Lecture discussions are conducted to review CHD concepts, principles and strategies. This
allows the lecturers to interact with the participants. Workshops allow participants to give new
inputs into existing frameworks.
Participants
1. Provincial representative of the Department of Health

2. NGO partners
3. Core Field Worker Team representatives
4. Barangay Health Team representatives – (i.e. barangay council representatives, midwife,
BHW, key women leaders)
Schedule of Activities
The following proposed schedule might be integrated into other orientation schedules on
community organizing, partnership building and the like.
08

Orientation Schedule
TIME TOPIC
8:30 – 9:00 Training Objectives
Introductions
Expectation Check
9:00 – 9:40 Lecture Discussion:
International Agreements Affecting Health:
- Alma Ata, Cairo ICPD, Beijing
Declarations
- Philippine Plan for Gender- Responsive
Development
Lecture Discussion
9:40 – 10:30 Women’s Health Framework
Open Forum/Break
10:30 – 10:45 Lecture Discussion:
10:45 – 12:00 Community Health Development Strategies
- Community Organizing
- Primary Health Care
- Gender and Development
- Partnership Building
Open Forum
12:00 – 1:00 Lunch Break
1:00 – 2:00 Discussion/Sharing of Experience:
Women's Empowerment Model
2:00 – 2:30 Workshop
Gender and Women’s Health:
A Conceptual Framework
2:30 – 3:00 Plenary
3:00 - 3:10 Break
3:10 – 4:00 Discussion of CHD components and Experiences
in Community Health Development and Planning
(Example : WHSMP Project Implementation)
4:00 – 4:30 Synthesis
4:30 - 5:00 Closing Ceremonies

Notes for the Facilitator
1. The boxed items in the CHD Principles and Practices Handbook are handy materials for
presentation, discussion or workshop.
• National and International Declarations affecting Women’s Health

• Women’s Health Framework
• Community Health Development Strategies
2. Discussion of CHD Components
Use Figure 3 to give a brief description of the scope of activities and interventions, with the
WHSMP-PC model and pilot site experiences as examples. From here, lead the group in a
discussion on the project’s experience in implementing some key components.
• Are there good examples for each that participants know about?
• How were these implemented?
• What are the effects of these interventions?
• What are some lessons learned?
• How is sustainability ensured?
3. Synthesis
The synthesis recaps CHD’s key concepts and practices. It can also be done by way of guided
discussion or through presentations of significant concepts learned by participants. The synthesis
brings out the following highlights:
• What are CHD’s concepts on health? Women’s health? How do these differ from conventional
concepts?
• What would be the advantages of shifting to CHD principles and strategies?
• How do these affect current practices?
• What are challenges in mainstreaming these concepts and strategies in the region/locality?
From the perspective of health practitioners? From that of community members?
• What are significant lessons learned from previous experiences in implementing CHD?
• What are the prospects for CHD in the area?
• What is the role of the participant in promoting CHD?
10

I. National and International Agreements
affecting Health Care
Advocacy by the United Nations boosted the pursuit of alternative concepts

of health care in developing countries.
A. THE ALMA ATA DECLARATION AND

PRIMARY HEALTH CARE (PHC)
Many countries are now advocating Primary Health Care (PHC) as an approach. One-hundred
fifty member countries of the World Health Organization, including the Philippines, committed
to promote primary health care when they signed the 1978 Alma Ata Declaration in Russia
during the 30th Assembly of the WHO. The Declaration redefined health and health service
delivery as not just the domain of health professionals, whose services may not be accessible
to many in developing countries. It marks a paradigm shift in the concept of health service
delivery by recognizing the role of traditional health systems and the community in the
maintenance of health.
1. Primary Health Care Defined
The concept of Primary Health Care is explained as follows:
Box 1. Alma Ata Declaration on Primary Health Care
Primary health care is essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally accessible
to individuals and families in the community through their full participation and at a cost
that the community and country can afford in the spirit of self-reliance and determination.
(Section VII, Alma Ata Declaration)

2. Key Elements of Primary Health Care
PHC as a “Health for All” program has eight elements, which fall under three
major aspects of health care.
Box 2. Eight Elements of Primary Health Care (Alma Ata Declaration)

Major Aspects of Health Care Elements of Health Care
Promotive 1. Education concerning health

problems and the methods of
preventing them
2. Promotion of food supply and
proper nutrition
3. Adequate supply of safe water
and basic sanitation
Preventive 4. Maternal and child health care,

including family planning
5. Immunization against major
infectious diseases
6. Prevention and control of locally
endemic diseases
Curative 7. Appropriate treatment of common

diseases and injuries
8. Provision of essential drugs
12

3. Comparison Between Conventional and Primary Health Care
Table 1 compares key concepts of conventional medicine with those of Primary Health Care.
Primary Health Care stands on the three pillars of participation, inter-sectoral collaboration and
equity.
Table 1. Conventional vs. Primary Health Care
The Three Pillars Conventional Health Care Primary Health Care

of PHC
• Generally passive role • Active community involvement

of beneficiaries in health
• Focus is on individual • Treatment of individual symptom
I. Participation pathology while acknowledging that ill-
• Ill-health as technical health may have structural causes
problem to be treated (e.g. poverty, power structure,
by expert gender gap)
• Concerns only the • Other sectors have important role

medical profession in establishing good health
• Policy directive for health sector
to work with other sectors that
II. Intersectoral contribute to health
Collaboration • Indigenous knowledge systems
and practices are recognized and
enhanced (i.e. traditional birth
attendants equipped with more
hygienic methods)
• No analysis of context • Involves the people and govern-

of medical problems ment’s commitment to equity
through adequate health and
III. Equity social measures
• Addresses issues of poverty and
powerlessness in the spirit of
social justice
Source: John Macdonald, Primary Health Care: Medicine in its Place. London: Earthscan, 1993

B. CONVENTIONS ON GENDER AND DEVELOPMENT
Inequality between men and women has been identified as one of the barriers to women’s
good health. The United Nations Decade for Women (1976 – 85) highlighted the invisible role
of women in many societies.
Three international conferences affirmed improvement of women’s health and their overall
position in society as a priority in the 1990’s. Signatory governments, including the
Philippines, have acted on recommendations made at the 1994 International Conference on
Population and Development (ICPD) in Cairo and at the Fourth World Conference on
Women in Beijing in 1995.
The Philippines is also a signatory to the Jakarta Declaration, which affirms, “that women’s
health needs in all stages of the life cycle should be adequately articulated and properly met
by the requisite provision of budgetary resources, legislative support and social and health
reorientation.”
1. The Cairo ICPD Recommendations of 1994
Three major points of ICPD:
• Defines women empowerment in relation to sexuality, reproduction and population —

a milestone
• Sees improvement of women’s status as precondition for effective population and

development programs
• Encompasses women's health while promoting gender equality in all spheres of life
14

Box 3. Cairo ICPD Recommendations on
Empowerment and Status of Women
The empowerment and autonomy of women and the improvement of their political, social, economic
and health status is a highly important end in itself. In addition, it is essential for the achievement
of sustainable development. The full participation and partnership of both women and men is
required in productive and reproductive life, including shared responsibilities for the care and
nurturing of children and maintenance of the household. In all parts of the world, women are facing
threats to their lives, health and well-being as a result of being overburdened with work and of
their lack of power and influence. In most regions of the world, women receive less formal education
than men, and at the same time, women's own knowledge, abilities and coping mechanisms often
go unrecognized.
The power relations that impede women's attainment of healthy and fulfilling lives operate at many
levels of society, from the most personal to the highly public. Achieving change requires policy
and program actions that will improve women's access to secure livelihoods and economic
resources, alleviate their extreme responsibilities with regard to housework, remove legal impediments
to their participation in public life, and raise social awareness through effective programs of
education and mass communication. In addition, improving the status of women also enhances
their decision-making capacity at all levels in all spheres of life, especially in the area of sexuality
ad reproduction. This, in turn, is essential for the long-term success of population programs.
Experience shows that population and development programs are most effective when steps
have simultaneously been taken to improve the status of women.
Paragraph 4.1 "Empowerment and Status of Women,” Report of the International Conference on Population
and Development. Cairo, 5 - 13 September 1994, p. 25

2. The Beijing Declaration and Platform for Action, 1995
One-hundred eighty five countries have signed the Declaration. Its major points are the
following:
• Recognizes, reaffirms right of women to control all aspects of their health, including their
fertility
• Considers recognition and reaffirmation of this right as basic to women’s empowerment
• Women health issues go beyond biological concerns and are affected by inequalities in
gender and class, which should be addressed
Box 4. Beijing Definition of Women's Health
Women have the right to the enjoyment of the highest standard of physical and mental health.
Their enjoyment of this right is vital to their life and well-being and their ability to participate in
all areas of private and public life … Women's health involves the social, political, and economic
context of their lives, as well as the biological. However, health and well-being elude majority of
women. A major barrier for women to the achievement of the highest attainable standard of health
is inequality both between men and among women in different geographical, social classes and
indigenous and ethnic groups.
Beijing Platform for Action, Paragraph 89
16

II. Concerns/Issues of Importance in
Women's Health in the Philippines
In the Philippines, common and preventable diseases remain the major causes of mortality
and morbidity. Many of the country's diseases are related to poverty. Malnutrition complicates
common diseases or develops a cycle of diseases. Government services and resources cannot
reach many remote areas in the country. The population rate remains one of the highest.
Gender oncerns including violence against women are facts of life.
Six priority health issues for women are reflected in the framework for women’s health in
the Philippine Plan for Gender-Responsive Development. Major concerns include:
• Reproductive health and sexuality

• Health of women of reproductive age as well as of ageing women
• Poverty and access to health services and proper nutrition
• Family planning
• Violence against women and children
• The health effects of gender issues - i.e. marginalization, stereotyping, multiple burden
(division of labor and workload), subordination and violence
Women's health concerns, however, extend to structures and processes of health care and
information delivery. These influence women's interactions with the health system, affect
the quality of care women receive, their access to appropriate and acceptable services and
their health condition.
To improve women’s health care, action is required in the four broad struc-tural areas of
the health system:
• Improvement of health services for women

• Provision of health information for women
• Women empowerment - participation in decision-making on health issues, in production
and reproduction and in community life
• Training and gender sensitizing of traditional and existing health care providers

Box 5. Gender Concerns in Women’s Health
Concerns Affecting Women as Health Agents

1. Low level of gender consciousness of policy makers, legislators, local government executives
and program managers on women’s health needs and concerns
2. Non-implementation of the Magna Carta for public health workers in some localities
3. Inadequate benefits for community volunteer workers who are mostly women
4. Need to strengthen gender and development focal persons at national and sub-national levels
Concerns/Issues Affecting Women

1. Need to address leading causes of women’s mortality and morbidity (including heart disease,
tuberculosis, cancer, and pregnancy-related deaths)
2. Poor nutritional levels of women, especially pregnant and lactating women
3. Inadequate access to medical assistance during birth
4. Reproductive health-related infections among women
5. Women’s multiple burden which makes them vulnerable to disease and disabilities
6. Women giving more priority to their husbands and children than themselves in seeking
medical care
7. High awareness but low practice of family planning
8. Poor functional health and nutrition literacy among men and women
9. Lack of awareness of environmental/occupational health and safety hazards
10. Inadequate investment in information and education to counter socio-cultural values
and practices, which have great influence on women’s health-seeking behavior.
18

III. Community Health Development
Principles and Practices
This section characterizes the various influences in the development of the CHD Framework.
It shows that CHD builds on Primary Health Care by mainstreaming gender in health and
by strengthening partnership building and the use of community organizing and development
approaches.
Key concepts and developments in the major components of CHD are described below:
Figure 1. Evolution of Community Health Development Strategy
Primary Health Care Gender and Health

(Health)
+
Primary Health Care Strengthened Community

Elements at Varied
Levels and Scope
+ Partnership Building
and Community
= Health
Development
of Partnerships and Organizing Strategies
Community
Participation
A. COMMUNITY ORGANIZING
The World Health Organization affirms:
“Community participation is a fundamental requirement to achieve health

and sustainable development. At the local level, it should enable citizenship
to become an integral part of the decision making and action process and
reflects the need for the development of more active communities in their
rights.” (WHO Regional Office for Europe 1995:4)
Community organizing and development approaches are useful in effecting the paradigm
shift to make communities partners and managers in local development. It is the key to
realizing the aims of Community Health Development. (PHS-DOH 1996)

1. Definition
Community Organizing (CO) is a social development methodology used to facilitate the process
of forming self-reliant, self-determining communities, which are able to sustain their development
activities. In this sense, community organizing is complemented with community development,
which addresses livelihood and other critical concerns to make a community truly self-reliant
and sustaining.
Community organizing:
• Proceeds from the people's identified priority needs
• Based on community analysis
• Reflects urgent issues and the community’s resolve to act on these issues.
“Interest groups” are formed in the process of community organizing. These groups work with
the proper authorities on issues and concerns that affect their common welfare. This approach
is at times called “issue-based organizing.” Some of these issues are basic services such as water
and health care delivery and education.
This, however, does not negate the long-term perspective of attaining holistic human development
in pursuing CO and highlights the ultimate goal of sustainable development in community
organizing.
2. Approaches
2.1 Issue-Based Approach

An issue is a problem of public concern on which people are willing to act to change. For
instance, violence against women and children and high maternal and infant mortality rates
are problems. So are poor health services and gender-insensitive health practitioners. People
can organize to act on these issues. Organizing happens when the community, usually with
external facilitation, begins to believe they can change these realities through local action and
advocacy. A vision or a goal usually guides the community or organization in changing
problematic conditions. It holds the group together until it is attained.
Issue-based or vision-oriented organizing has the following fundamental elements:

• Should identify a problem that many feel strongly about
• Should identify a problem that many are willing to act on
• Must be on the lookout for available external sources of help
• Must ensure that the identified issue is winnable and gains achievable; must be result-oriented
• Must follow principle of homogeneity in forming interest groups
• Must have a geographical concentration
20

• Must be a learning process following action-reflection-action cycle
• Must develop local leadership and expertise on program management based on shared
responsibility and gender fairness at the barangay level
• Must develop inter-agency coordination and linkages at the barangay and municipal levels;
must be able to influence the existing barangay development plan
• Must be sustainable in terms of resource access generation, utilization and management and
the use of participatory community processes
• Must be gender-oriented and environment-friendly
• Should address deeper issues of justice and equity
• Should naturally move beyond one-issue, one-project, one-barangay perspective into broader
sectoral concerns, multi-issue, inter-barangay, inter-municipal/provincial networks and
alliances
• Should lead towards the emergence of a strong, empowered and viable people’s organization,
that pursues a common goal
2.2 Micro-Project Approach

In some instances, issue-based organizing may not be the effective way to mobilize people
to action. Experience shows that in disaster-affected areas where there is poverty, urgent
micro-projects, which people strongly demand, may be an entry point for organizing.
Care must be taken to prevent a dole-out orientation and dependency relationship with
donor agencies. The following are must-do’s:
• Before implementing projects, the assisting agency should:

- Organize with existing community groups and associations rather than with individual
families or residents
- Build new organizations only when there are no organizations or when it is impossible
for the program to work with existing organizations
• Work closely with local government units, government line agencies and local NGOs
- Involvement of these groups in all aspects of the project cycle ensures continual assistance
to the communities when the program phases out
• Build capabilities of target population through education and training

- Requiring community counterpart in project implementation helps revive the people's
spirit of cooperation and sense of project ownership
- In implementing micro-projects, training component should involve organizational
capability building and skills development

3. Principles of Community Organizing
Participatory
Participation denotes having a share in decision-making. Participation involves collective
decision-making and efforts to educate the community on issues that affect them. Active
community involvement in implementing the project is pursued from the very start.
In participation, people:
• Accept the project
• Cooperate in implementing the project
• Help facilitate capability building by experiential learning that takes place as the project
progresses.
Participants are active in every stage of the project cycle–planning, implementation,

monitoring and evaluation.
Gender-Sensitive, Promoting Gender Equality and Empowerment

What is the Gender Equality and Empowerment Framework (GEEF)?
• Focuses on the transformation of gender roles
• Seeks to improve women's lot in their traditional roles as mothers, wives and workers.
• Puts under analysis social relations of men and women in their roles in production and
reproduction.
• Concerned with equality in gender relations and the empowerment of women to fulfill
their fullest potentials
• Supports more participation and control for women in decision-making at home and
in the community
• Supports change that addresses women's welfare needs
• Promotes access to health services and the means of production (i.e. family planning,
pre-natal checkup, livelihood options, credit, technical assistance, etc.).
GEEF means that while access to welfare and women’s health services and livelihood
opportunities is promoted, gender sensitivity training or conscientization also addresses
the need to change prevailing gender structures. Men are part of the reorientation process.
Organizing women is a key strategy to actively involve them in actions to improve their
health and welfare. Women are involved in decision-making processes during implementation
of community-based and managed health projects. Moreover, the promotion of women’s
rights helps women exercise control over their bodies and to have more meaningful
participation in family and community decision-making.
Thus, in promoting women’s health, the concern is not only to create change relative to the
welfare box. Lasting change in women’s health conditions could only be achieved by
22

working on the other boxes as well until women attain equality of control with men. In the
long term, gender equality is a prerequisite for ensuring women’s welfare.
The boxes and figures below illustrate the gender empowerment concept.
Figure 2
Gender Equality and Empowerment Framework
Equality Empowerment
Control
Participation
Conscientization
Access
Figure 3
Gender Empowerment Cycle
Welfare
Access
Control
Empowerment
Conscientization
Participation

Gender Equality and Empowerment Framework
Welfare Access
• Material needs around reproductive Arises from inequality of access to

needs resources, e.g. land, labor, credit,
• Feeding program, family planning, services, technology
dole-out
• Women as passive recipients of welfare • Equality of access according to
benefits rather than individuals capable principle of equal opportunity
of changing their lives
• A step towards women's
advancement
Conscientization
Women's low status and the traditional Participation

gender division of labor is part of the
natural order or is God-given • The gender gap is most visible
• Empowerment is recognizing that • Easily quantified
women's subordination is imposed by • Women, equally with men, are actively
a system of discrimination that is involved in the development process
socially constructed • Women's equal participation in
decision-making
Control
Equality of Control
Gender gap is unequal power relations
between men and women • Enables women to gain improved
• Equality of control - a balance of power, access to resources
so neither is in a position of dominance • Enables improved welfare for
• Increased participation - increased themselves and their children
development and empowerment of • Equality of participation and control -
women when used to achieve prerequisites to make progress towards
increased control over the factors of gender equality and welfare provision
production - equal access to resources
and distribution of benefits
24

Community-Managed Health Care
The key to overcoming oppressive obstacles to health and well-being lies in people gaining
the capacity to organize themselves around the pursuit of common interests. A broader
consciousness leads marginalized groups to consider ways of reversing their dependency,
taking action, assessing results and then deciding on the next step in accordance with CO’s
analysis-action-reflection cycle. (Batangan IPC n.d.:23)
Recognition of Indigenous Knowledge Systems and Practices

Traditional health practitioners are recognized as partners. In addition, appropriate indigenous
knowledge systems and structures that promote health shall be strengthened.
B. PRIMARY HEALTH CARE:

THE PHILIPPINE EXPERIENCE
The Department of Health Policy on Primary Health Care for Community Health
Development (1996) is also known as a program that puts Health in the Hands of the People.
People are not mere beneficiaries of health care.
They are active participants in addressing their health needs.
Former DOH Secretary Jaime Galvez-Tan described at least four types of people’s participation.
Box 6. Primary Health Care in the Philippines:

Four Models of People's Participation
1. Hospital/Clinic-based, where people are merely informed of health activities

2. Community-oriented, where packaged programs and projects are confirmed through consultations
3. Community-based, where there is a joint-effort in decision making among health workers and
the community through partnerships, and
4. Community-managed, where conceptualization, implementation, management and major decision-
making are all lodged in the community itself.

The fourth, which is the community-managed model, is considered as the ideal level for
PHC. Here, community organizing is both an end and the means to an end. It is not only
to promote health but is also a "tool for empowerment and…a long-lasting safeguard to
protect the community's interests…and…guarantee self-reliant development initiatives"
(Tan 1987:112 In Bautista, et al, 1998:3)
C. MAINSTREAMING GENDER IN HEALTH
1. Gender and Health Status: A Conceptual Framework
To promote gender-sensitive and women-centered programs and activities, one must

understand the interrelationship of women’s position and gender with women’s health,
population and development.
This diagram extracted from CHETNA’s pamphlet on Gender and Women’s Health, links
conceptually the health needs of women and the gender impli-cations of women’s health
status. (Adapted from CHETNA's Gender and Health Pamphlet In ARROW - Resource Kit, 1996)
Gender and Women’s Health Status: A Conceptual Framework

Health Needs POOR HEALTH STATUS Gender Implications
of Women OF WOMEN
THROUGHOUT A Undernutrition HIGHER SOCIAL VALUE OF BOYS

WOMAN’S LIFE Girls: less food, more work, early
Adequate food, rest and marriage, son preference
health care
High Morbidity Rates WOMEN’S LACK OF DECISION-MAKING
DURING MENSTRUATION POWER
Five times as much iron Little control over fertility
Little control over resources
DURING PREGNANCY Anemia
Extra rest UNEQUAL DISTRIBUTION OF LABOR
Food Productive/reproductive work
20 x as much iron All child care and housework
Prenatal care Gynecological Health Women work longer hours
Problems
DURING DELIVERY HARMFUL TRADITIONAL BELIEFS
Access to quality obstetric AND PRACTICES
services Food taboos, especially
High Maternal Mortality during menstruation and
DURING LACTATION pregnancy and lactation
More food, especially dairy Unhygienic child
products delivery practices
Mental Illness
DURING MENOPAUSE QUALITIES VALUED IN GIRLS
Emotional support AND WOMEN
Self-sacrifice, tolerance, compromise,
DURING OLD AGE Low Life Expectancy patience
Calcium and iron-rich foods
Emotional support
Source: Adapted from CHETNA's Gender and Women's Health Pamphlet. In Sensitizing Health Care Practitioners on
Gender and Women's Health, ARROW - Resource Kit, 1996 E-mail: Indu.Capoor@lwahm.nandanet.com
26

2. Comparative Summary of Pre- and Post-Cairo/Beijing
Approaches to Women's Health
The following framework is a summary comparing women-centered and gender-sensitive

policies and programs for women's health (the ICPD Program of Action or POA and the
Beijing Platform for Action or PFA) with earlier approaches to women's health.
The framework describes different points of view of women's health, thus, divergent
solutions. In the '90's, a clearer articulation of the gender, socio-cultural and class contexts
of women's health issues emerged. The prescribed solution, since then, has tended toward
women empowerment rather than just bio-medical action to promote women's health.
Table 2. Comparative Summary of Pre- and Post-Cairo/Beijing

Approaches to Women's Health
Area for Change Primary Health, Women-Centered and
Maternal Health and Gender-Sensitive
Family Planning Post-Cairo and Beijing
1970's and 1980's 1990's
Concept of A narrow bio-medical Emotional, social and physical well-

Women's Health meaning in terms of absence being of women determined by the
of illness and disease. Focus social, political and economic
on women's reproductive context of women's lives as well as
role as mothers. the biological context
Health not seen as a right. Health stated as right
Goals Improve primarily the physical Attain a high standard of physical,

health of women of childbearing social and emotional well-being for
age during pregnancy and women of all ages.
childbirth.
Increase women's control over their
bodies (i.e. their reproductive rights)
and ultimately their lives.
Change socio-economic and cultural

conditions, which are barriers to
women's right to good health, their
reproductive rights and their equality
with men (e.g. women's legal status,
education, poverty level, decision-
making power in the household).
Program Objectives • To reduce maternal mortality • Improve services to meet the total
• To reduce infant mortality health needs of women
• To increase use of • Promote gender equality and
contraception eliminate barriers to the attain-
ment of a high standard of
health for women.

Program Approaches • Primary health care • Comprehensive women's health
preventive medical services
treatment • Reproductive health services
• Family planning within the context of women's
• Culture considered, i.e. rights and women's reproductive
food taboos during rights
pregnancy and after • Empowerment of women; efforts
childbirth to overcome barriers to exercising
right to good health such as culture,
religion, economics, gender, etc.
by initiating or supporting other
programs' efforts.
Beliefs and Values
Determinants of Women's health is biological. Social, political, cultural and

Women’s Health Ill health is due to weakness economic factors as well as
and lack of care/deterioration biological ones determine women's
of the body health. Gender is a cultural factor.
Inequality between women and
men (gender inequality) is a major
obstacle to the attainment of
good health.
Gender Roles, Identity The role and identity of Women of all ages play many important
and Responsibilities women as mothers (social roles in society, contributing to
reproduction) is the most economic, social and family
important role women play development. Motherhood is only one
in society. of these roles (which not all women
experience or want to experience) and
this spans only about 15 to 20 years
of a woman's life.
Women have the most Men have equal personal and social
responsibility for reproductive responsibility for the effects of their
health matters as they bear sexual behavior on the health and well-
children. being of their partners and children.
They need to control their fertility by
using contraception and by practising
safe sex.
28

Women have the main Women and men share the
responsibility for child care and responsibility to care for and nurture
domestic work due to their children and maintain the household
biological role as mothers. as part of gender equality in the family.
National goals such as Women have the individual right and

demographic priorities (population the social responsibility to decide
increase) are more important than whether, how and when to have
the human rights of individuals. children and how many to have. No
woman can be compelled to bear a
child or be prevented from doing so
against her will.
Individual Rights The medical profession knows Women's own expression of their
best what women's health needs experiences and understanding of
are and what services to provide. their bodies and lives are critical to
determining their health needs
(women-centered).
Women have the right to request

and demand access to appropriate,
acceptable and affordable compre-
hensive health services of high
standards.
Service Range • Limited • Comprehensive

• Ante-natal and post-natal • Maternal health
services for mothers • Reproductive cancers
• Contraception for married • STDs
women • HIV/AIDS
• Sexuality
• Nutrition
• Contraception
• TRIs
• Occupational Health
• Mental health
• Violence against women
• Services provided in the context
of gender-power relationships
(e.g. husband, father, state)

Age of Women and Married women of reproductive All ages from primary school
Marital Status age (15 - 49 years) to elder women, unmarried
and married.
Accountability First priority to the organization, The women clients are seen
then the funders to own the program, and
mechanisms to bring this about
are built into the program planning,
implementation, evaluation
and management.
Women’s Health • Quantitative measures of • Quantitative measures of the

Indicators death (mortality) of mothers prevalence of all major health
and babies problems experienced by women
• Life expectancy of women and the extent to which services
• Number of contraceptive are available and actually accessible
users and the fertility to women
• Qualitative measures with much

emphasis on women's satisfaction
with services, improvement in well-
being and control over their lives
(empowerment)
• Measures of well-being rather

than death (mortality).
Source: Rashida Abdullah, Asia-Pacific Resource and Research Center for Women (ARROW), Kuala Lumpur, 1995
3. Evolution of Approaches to Women’s Development and Empowerment

in the Philippines
Different approaches to women’s development have evolved through the decades:
• Welfare Approach
– Earliest approach. Emerged after World War II
– Mainstream approach up to around 1970.
– Brings women into development as better mothers/Recognizes their reproductive role
and the satisfaction of some of their practical gender needs.
30

Main line of action:
º Provision of food aid
º Measures against malnutrition
º Health services
º Family planning
• Women in Development Approach (WID)

– Emerged in early ‘70s
– Asserts that women’s exclusion from the development process leads to their
marginalized situation
– Pushes for women’s integration into ongoing development initiatives
– Does not challenge sources of women’s subordination and oppression
– Main strategy: Introduction of women’s income generating projects.
• Women and Development Approach

– Emerged second half of the ‘70s
– Alternative to WID; Questions roots of women’s oppression
– Posits the following:
º Women have been part of the development process
º Women’s marginalized situation results from international inequitable structures.
– Views WID as maintaining the economic dependency of Third World countries on
developed industrial countries.
– Main strategy:
º Income generating activities
º Focused solely on the productive sector (tends to overlook reproductive side of
women’s lives)
• Gender and Development Paradigm
– Emerged in the 1980s as alternative to WAD
– Views women’s oppression as rooted in the unequal relations of power between rich
and poor, women and men.
– Identifies patriarchy as culprits in women’s oppression
º Patriarchy stresses dichotomy, discrimination, domination, exploitation and sees
women as inferior to men
– Main line of action:
º Transform unequal power relations.
º Address practical gender needs and strategic gender interests
º Link with all efforts to address exploitation, discrimination and domination,
exploitation of natural resources (in line with philosophy of eco-feminism)
Different social institutions continue to use these four approaches, depending on their
perspectives of women’s development. Of all these approaches, the most popular is GAD.

Many social development institutions have considered the unequal and inequitable relations
between men and women or the gender gap as the root cause of women’s marginalization.
In the Philippines, gender concern started with the creation in 1975 of the National
Commission on the Role of Filipino Women (NCRFW). Here are the milestones in the
development of a national policy on women’s integration in development:
• Balikatan sa Kaunlaran Strategy – launched by the NCRFW inobservance of the UN

Decade for Women from 1976 to 1985
– Sought to integrate women in the country’s development efforts
– Focused on women’s welfare in the first half of the decade and on women’s inclusion
in national planning in the second half
• 1987 Constitution included a provision on the role of women in nation building

– Largely due to advocacy of militant women’s movement in ‘70s and ‘80s
• Executive Order No. 348 approved and adopted the Philippine Development Plan for
Women (PDPW) for 1989 – 1992
– Guided the NCRFW and committed the government to the goals of widening the
prospective roles of women
– Objectives:
º Ensure equity in access to basic welfare and social services
º Make services responsive to the special needs and concerns of women
º Mitigate the difficulties faced by women associated with migration, prostitution
and violence
º Support gender-responsive planning and implementation
- Develop statistical indicators relevant to the involvement of women in government
programs and projects
• Republic Act 7192, Women in Development and Nation Building Act, enacted by Congress
in 1992
– Mainstreamed gender in the agenda for development
• Executive Order No. 273 approved and adopted in 1995 the Philippine Plan for Gender-
Responsive Development (PPGD) for 1995 – 2025
– 30-year framework for pursuing full equality and development for women and men
– Translates into concrete efforts strategies endorsed in the Beijing Platform for Action
in 1995 (Batistiana, PA-LAMP 2003)
– Continues PDPW initiatives and pushes other issues more aggressively
– Reiterates need to appropriate resources for gender and development programs and
projects
32

º Section 28 of the 1998 General Appropriations Act and Local Budget
Memorandum No. 28 of the Department of Budget and Management
required all agencies, including local government units to allocate
5% of their budget for gender-responsive projects.
4. Framework for Women’s Health in the Philippine Plan for Gender-Responsive

Development (PPGD 1995 – 2025)
Two provisions of the Philippine Constitution refer to health as a basic human right. Section
15 under State Policies provides that “the State shall promote the right to health of the
people and instill health consciousness among them.” Section 11 under Social Justice and
Human Rights states: “The state shall adopt an integrated and comprehensive approach to
health development … There shall be priority for the needs of the underprivileged sick,
elderly, disabled, women and children.”
Thus, national policies and international conventions are seen clear mandates for government
to address women’s health.
Health refers not only to the absence of disease or disability but encompasses a person’s
state of complete physical, mental, emotional and social well-being. Women’s health in all
states of the life cycle is of immense importance, not only because it affects the health of
the next generation through its impact on children, but also because women are half of the
country’s human resource.
Meeting the health needs of women means considering their needs in all
stages of their life cycle and not simply focusing on maternal health.
Maternal health is defined as the sense of well-being related to the ante-natal, natal and
post-natal periods of the life cycle. On the other hand, reproductive health is the state of
well-being in all matters relating to sexuality and the reproductive system. Reproductive
health could only be fully achieved if reproductive rights are recognized and enjoyed by
everyone regardless of race and creed. Reproductive right is the basic human right of
women/couples to decide freely and responsibly on the number, spacing and timing of
their children, based on their own choice and free from coercion, discrimination and violence.

Box 7. Women's Health in the Philippine Plan for Gender-Responsive Development 1995 - 2025
Some Provisions
• Primary health care, or health in the hands of the people, shall permeate the core strategy for
women's health… to enable women to participate actively in improving women's health status
and to become more self-reliant in looking after their own health.
• Women's empowerment and participation shall be ensured…Community organizing and other
empowering approaches shall be used at the community level at all times.
• Women's health and related programs shall be planned, implemented and evaluated in partnerships
and collaboration with all concerned.
• The sector shall see to it that laws and policies pertaining to women's health are enforced.
• Existing health and development programs shall be strengthened and expanded through the
integration of gender concerns.
• An integrated package of gender-sensitive, promotive, preventive and curative women's health
care services shall be implemented at all levels of health care… for all stages of a woman's life
cycle.
• The women's health and related programs of DOH shall support researches on appropriate,
indigenous, alternative women's health technology.
• A peripheral bias strategy shall be adopted… Women's health shall give priority to the unserved
and underserved areas and shall reach out to women marginalized by poverty, indigenous
women, women living in difficult circumstances (armed conflict, disasters), and disabled women.
• Family planning and reproductive health and rights shall be promoted… with the involvement
of both spouses in family planning discussions.
• Schemes to secure food for the household shall be devised and promoted.
• Health field workers shall be given training to improve the quality of services.
34

D. PARTNERSHIP BUILDING
Partnership building, a pillar of Primary Health Care, was carried a step forward under
Community Health Development.
1. Partnership-Building Antecedents in the Department of Health
• Partnership for Community Health Development Project, an approach to Primary Health Care
- Implemented in the Philippines from 1989 to 1994; piloted in 16 provinces
- Inspired by the recognition of the role of NGOs in nation-building
- Attempted to facilitate PHC through partnership among local government units, non-
government organizations, the private sector, people's organizations and the
Department of Health (DOH)
• Local Government Code of 1991
- Passed during the Ramos administration
- Resulted in a paradigm shift
- Devolved Primary Health Care to local government units
- Context for the conceptualization of projects such as the Women's Health and Safe
Motherhood Project-Partnerships Component
- Partnership process designed to evolve into community-managed Primary Health Care
2. Levels of Partnership
Empowered communities that enjoy a sense of project ownership have the capability to
shift from community-based level of participation to community managed projects. The
DOH Center for Health Development has the mandate to replicate the process of Community
Health Development by forming, strengthening and sustaining partnerships with non-
government organiza-tions, local government units and agencies and people's organizations.
Structures that have been established to sustain community-managed projects include:

• Regional Steering Committees with multiagency/NGO representation
• Core Field Workers Team at the municipal level
• DOH representative designated at the provincial and municipal levels
• Barangay Health Resource Team assisting in groundworking for community partnerships
• Women/community organizations at the baranggay level (Javier, WHSMP 2002)

IV. Program Components
CHD subscribes to the Post-Beijing/Cairo approach to women's health.
Gender-oriented community organizing and development is key strategy to put Community

Health Development in operation and to achieve women's health and women's empowerment.
To sustain projects and develop a sense of project ownership among stakeholders, advocates
of CHD build partnerships in all its components, which are described below:
A. IMPROVED HEALTH SERVICES
CHD advocates improve and enhance access to health services for women by working to
improve basic health facilities and make health practitioners gender-sensitive. CHD recognizes
the value and taps the services of traditional birth attendants and health practitioners. Health
services are upgraded to Sentrong Sigla standards.
Sentrong Sigla is a quality assurance movement to improve quality of health services in hospitals,
rural health clinics, health centers and other health facilities. The regional offices of the Department
of Health implement the Certification/Recognition Program and the Continuous Quality
Improvement of public hospitals by certifying facilities that meet or exceed
established criteria as providing quality services.
36

Facilities not meeting the standards are expected to use the assessment results to lobby for more
funding support from LGUs. On the other hand, the Continuous Quality Improvement program
focuses on capability building of the health staff. In so doing, the project also recognizes and
enhances appropriate indigenous structures and practices.
B. Health, Gender and Development as Entry Points for Community

Organizing
Most of the communities where CHD activities have been initiated are poor. Health care
needs and concerns of local communities and groups become closely linked with their
survival strategies. In Community Health Development, government ceases to be merely
a health service provider but an enabler in a process that allows and encourages local groups
and communities to become managers of their own health concerns. Communities are active
partners in health promotion and preventive health measures. Community Health Referral
System and support mechanisms, such as a health savings scheme, are set to improve access
of women and vulnerable groups to health services.
CHD also addresses non-health concerns. (Veneracion, IPC) Therefore, through the community
organizing process, women's actions that deliver basic services such as potable water, as
well as livelihood and other development initiatives of organized groups, get support.
Training and intensive information and education campaigns tackle women's health and
gender concerns. Reproductive health and rights and gender sensitivity are some of the
topics discussed.
How is women empowerment promoted in the CHD process?

• By strengthening or organizing women’s groups
• By doing community and gender analysis using Participatory Rapid Appraisal techniques
How do CHD advocates open opportunities for action?

• By implementing the Community Health Plan
• By encouraging, supporting or initiating “women’s actions” that range from maintaining
Health Savings Funds to advocacy work and keeping vegetable and herbal gardens
Women participate in the entire project cycle by monitoring and evaluating their actions
and conditions.

C. LGU Initiatives and Support from Project Agencies
How do local government units help in the CHD process?

• Legislative action
• Budgetary support for gender and health (sometimes with advocacy from women’s
organizations)
• Adoption of the Community Health Plan as part of the Barangay Development Plan
• Establishment of Gender and Development (GAD) Centers that provide support services
like counseling in cases of violence against women and children (VAWC)
How can government agencies help?

• By providing training
• By supporting development of livelihoodprojects of organized groups
What do NGOs do in the CHD process?

• Help address community concerns, which are beyond the mandate of the health agency,
but are necessary for sustainable development
• Provide communities and LGUs with assistance in the following:
- Identifying and analyzing community concerns
- Organizing action groups / building partnerships
- Selecting strategies and projects
Through partnership building, communities, government and non-govern-ment organizations

work together to improve health access by women.
The various components that make up the Women's Health and Empower-ment Model are
illustrated next page.
38

Figure 4. Women’s Health and Empowerment Model
Improved Health Delivery
• BHS construction/upgrade
• Sentrong Sigla standards on equipment
and health practitioners
• Training/equipment for BHW/TBA
Women’s Health
• Community Health
Women’s Practical Needs
Referral System
- Referrals
• Livelihood Fund
- Blood Directory
• Training: Micro finance GAD Center
- Community Health
• Women’s Actions
Savings
• Counseling
service
• Alternative Health
• Assertiveness
Care Women Organizing Training
- Pap Smear
(GST)
- Herbal Gardens
• VAWC Support
- Vegetable Gardens
Network
and Nutrition
• Training Program LGU Initiatives

- RH and GST
- Macrobiotics • Legislative Action
- Mothers’ • Budgetary Support
Classes • GAD Center
• Integration of CHP in
Barangay and Municipal
Development Plans

GLOSSARY
Gender refers to the social differences and relations between women and men, which are
learned, changeable over time, and have wide variations within cultures and between cultures.
These differences and relationships are socially constructed and are learned through the
socialization process. They are context-specific and can be modified. (ILO, 2000)
Gender Equality refers to the equal rights, responsibilities and opportunities of women and
men, girls and boys. Gender equality is not just a “women’s issue.” It concerns men as well.
Equality does not mean that women and men will become the same, but that women’s and
men’s rights, responsibilities and opportunities will not depend on whether they are born
male or female. Equality between women and men is both a human rights issue and a
precondition for sustainable people-centered development. (ILO, 2000)
Gender Equity refers to a situation where women and men have the opportunity to equitably
benefit from the available resources and opportunities. The following elucidates this meaning
of gender equity: “A fox and stork may be given equal opportunity to eat from a dish. Who
gets most depends on whether the dish is wide and shallow to suit the fox, or deep and
narrow to suit the stork. For equitable impact, each would have to eat a share of the food
from its own dish.” (CCIC, MATCH International Center, 1991)
Gender Responsiveness refers to the presence of concrete actions or measures (e.g. programs,
projects, processes, etc.) to resolve gender inequality and inequity, and to respond to the needs
and interests of women and men.
Gender Sensitivity refers to the recognition of the underlying and hidden causes of inequity
between women and men, and to the acknowledgement of their different and common
practical and strategic gender needs and interests.
Practical Gender Needs refer to needs identified to help women in their existing subordinate
position in society. They do not challenge the gender divisions of labor or women’s subordinate
positions in society, although they rise out of them. They respond to an immediate perceived
necessity identified within a specific context. They are practical in nature and are often
concerned with inadequacies in living conditions such as water provision, health care and
employment. Practical gender needs may include: water provision, health care, income earning
for household provisioning, housing and basic services, and family food provision. They are
needs shared by all household members yet are probably identified specifically as practical
gender needs of women or men because women assume the responsibility for meeting these
needs. (Moser, 1993)
40

Strategic Gender Needs are the needs women identify because of their subordinate position
to men in their society. Strategic gender needs vary according to particular contexts. They
relate to gender divisions of labor, power and control and may include such issues as legal
rights, domestic violence, equitable wages and women’s control over their bodies. Meeting
strategic needs helps women to achieve gender equality. It also changes existing roles and
therefore challenges women’s subordinate position. Strategic gender needs may include:
abolition of sexual division of labor, alleviation of the burden of domestic labor and child
care, the removal of institutionalized forms of discrimination such as rights to own land or
property, marriage divorce, custody of children, etc., access to credit and other resources,
freedom of choice over child bearing, and measures against male violence and control over
women. (Moser, 1993)
Women's Health - A woman's health starts with her birth, from the moment of conception
and continues till death. Her health is her complete physical, mental and social well-being,
which is influenced by the man and woman relationship in the society. (RECPHEC, 1994)

BIBLIOGRAPHY
Batangan, Dennis. Global Issues in Health. Institute of Philippine Culture
Batistiana, Brenda. Mainstreaming Gender in LAMP. DENR: PA-Land Administration and

Management, February 2003
Bautista, Victoria, et al. Forging Community –Managed Primary Health Care. Manila:
Community Health Service, DOH and College of Public Administration, University
of the Philippines, 1998
Canadian International Development Agency. Philippine Plan for Gender-Responsive

Development, 1995 – 2025
Javier, Alwynn. Building Partnerships for Women's Health: An Implementation Handbook.

(Final Draft) WHSMP, 2002
MacDonald, John. Primary Health Care: Medicine in its Place. London: Earthscan Publications
Limited, 1993
CHETNA, Gender and Women’s Health Pamphlet. In ARROW – Resource Kit, Sensitizing
Health Care Practitioners and Policy Makers on Gender and Women’s Health, 1996
Department of Health. Sentrong Sigla. Strategic Framework and Plan Year 2000 - 2004.
Manila, 2000
Philippine-Australia Land Management Project. Plan for Gender Mainstreaming in Philippine

Land Administration and Management, DENR, 2003
Resource Center for Primary Health Care. Gender and Women's Health, Nepal, 1994
In ARROW - Resource Kit, 1996
United Nations. "Platform for Action and the Beijing Declaration," Fourth World Conference
on Women, Beijing, China, 4 - 15 September 1995. New York: United Nations Department
of Public Information In ARROW - Resource Kit, 1996
United Nations. "Report of the International Conference on Population and Development,"

Cairo, 5 - 13 September 1994
Veneracion, Cynthia. Initiatives and Strategies for Community Health Development: Case
Studies of Four Philippine Rural Barangays. Quezon City: IPC, Ateneo de Manila
42

ACKNOWLEDGEMENTS
The modules that comprise the Community Health Development Package (CHDP) were
developed throughout the six-year implementation of the Women’s Health & Safe Motherhood
Project—Partnerships Component.
They are the product of the collective work of the Project staff, International and Local
consultants, Partner NGOs, Women’s Organizations, LGUs and the Department of Health
(DOH) Centers for Health Development across the five Project regions: Cordillera Autonomous
Region, Bicol, Eastern Visayas, Northern Mindanao and Caraga. The modules were field
tested in barangays in those regions.
This series of training and instructional manuals provide a “how to,” “step-by-step” guide
to implementation of the modules.
The Project is indebted to countless people who painstakingly worked to produce these
manuals. It would take a whole book to name them all. Just the same, we would like to
express our sincerest gratitude to the following:
• the International and Local consultants who provided invaluable technical inputs;
• the writers who spent sleepless nights poring over voluminous Project documents and
synthesizing disparate experiences to produce usable instructional manuals;
• the Project partners who reviewed the drafts and provided insightful comments;
• the copyeditors who labored long and hard to make the manuals easy to understand and
reader-friendly;
• the illustrators, lay-out artists and production staff who worked under extreme pressure
and tight deadlines to make the manuals look interesting and distinctive; and
• the Project staff who exerted their best efforts to make possible the impossible—producing
26 manuals in an extremely short time.
Finally, our special thanks go to all the women and their communities who participated in
the Project. They welcomed us into their homes and lives, and they trusted us to journey
with them towards better health and empowerment. Their daily lives and struggles are our
continuing inspiration. To them we dedicate this work.

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MODULE

Principles and Practices of

FINAL module 01 PAGE 01

Women’s Health & Safe Motherhood Project-Partnerships Component

PAGE 02 module 01 FINAL

I. National and International Agreements Affecting Health Care

II. Concerns/Issues of Importance in Women’s Health

III. Community Health Development: Principles and Practices 19

IV. Program Components 36

Principles and Practices of Community Health DevelopmenA 03

FINAL module 01 PAGE 03

In addition to the movement to democratize health care, efforts to mainstream gender

Principles and Practices of Community Health Development 05

FINAL module 01 PAGE 05

ORIENTATION-WORKSHOP ON COMMUNITY HEALTH DEVELOPMENT

Participants are briefed on Community Health Development principles and strategies.

The orientation shall fulfill the following objectives:

1. Participants are briefed on the CHD's fundamental concepts and principles

1. Participants internalize CHD concepts, principles and strategies.

Principles and Practices of Community Health Development 07

FINAL module 01 PAGE 07

1. Provincial representative of the Department of Health

PAGE 08 module 01 FINAL

Principles and Practices of Community Health Development 09

FINAL module 01 PAGE 09

• National and International Declarations affecting Women’s Health

2. Discussion of CHD Components

PAGE 10 module 01 FINAL

Advocacy by the United Nations boosted the pursuit of alternative concepts

A. THE ALMA ATA DECLARATION AND

1. Primary Health Care Defined

The concept of Primary Health Care is explained as follows:

Box 1. Alma Ata Declaration on Primary Health Care

Principles and Practices of Community Health Development 11

FINAL module 01 PAGE 11

Box 2. Eight Elements of Primary Health Care (Alma Ata Declaration)

Promotive 1. Education concerning health

Preventive 4. Maternal and child health care,

Curative 7. Appropriate treatment of common

PAGE 12 module 01 FINAL

Table 1. Conventional vs. Primary Health Care

The Three Pillars Conventional Health Care Primary Health Care

• Generally passive role • Active community involvement

• Concerns only the • Other sectors have important role

• No analysis of context • Involves the people and govern-

Principles and Practices of Community Health Development 13

FINAL module 01 PAGE 13

1. The Cairo ICPD Recommendations of 1994

Three major points of ICPD:

• Defines women empowerment in relation to sexuality, reproduction and population —

• Sees improvement of women’s status as precondition for effective population and

PAGE 14 module 01 FINAL

Principles and Practices of Community Health Development 15

FINAL module 01 PAGE 15

• Considers recognition and reaffirmation of this right as basic to women’s empowerment

Box 4. Beijing Definition of Women's Health

PAGE 16 module 01 FINAL

• Reproductive health and sexuality

• Improvement of health services for women

Principles and Practices of Community Health Development 17

FINAL module 01 PAGE 17

Concerns Affecting Women as Health Agents

Concerns/Issues Affecting Women