THE COMMUNITY DIAGNOSIS

PROCESS
(Health Problems & Prioritization)
ROSA MARIE N.FLORES,M.D, DFM,FPAFP,MPH
 COMMUNITY
DIAGNOSIS
Community diagnosis generally refers
to the identification and
quantification of health problems in a
community as a whole ,(determining
the factors that affect the health of a
population) using health indicators, in
terms of mortality and morbidity
rates and ratios, and identification of
their correlates for the purpose of
defining those at risk or those in need
of health care and determining the
opportunities and resources available
to adequately address these
 Process of Community Diagnosis

Collecting background information of various communities.

Selecting a target community.
Initial Planning:
Developing tools and techniques:
Entry to the community, Rapport Building, Social Mapping.
Data collection.
Process of Community Diagnosis
• 1. Collecting background information of various communities
•

• 2. Selecting a target community

•

• 3. Initial Planning:
• Establishing the Community diagnosis survey objectives,
-

• - Scope of the survey (how much detailed information is needed?

how big area should it cover? E.g. Ward level, VDC level, district
level),
• - Selection of appropriate indicators
Process of Community Diagnosis
• - Selecting appropriate time of the year (seasonality might affect results)

• - Identifying resources (human resources, financial resources, etc.)

• 4. Sampling: Selection of study population from reference population; probability and
non-probability sampling (usually we use probability sampling methods in community diagnosis
survey)\
• 5. Developing tools and techniques:
• - Household questionnaire
• - Anthropometric instruments (weighing machines, salter scales, MUAC tapes etc.)
• - Observation checklist
• - Key-informant interview guidelines (e.g. for interviewing HF in-charges, school teachers, local
leaders, traditional healers etc.)
• - In depth interview guidelines (patients visiting health facility)
• - FGD guidelines (e.g. with FCHVs, representatives from mothers groups etc.)
•
• 1. Collecting background information of various communities
•

• 2. Selecting a target community

•

• 3. Initial Planning:
• - Establishing the Community diagnosis survey objectives,
• - Scope of the survey (how much detailed information is needed? how big area should it
cover? E.g. Ward level, VDC level, district level),
• - Selection of appropriate indicators
• - Selecting appropriate time of the year (seasonality might affect results)
• - Identifying resources (human resources, financial resources, etc.)
 Community
Diagnosis (community
Community assessment)
Diagnosis
(community a = is the foundation for
ssessment) improving and promoting
the health
of community members.
Arefat slides ----some were used
 • 37.17(deaths per 100 population)in 2020
• In 2020, adult mortality rate for Philippines was
37.17 deaths per 100 population. Adult mortality
rate of Philippines increased from 22.12 deaths per
100 population in 1975 to 37.17 deaths per 100
population in 2020 growing at an average annual
Philippines - Adult rate of 6.03%.
• The description is composed by our digital data
mortality rate assistant.
between age 15 • What is adult mortality rate?
and 60 • Percentage of total deaths between ages 15 and 60
(per 100 total population), both sexes combined
• CORONAVIRUS DATA AND INSIGHTS
• Live data and insights on Coronavirus around the
world, including detailed statistics for the US, EU,
and China — confirmed and recovered cases,
deaths, alternative data on economic activities,
customer behavior, supply chains, and more.
What is the mortality rate in the Philippines
2019?

•about 5.92 deaths per 1,000 inhabitants

What is the mortality rate in the Philippines
2020?

37.17 deaths per 100 population

In 2020, adult mortality rate for Philippines was 37.17 deaths per 100
population.
Adult mortality rate of Philippines increased from 22.12 deaths per
100 population in 1975 to 37.17 deaths per 100 population in 2020
growing at an average annual rate of 6.03%.
•
COMMUNITY
PROFILE = N
SBORR
• Demographic and fertility Indicators
• Basic Needs Indicators
• Health for all Indicators
Mortality Rates
• The traditional measures of health status. Widely used because of
their ready availability.( death certificate is a legal requirement in
many countries)
• Crude death rates
• Specific death rates: age/disease
• Expectation of life Infant mortality rate
• Maternal mortality rate
• Proportionate mortality ratio
• Case Fatality rate
Morbidity Indicators Morbidity rates
Incidence and prevalence
• Data on morbidity are preferable, although often difficult to obtain.
• Incidence and prevalence
• Notification rates
• Attendance rates: out-patient clinics or health centers.
• Admission and discharge rates
• Hospital stay duration rates
Disability Indicators
• Disability rates
• No. of days of restricted activity
• Bed disability days
• Work/School loss days within a specified period.
• Expectation of life free of disability
Nutritional Indicators
• Nutritional Status Indicators- It is an indicator of positive health
• Anthropometrics measurements
• Height of children at school entry
• Prevalence of low birth weight
• Clinical surveys: Anaemia, Hypothyroidism, Nightblindness
Health Care Delivery Indicators

• Reflect the Equity / Provision of health careDoctor / Population ratio

• Doctor / Nurse ratio
• Population / Bed ratio
• Population / per health center
Utilization Indicators
• Health care utilization Rates- Extent of use of health services-
Proportion of people in need of service who actually receive it in a
given periodProportion of infants who are fully immunized in the 1st
year of life i.e..immunization coverage.
• Proportion of pregnant women who receive ANC.
• Hospital-Beds occupancy rate.
• Hospital-Beds turn-over ratio
• Social/Mental Health Indicators
Indicators of Social and Mental Health- Valid positive indicators does
not often exist- Indirect measures are commonly used
• Suicide & Homicide rates
• Road traffic accidents
• Alcohol and drug abuse.
• Environmental Indicators
Environmental health Indicators- Reflect the quality of environment
• Measures of Pollution
• The proportion of people having access to safe water and sanitation
facilities
• Vectors density
• Socio-economic Indicators
- Is not a direct measure of health status.- For interpretation of health
care indicators.
• Rate of population increase
• Per capita GNPLevel of unemployment
• Literacy rates – females
• Family size
• Housing condition e.g. No. of persons per room
• Health Policy Indicators
- Allocation of adequate resources.
• Proportion of GNP spent on health services.
• Proportion of GNP spent on health related activities.
• Proportion of total health resources devoted to primary health care
• Other Indicators Other health indicators
Indicators of quality of life.
• Basic needs indicators.
• Health for all indicators.
What are the top 10 leading causes of mortality
in the Philippines?
• The leading causes of death are diseases of the heart, diseases of the
vascular system, pneumonias, malignant neoplasms/cancers, all forms
of tuberculosis, accidents, COPD and allied conditions, diabetes
mellitus, nephritis/nephritic syndrome and other diseases of
respiratory system.
What are the top 10 leading causes of morbidity
and mortality in the Philippines?
• The leading causes of death are diseases of the heart, diseases of the
vascular system, pneumonias, malignant neoplasms/cancers, all forms
of tuberculosis, accidents, COPD and allied conditions, diabetes
mellitus, nephritis/nephritic syndrome and other diseases of
respiratory system.
Leading Causes of Morbidity

• Acute Respiratory Infection ** 1,289,168. 1371.3.

• Acute Lower Respiratory Tract Infection and Pneumonia. 586,186. 623.5.
• Bronchitis/Bronchiolitis. 351,126. 373.5.
• Hypertension. 345,412. 367.4.
• Acute Watery Diarrhea. 326,551. 347.3.
• Influenza. 272,001. ...
• Urinary Tract Infection** 83,569. ...
• TB Respiratory. 72,516.
• More items...
•
 2010*

10 Diseases
Number Rate

Leadi 1. Acute Respiratory Infection ** 1,289,168 1371.3

ng
Caus 2. Acute Lower Respiratory Tract Infection
and Pneumonia
586,186 623.5

es of
Morb 3. Bronchitis/Bronchiolitis 351,126 373.5

idity 4. Hypertension 345,412 367.4

5. Acute Watery Diarrhea 326,551 347.3

6. Influenza 272,001 289.3

7. Urinary Tract Infection** 83,569 88.9

8. TB Respiratory 72,516 77.1

9. Injuries 51,201 54.5

10. Disease of the Heart 37,589 40.0

 Process of Community Diagnosis
•Collecting background information of various
communities.
•Selecting a target community.
•Initial Planning:
•Developing tools and techniques:
•Entry to the community, Rapport Building, Social
Mapping.
•Data collection.
The Process (cont’d)

•Examining the aggregates of health

and social statistics in addition to
the knowledge of the local situation
, aiming at determining the health
needs of a given community
• 1. Collecting background information of various communities
•

• 2. Selecting a target community

•

• 3. Initial Planning:
• - Establishing the Community diagnosis survey objectives,
• - Scope of the survey (how much detailed information is needed? how big area should it cover? E.g. Ward level,
VDC level, district level),
• - Selection of appropriate indicators
• - Selecting appropriate time of the year (seasonality might affect results)
• - Identifying resources (human resources, financial resources, etc.)
• 4. Sampling: Selection of study population from reference population; probability
and non-probability sampling (usually we use probability sampling methods in
community diagnosis survey)\
• 5. Developing tools and techniques:
• - Household questionnaire
• - Anthropometric instruments (weighing machines, salter scales, MUAC tapes
etc.)
• - Observation checklist
• - Key-informant interview guidelines (e.g. for interviewing HF in-charges, school
teachers, local leaders, traditional healers etc.)
• - In depth interview guidelines (patients visiting health facility)
• - FGD guidelines (e.g. with FCHVs, representatives from mothers groups etc.)
• 6. Entry to the community, Rapport Building, Social Mapping
•

• 7. Data collection
•

• 8. Data entry and processing: Data validation, Data sorting and

sequencing, summarizing, coding, aggregation, computing etc.
• 9. Data analysis and Interpretation: Descriptive and Inferential analysis, in
community diagnosis we usually perform descriptive analysis (frequency,
ratio, proportions, percent etc.) Data can be displayed in the form of
sentences, tables, graphs, charts. etc.) Data can be displayed in the form of
sentences, tables, graphs, charts.
• 10. Need identification: Determining observed needs and felt needs, and then
finalizing the real needs of the community and ultimately identifying the
necessary measures to solve them.
• 11. Prioritizing needs with community people:
• Not all needs can be met. There are certain to be used to prioritize the health
needs of the community, which are listed as follows:
• - Equity
- Burden of disease (Magnitude, severity)
- Cost effectiveness
- Community interest
- Existing capacity
- National Priority
-Sustainability
- Time for evaluation
Need prioritization score table

Needs Assessment Table

Need Magnitude SeverityCost CommunityNationalFeasibility Sustainabilit Time for Total

s effectivene interest priority y evaluatio score
ss n
1
2
3
• 12. Conducting Micro-Health Project and evaluation
•

• 13. Dissemination: Community presentations, final report sharing to

community and concerned authorities
• 14. Follow up
• It is important to realize that Community Diagnosis is not a one-off project,
but is part of a dynamic process leading to health promotion in the
community. Therefore community diagnosis should be conducted at regular
intervals to allow the health status of the community to be continuously
improved.and concerned authorities
What are the steps community diagnosis?

•The CD process encompasses four

primary activities: a windshield tour, an
analysis of existing secondary data,
interviews and focus groups with
community members and service
providers, and a community forum (see
Table 2 for greater detail).
The process of community diagnosis
involves four stages:

•Initiation.
•Data collection and analysis.
•Diagnosis.
•Dissemination.
Types of Community Diagnosis
Comprehensive Problem-Oriented
Community Community Diagnosis
Diagnosis

aims to obtain general type of assessment

information about the responds to a particular
community need
Purpose of Community Diagnosis

•Community Diagnosis (community assessment)

is the foundation for improving and promoting
the health of community members. The role of
community assessment is to identify factors
that affect the health of a population and
determine the availability of resources within
the community to adequately address these
factors.
What are the 6 steps of community
assessment
• This workbook explains steps 1, 3, 4 and 5 in detail.
• Step 1: Plan for a community needs assessment. • Identify and
assemble a diverse community team. ...
• Step 2: Conduct the needs assessment. ...
• Step 3: Review and rate the data. ...
• Step 4: Record and review consolidated data. ...
• Step 5: Develop a community action plan.
 What is usually the first step in
completing a community
assessment

•What is the first step in beginning a

community assessment? Before a
community can be assessed, the exact
community must be clearly
delineated; the nurse accomplishes this
by defining the community and
determining its boundaries or
parameters. This will determine what
data the nurse will need to collect.
 10 steps in the Community Health
Assessment Diagnosis Process
• Establishing the assessment team.
• Identifying and securing resources.
• Identifying and engaging community partners.
• Collecting, Analyzing, and Presenting Data.
• Setting Health Priorities.
• Clarifying the Issue.
• Setting Goals and Measuring Progress.
• Choosing the Strategy.
• Developing the Community Health Assessment document.
• Managing and sustaining the process.
•The process of community diagnosis should
possess some characteristics, namely ability
to address important community problems
which are amenable to practical control;
ability to identify most of the targeted
health events; adequacy in reflecting
changes in distribution of events over time,
place and person; a clearly ...Oct 16, 2014
What are the factors to be considered in
community diagnosis?
•Six factors accounted for 74% of the
total variance and were interpreted as:
'Poverty and social disorganization',
'Distribution and problems of the
elderly', 'Ethnic composition', 'Fertility',
'Infant mortality' and 'Foetal mortality'.
•The process of community
diagnosis involves four stages:
•Initiation.
•Data collection and analysis.
•Diagnosis.
•Dissemination.
Aim of CD
•Community Diagnosis (community assessment)
is the foundation for improving and promoting
the health of community members.
•The role of community assessment is to identify
factors that affect the health of a population and
determine the availability of resources within
the community to adequately address these
factors.
How do you conduct a CD
•Process of Community Diagnosis
•Collecting background information of various communities.
•Selecting a target community.
•Initial Planning: ...
•Sampling: Selection of study population from reference
population; probability and non-probability sampling (usually
we use probability sampling methods in community
diagnosis survey)\
What are the characteristics of heslth
indicators?

•Section 1 detailed the attributes of a good

indicator, emphasizing that indicators should
be measureable, feasible, valid, timely,
replicable, sustainable, relevant, and
comprehensive. In addition, indicators should be
stratified by person, place, and time as desirable.
Characteristics of a healthy community
•The environment meets everyone's basic
needs. The environment promotes social
harmony and actively involves everyone.
There is an understanding of the local
health and environment issues. The
community participates in identifying local
solutions to local problems.
What are community health indicators
•The environment meets everyone's basic
needs. The environment promotes social
harmony and actively involves everyone.
There is an understanding of the local health
and environment issues. The community
participates in identifying local solutions to
local problems.
What is CD in Public Health
• The environment meets everyone's basic needs. The environment
promotes social harmony and actively involves everyone. There is an
understanding of the local health and environment issues. The
community participates in identifying local solutions to local
problems.
Which of the following is the best indicator of
the health status of a community?

• Answer: Life Expectancy. Life expectancy is an important health

status indicator based on the average number of years a person at a
given age may be expected to live given current mortality rates.Jul 14,
2021
What are the best indicators of health
• Here are some fundamental indicators of good health, along with
suggestions on how we can achieve them:
• Restful and consistent sleeping patterns. ...
• Good energy levels. ...
• Healthy bowel movement. ...
• Healthy Urinary System. ...
• Healthy, dewy skin. ...
• Healthy hair. ...
• Good oral health and neutral-smelling breath. ...
• Regular menstrual cycles.
• Step 5: Prioritize Community Health Issues
• Community Health Assessment Toolkit
• Purpose
• Hospitals and community stakeholders go through a process to
distinguish the most pressing community health needs based on the
data collected. The identified priority health needs will be addressed
through the implementation strategies.
• Key Components
• Identify criteria for prioritization
Hospitals are at their discretion to develop prioritization criteria and processes. A set of criteria should be
determined to guide the prioritization process. Typically, three to six priorities are selected, based on:
• Magnitude of the problem
• Severity of the problem
• Need among vulnerable populations
• Community’s capacity and willingness to act on the issue
• Ability to have a measurable impact on the issue
• Availability of hospital and community resources
• Existing interventions focused on the issue
• Whether the issue is a root cause of other problems
• Trending health concerns in the community
• Additional prioritization criteria can include:
• The importance of each problem to community members
• Evidence that an intervention can change the problem
• Alignment with an organization’s existing priorities
• Hospital’s ability to contribute finances and resources to
address the health concern
• Potential challenges or barriers to addressing the need
• The opportunity to intervene at the prevention level
• Select community health priorities
Priorities can be selected as part of an established
process informed by contributing partners, including
community stakeholders, health departments, social
service agencies, policy makers and hospital leadership.
Action steps to be considered are:
•Select a prioritization committee – Members can be from
hospitals, community stakeholder organizations and other
organizations/institutions with specialized knowledge or
constituents.
•Discuss the data – Present the qualitative and quantitative
data to the prioritization committee. Make sure that the data
are presented in a format that is accessible for the
individuals on the committee. Foster an environment for
open dialogue to discuss the identified health needs
thoroughly.
•Review community assets – Reflect back on your asset
map to identify what resources exist in your community to
address the need. Take stock of what resources (staffing,
in-kind, financial, etc.) in your hospital could potentially be
leveraged to address that need.
•Select priorities – Decide which approach you want to use
to determine priority needs.
ECHNIQUES DESCRIPTION

Multi-voting technique Decide on priorities by agreeing or disagreeing in group

discussions and continuing process/rounds until a final list is
developed.

Strategy lists Determine if the health needs are of “high or low

importance” by placing an emphasis on problems whose
solutions have maximum impact, with the possibility of
limited resources.

Nominal group technique Rate health problems from 1 to 10 through group discussion.

Hanlon method List those health needs viewed as priorities based on

baseline data, numeric values and feasibility factors.

Prioritization matrix Weigh and rank multiple criteria for prioritization with
numeric values to determine health needs with high
importance.
• Build consensus around priority needs – If you select priorities that vary from
community recommendations, justify the reasons for making those choices.
Consider the consequences of not addressing an issue and how that can affect the
community’s well-being in the future. In the case of overlapping health needs,
consider consolidating into a single priority.
• Validate selected priorities – Conduct discussion groups with members of your
hospital’s steering committee and community members for additional input. Make
sure the selected priority needs align with hospital and community sentiment.
• Present priorities to senior leadership and the hospital’s board of trustees for
approval – Align your hospital’s population health management strategy with the
community health priorities.
• Describe which needs were not prioritized
It may not be possible to address all community health needs at once.
If there are significant needs that are not prioritized or will not be
addressed, you should be able to describe what the needs are and
why you have chosen not to address them.

D
•
How do you prioritize your health
• Here are six simple steps for accomplishing this:
• Don't try to change everything at once. ...
• Aim to create a positive new habit, not just a result. ...
• Change your environment. ...
• Recognize that small changes add up. ...
• When you slip, get back on track quickly. ...
• Schedule your new habits into your life. ...
• Repeat.
What is the process od community diagnosis
• The purpose of community diagnosis is to define existing problems,
determine available resources and set priorities for planning,
implementing and evaluating health action, by and for the
community.
WHO definition of community diagnosis

• What is community diagnosis? According to WHO definition, it is “a

quantitative and qualitative description of the health of. citizens and
the factors which influence their health. It identifies problems,
proposes areas for. improvement and stimulates action”
END
• etc.) Data can be displayed in the form of sentences, tables, graphs,
charts.
•Process of Community Diagnosis

•1. Collecting background information of various communities

•2. Selecting a target community

•3. Initial Planning:

•- Establishing the Community diagnosis survey objectives,

•- Scope of the survey (how much detailed information is needed? how big area should it cover? E.g. Ward level, VDC level, district level),

•- Selection of appropriate indicators

•- Selecting appropriate time of the year (seasonality might affect results)

•- Identifying resources (human resources, financial resources, etc.)

•4. Sampling: Selection of study population from reference population; probability and non-probability sampling (usually we use probability sampling methods in community diagnosis survey)\

•5. Developing tools and techniques:

•- Household questionnaire

•- Anthropometric instruments (weighing machines, salter scales, MUAC tapes etc.)

•- Observation checklist

•- Key-informant interview guidelines (e.g. for interviewing HF in-charges, school teachers, local leaders, traditional healers etc.)

•- In depth interview guidelines (patients visiting health facility)

•- FGD guidelines (e.g. with FCHVs, representatives from mothers groups etc.)

•6. Entry to the community, Rapport Building, Social Mapping

•7. Data collection

•8. Data entry and processing: Data validation, Data sorting and sequencing, summarizing, coding, aggregation, computing etc.

•9. Data analysis and Interpretation: Descriptive and Inferential analysis, in community diagnosis we usually perform descriptive analysis (frequency, ratio, proportions, percent, etc.) Data can be displayed in the form of sentences, tables, graphs,
charts.

•10. Need identification: Determining observed needs and felt needs, and then finalizing the real needs of the community and ultimately identifying the necessary measures to solve them.

•11. Prioritizing needs with community people:

•Not all needs can be met. There are certain to be used to prioritize the health needs of the community, which are listed as follows:

•- Equity
- Burden of disease (Magnitude, severity)
- Cost effectiveness
- Community interest
- Existing capacity
- National Priority
- Sustainability
- Time for evaluation

•Need prioritization score table

Process of Community Diagnosis
1. Collecting background information of various communities

2. Selecting a target community

3. Initial Planning:
- Establishing the Community diagnosis survey objectives,
- Scope of the survey (how much detailed information is needed? how big area should it cover? E.g. Ward level, VDC level, district level),
- Selection of appropriate indicators
- Selecting appropriate time of the year (seasonality might affect results)
- Identifying resources (human resources, financial resources, etc.)
4. Sampling: Selection of study population from reference population; probability and non-probability sampling (usually we use probability
sampling methods in community diagnosis survey)\
5. Developing tools and techniques:
- Household questionnaire
- Anthropometric instruments (weighing machines, salter scales, MUAC tapes etc.)
- Observation checklist
- Key-informant interview guidelines (e.g. for interviewing HF in-charges, school teachers, local leaders, traditional healers etc.)
- In depth interview guidelines (patients visiting health facility)
- FGD guidelines (e.g. with FCHVs, representatives from mothers groups etc.)
6. Entry to the community, Rapport Building, Social Mapping
What are the steps in community diagnosis
• The CD process encompasses four primary activities: a windshield
tour, an analysis of existing secondary data, interviews and focus
groups with community members and service providers, and a
community forum (see Table 2 for greater detail). ...
What is the first step in conducting
community diagnosis?
• And, how do we share our findings and decisions with community
members?
• Also, you will learn each of the six steps involved in conducting a
community assessment:
• define the scope,
• go solo or collaborate,
• collect data,
• determine key findings,
• set priorities and create an action plan, and
• share your findings.
Starting the Community Health Improvement
Planning Process: 10 Simple Steps

• Implement a Data Management System. ...

• Identify and Engage Partners. ...
• Develop Results Statements. ...
• Prioritize Issues. ...
• Define Indicators. ...
• Create Population-Level Strategies. ...
• Partners Define Performance Measures.
• More items...
Starting the Community Health Improvement Planning
Process: 10 Simple Steps
•
10 Steps in Community Health Assessment Development Process
• Assessment planning models and frameworks identify 10 Steps in the
Community Health Assessment development process. They are:
• Establishing the assessment team.
• Identifying and securing resources.
• Identifying and engaging community partners.
• Collecting, Analyzing, and Presenting Data.
• Setting Health Priorities.
• Clarifying the Issue.
• Setting Goals and Measuring Progress.
• Choosing the Strategy.
• Developing the Community Health Assessment document.
• Managing and sustaining the process.
• Links on "How to do Assessments" provide more insight into the 10 step
process.
• 1. Implement a Data Management System
• Kayleigh Weaver
• Creating an effective CHIP is all about being a great “health detective”, digging deep into root
causes, creating appropriate strategies with a reasoned chance of improving things, and getting
serious about continuous improvement. By following the recommended steps below, we’ll help
you get on the fast track to measurable health improvements.
• Some of these steps will be completed simultaneously, but all are critical parts of the process. Be
sure to document your efforts throughout the process so that you have all the information you
need when it’s time to publish your CHIP and share it with the world.
• Data is the foundation of both the CHA and CHIP planning process. Without it, we have no way to
build an accurate picture of conditions of health in our communities. Data also tells us how well
our strategies are working and how well our programs are performing. Throughout both of these
processes, you’re going to be working with a lot of qualitative and quantitative data, so it’s
important to set up a reliable system that allows you to easily store, organize, analyze, and share
both kinds of data with partners. When done effectively, you can actually use your data
management system to document the whole planning process and create an electronic version of
your final CHIP. Clear Impact Scorecard is one option that can help you do this.
•
• 2. Complete Community Health Assessment
• What type of community do you want to live in? You can’t plan your
journey if you don’t know where you’re going. Take a look at the state of
health in your community. Do research. Ask questions. What do community
members want? What needs to change? What type of assets do you have
access to and which ones do you need to develop? What seems to be the
most troubling or pressing health issues? Make sure you disaggregate the
data to see if there are inequities. You can gather all of this data a variety of
ways, including through surveys, interviews, focus groups, primary
quantitative sources, and secondary quantitative sources. If you’re looking
for data, the CDC has a lot of helpful resources for State, Local, Tribal, and
Territorial health professionals.
• 3. Identify and Engage Partners
• You probably already engaged some partners in step two. Think about who
else might have a role to play in improving your state, neighborhood, or
community’s health. It is important to think “outside the box” when
considering partners. Consider the role that different industries play in
community health and how you can engage them. Consider engaging
leaders in business, nonprofits, foundations, local government, faith-based
institutions, financial institutions, community groups, schools, and others.
Don’t forget to include the individual community members you are serving.
Once you have enlisted partners, the following steps should be completed
collaboratively whenever possible to ensure alignment and clarity of roles.
• 3. Identify and Engage Partners
• You probably already engaged some partners in step two. Think about who
else might have a role to play in improving your state, neighborhood, or
community’s health. It is important to think “outside the box” when
considering partners. Consider the role that different industries play in
community health and how you can engage them. Consider engaging
leaders in business, nonprofits, foundations, local government, faith-based
institutions, financial institutions, community groups, schools, and others.
Don’t forget to include the individual community members you are serving.
Once you have enlisted partners, the following steps should be completed
collaboratively whenever possible to ensure alignment and clarity of roles.
• 4. Develop Results Statements
• Develop some results statements that describe how you want your
community to look. These statements should be clear, concise, and
written in language that anyone can understand. Maybe you want
“Natural environments are clean and safe.” Maybe you want “Babies
are born healthy.” Collaborate on these and write them down – this is
the vision that is going to guide you through the rest of the process.
•
• 5. Prioritize Issues
• In this step, you’re going to use the knowledge gained through the CHA
process, as well as the collective knowledge of the collaborative, to
prioritize health issues to bring a more focused approach to the
improvement plan. According to the National Association of County and
City Health Officials, prioritization helps communities focus on key issues in
order to maximize impact and use their resources as efficiently as possible.
It is generally recommended that a community choose no more than three
to five priorities to focus on within one community health improvement
process cycle. This will increase focus, maximize impact, and create
alignment of individual action against community goals. If you’re having
trouble figuring out how to prioritize your health issues, NACCHO created
this useful tip sheet.
• 6. Define Indicators
• How are you going to determine if your priority areas are improving?
Develop some measures for each priority area. If one of your
priorities is to reduce underage drinking, then you might want to
measure the “number of 13-20 year olds reporting that they’ve
consumed alcohol in the last 60 days.” Develop 1 to 3 Indicators for
each of your 3 to 5 focus areas.
• 7. Create Population-Level Strategies
• Create overarching strategies to improve each Indicator. It is important to
remember that strategies at the community level are shared strategies. The
“Turn the Curve” thinking process is a simple 5-step process that can be
used to create effective strategies to improve your Indicators. It consists of:
1) graphing a baseline for your Indicator, 2) developing the “Story behind
the Baseline,” 3) Selecting Relevant Partners, 4) Exploring “What Works” to
Turn the Curve, and 5) Developing an Action Plan. This process forces you
to dive deep into the factors that are influencing health conditions in your
community so that you can create strategies and action-plans that get
results. Read our webpage here to learn more about the Turn the Curve
Process.
8. Partners Create Organizational-Level Strategies (Programs, Services, etc.)
• What we do at the organizational (or service-system) level is our contribution to
community-level strategy. Partners should, therefore, develop organizational-level strategies
and programs designed to achieve the community-level strategy. For example, if one of the
focus areas determined in step 4 is “Cancer Reduction,” you or one of your partners may
develop a cancer-screening program. This organization should “own” the implementation and
performance of the program.
• Traditionally, this step might be considered a part of the “quality improvement” planning
process. Quality improvement planning is normally separate from community health
improvement planning. We believe that these processes should be developed in tandem as part
of a comprehensive health improvement strategy. Quality improvement planning will, for the
most part, be an individual-level activity, but it is important to ensure that partners are on the
same page BEFORE they engage in quality improvement. In other words, you and your partners
should determine what programs are “appropriate” BEFORE figuring out how to improve those
programs. Determining what programs are “appropriate” should stem from collaborative
conversations that take place during community-level strategizing. That’s why we recommend
including organizational-level strategy in your CHIP. You don’t need to include quality
improvement plans themselves in the CHIP, but a general overview of each partner’s
contributions (programs, strategies, actions) should be provided.
• Make sure each partner understands the difference between community-level strategy and
organizational-level strategy. If you’re having trouble understanding, read this.
• 9. Partners Define Performance Measures
• How will you know if the community members served by each organization
are better off? Each organization should create measures designed to
evaluate the effectiveness of each program or service they are responsible
for implementing. This is how they will communicate individual
contributions to community well-being. If one partner’s program is
designed to reduce tobacco usage, they may want to measure “% of
enrollees who successfully quit using tobacco at a 7-month follow-up.” The
most important performance measures are measures that tell us whether
our customers are “better off” and a result of our programs and services.
For more information on selecting effective performance measures, visit
our website here.
10.Managing and sustaining the process
• https://knoema.com/atlas/Philippines/topics/Demographics/Mortalit
y/Number-of-deaths-at-age-70-years
Classification of health Indicators
• Demographic and fertility Indicators
• Mortality Indicators
• Morbidity Indicators
• Disability rates
• Nutritional status indicators
• Health care delivery indicators
• Utilization rates
• Indiators of social & mental health
• Environmental indicators
• Socio-economic indicators
• Indicators of Quality of Life
• Basic needs indicators
• Health for all indicators
END
 • Step 5: Prioritize Community Health Issues
• Community Health Assessment Toolkit
Community • Purpose
Health • Hospitals and community stakeholders go through a
process to distinguish the most pressing community health
Assessment needs based on the data collected. The identified priority
Toolkit health needs will be addressed through the
implementation strategies.
Key Components
Identify criteria for prioritization
Hospitals are at their discretion to develop prioritization criteria and
processes. A set of criteria should be determined to guide the prioritization
process. Typically, three to six priorities are selected, based on:
• Magnitude of the problem
• Severity of the problem
• Need among vulnerable populations
• Community’s capacity and willingness to act on the issue
• Ability to have a measurable impact on the issue
• Availability of hospital and community resources
• Existing interventions focused on the issue
• Whether the issue is a root cause of other problems
• Trending health concerns in the community
Additional prioritization criteria can
include:
•The importance of each problem to
community members
•Evidence that an intervention can
change the problem
•Alignment with an organization’s
existing priorities
•Hospital’s ability to contribute finances
and resources to address the health
concern
•Potential challenges or barriers to
addressing the need
•The opportunity to intervene at the
prevention level
 Select community health priorities
•
Priorities can be selected as part of an established process informed by contributing partners,
including community stakeholders, health departments, social service agencies, policy makers
and hospital leadership. Action steps to be considered are:
• Select a prioritization committee – Members can be from hospitals, community stakeholder
organizations and other organizations/institutions with specialized knowledge or constituents.
• Discuss the data – Present the qualitative and quantitative data to the prioritization
committee. Make sure that the data are presented in a format that is accessible for the
individuals on the committee. Foster an environment for open dialogue to discuss the
identified health needs thoroughly.
• Review community assets – Reflect back on your asset map to identify what resources exist in
your community to address the need. Take stock of what resources (staffing, in-kind, financial,
etc.) in your hospital could potentially be leveraged to address that need.
• Select priorities – Decide which approach you want to use to determine priority needs.
TECHNIQUES DESCRIPTION

Multi-voting technique Decide on priorities by agreeing or disagreeing in group discussions and

continuing process/rounds until a final list is developed.

Strategy lists Determine if the health needs are of “high or low importance” by placing
an emphasis on problems whose solutions have maximum impact, with
the possibility of limited resources.

Nominal group technique Rate health problems from 1 to 10 through group discussion.

Hanlon method List those health needs viewed as priorities based on baseline data,
numeric values and feasibility factors.

Prioritization matrix Weigh and rank multiple criteria for prioritization with numeric values to
determine health needs with high importance.
Build consensus around priority needs – If you select priorities that vary from
community recommendations, justify the reasons for making those choices.
Consider the consequences of not addressing an issue and how that can affect
the community’s well-being in the future. In the case of overlapping health
needs, consider consolidating into a single priority.
Validate selected priorities – Conduct discussion groups with members of your
hospital’s steering committee and community members for additional input.
Make sure the selected priority needs align with hospital and community
sentiment.
Present priorities to senior leadership and the hospital’s board of trustees for
approval – Align your hospital’s population health management strategy with
the community health priorities.
Describe which needs were not prioritized
It may not be possible to address all community health needs at once. If there
are significant needs that are not prioritized or will not be addressed, you
should be able to describe what the needs are and why you have chosen not to
 • Located in Washington D.C., Children’s National Health System
has seven regional outpatient centers, an ambulatory surgery
center, two emergency rooms and an acute care hospital.
Children’s National leads many community-based initiatives
and collaborations to advance community health.
Children’s • Children’s National was the lead organization in conducting a
2016 community health assessment (CHA) on behalf of the DC
National Health Healthy Communities Collaborative (DCHCC), a coalition of
eight hospitals and community health centers that have
System partnered to improve health and well- being in Washington,
D.C. For the 2016 CHA, Children’s National shifted the focus
from disease- specific conditions to root causes and
Washington D.C. determinants of health.The CHA process revealed nine broad,
community-defined health needs. For its prioritization process,
the team adopted the Hanlon Method, a framework to select
priority needs. Various stakeholders and collaborators
developed a modified version of the Hanlon Method, which
included a criteria and weighting system that was aligned with
organizational mission, capacity to address change and existing
resources. A new weighting system was created based on
DCHCC’s capabilities, resources and funding to address the
health needs.The criteria and weighting system used to
prioritize needs was:
END
Four priority needs were selected through this process:
mental health, place-based care, care coordination and
health literacy.
Importance to community—40%
Capacity to address change—25%
Alignment with mission/vision—25%
Existing collaborations or
interventions—10%
•According to Chaya Merrill, director, Child Health Data
Lab at Children’s National, “It’s important to be
transparent when prioritizing health needs. A barrier
in this process is subjectivity. We want the
prioritization process to be as objective as possible.
However, there will undoubtedly always be a
subjective element. Using a structured prioritization
method helps minimize the subjective elements and
offers a more structured process at arriving at
priorities.”
Recommendations to make this process more
effective are:
Be transparent in your approach.
Know your hospital’s capacity and resources
when selecting priority needs.
Be aware of the community organizations that
are already addressing the needs your hospital
identified to avoid overlap and form potential
partnerships.
How do you prioritize community health
problems?
• Identify criteria for prioritization
• Magnitude of the problem.
• Severity of the problem.
• Need among vulnerable populations.
• Community's capacity and willingness to act on the issue.
• Ability to have a measurable impact on the issue.
• Availability of hospital and community resources.
• Existing interventions focused on the issue.
• More items...
How do you prioritize community health
problems?

•Priority is a category that identifies the relative

importance of an incident, problem, or change.
Priority is based on impact and urgency, and it
identifies required times for actions to be taken.
Impact and urgency are used to assign priority.
Impact criteria. Urgency criteria.
What are the steps of problem prioritization ?

This study therefore synthesized four-step

problem prioritization:
selecting stakeholder representative,
giving knowledge or educating
stakeholders about the study areas,
identifying problems, and
prioritizing problems.
 How do you identify health problems
Identifying Priority Health Issues
1.Social Justice Principles.= Principles of social
justice in health care focus on eliminating inequity
in treatment and care. ...
2.Supportive environments. ...
3.Priority population groups. ...
4.Prevalence of condition. ...
5.Potential for prevention and early intervention. ...
6.Costs to the individual and community.
What is problem prioritization?
APEXPH, prioritization is generally a
group process whereby organizational or
health issues are ordered by perceived
significance or importance. Prioritizing issues
is an important process, in that it assists an
organization in identifying the issues on which
it should focus its limited resources.
What are the community health problems?
Example Community Problems:
Adolescent pregnancy, mismanagement of resources,
access to clean drinking water, lack of funding for schools and
services,
child abuse and neglect,
ethnic conflict,
crime,
health disparities,
domestic violence,
HIV/ AIDS,
drug use,
hunger,
pollution,
inadequate emergency services,
...
• Critical Question 1: How are priority issues for Australia’s health identified?
• Identifying priority health issues
• In this section elements of the criteria used to identify priority issues are examined.
This information is sourced from a variety of data and are used by government
agencies to determine how to best spend their health budget and where to allocate
any additional resources.
• Social Justice Principles
• Principles of social justice in health care focus on eliminating inequity in treatment
and care. Organisations, groups and individuals who practice these principles
promote inclusive programs, which provide health care and medical support to all
people in Australia.
• There is a significant difference between equality and equity. Some people think
that health issues can be resolved by providing everyone with equal treatment.
However, not all demographic groups have the same benefits, opportunities and
advantages, so equal treatment will not necessarily result in equal results. Social
Justice Principles seek to address this disparity and provide equitable health
initiatives, which provide additional support to groups in need.
•To summarise, an equal situation is one where
everyone receives the same treatment, regardless of
their circumstances. Social justice principles support
a more equitable approach, which means
disadvantaged individuals receive assistance
respective to their needs to ensure that the
treatment results in the same benefits for every
patient.
•Remember, not all groups experience the same
advantages or have access to the same health care in
Australia. Groups in rural, socio-economically
disadvantaged or remote require more specialised
services and care than their urban counterparts.
• Supportive environments
• In health care, social justice principles create a supportive environment for patients.
An example of a supportive environment is one where the social, political and
environmental conditions help an individual or community achieve optimal health.
• Supportive environments should also be participatory so that individuals, groups
and communities can be involved in the decision making process, become
responsible for improving their own health and help design effective programs to
target health issues.
• For example, discussions around the health of Aboriginal and Torres Strait Islanders
should always involve members of these communities because they know the
customs and attitudes of that group better than anyone else. For a health program
to succeed, it needs to be tailored to the social values and behaviours of the target
group. Participatory environments create the culture necessary to address and treat
serious health issues.
• Supportive environments should also ensure that laws protect the rights of humans
to good physical health and adequate medical support. Part of this process involves
facilitating access by removing the barriers, which stop people from having fair and
equitable access to health care. They
•They For an environment to be
supportive it also needs to recognising
cultural, religious and other
differences and promote equity by
distributing resources in manner that
enables all individuals and groups to
achieve equal, healthy outcomes.
•Priority population groups
•Priority populations = are groups of people who experience an
abnormally high prevalence of a particular condition. In these
situations government agencies must consider whether
targeting the specific community will the improve the overall
health of all group members.
•For example, there are a number of groups who encounter an
abnormally high prevalence of CVD. These groups include
those from low socioeconomic backgrounds, rural areas and
indigenous communities. A targeted health campaign, aimed
at these communities has the potential to decrease the
prevalence of CVD, which is a highly modifiable disease.
• Potential for prevention and early intervention
• Many of the health issues which effect the Australian population are the
result of poor lifestyle choices. For example, lung cancer can be caused by
cigarette smoking and excessive drinking may lead to liver failure.
• If these high risk lifestyle risks are identified then government agencies can
implement relevant educational programs and promote healthy behaviours.
Raising awareness can result in modified attitudes and perceptions which can
lead to a healthier population and increased prevention of serious health
issues.
• Epidemiological data offers insight into Australia’s dynamic population and
groups. this information can also help agencies and organisations understand,
identify and even predict which lifestyle choices can have a negative effect on
health. Campaigns can then be designed to facilitate early intervention and
prevent the development of greater health problems.
•Many illnesses and diseases in Australia are caused by
the modifiable determinants of lifestyle choices (i.e.
diet) and behaviours (i.e. exercise). Therefore
investing in educational programs to promote healthy
attitudes is essential, and can have a lasting impact
federal budgets and the long term health and quality
of life for people in Australia.
•Early intervention and prevention of serious health
issues also eases the financial burden, pain and
suffering of individuals and their families and has the
potential to save the government millions of dollars.
Cost to the Individual and the Community
• When considering the priority of a particular health issue, the government
will consider the associated financial, societal and emotional costs to both
the individual and the larger community. The term, “burden of disease”, is
frequently used to describe the ‘expense’ of poor health.
• It is possible to break down the burden of a disease by identifying the direct
(financial) and indirect (social) costs.
• Consider the following scenario: An individual develops cardiovascular
disease and suffers a stroke.
• The potential direct costs to the individual may include:
• – hospital fees
• – medications
• – bills for medical opinions and consultation
• The indirect costs to the individual are harder to measure and may include:
• – persistent or debilitating pain
• loss of quality of life
• – social exclusion
• – mental exhaustion and depression
• Potential direct costs to the community are:
• – the funding needed for treatment
• – cost of procedures and other tests covered by medicare
• Potential indirect costs to the community are wide reaching and may
include:
• – the emotional and financial strain on friends and family
• – the premature loss of a valued or influential member of the community
• – impact on local business and industry due to loss of an employee
end
• Step 5: Prioritize Community Health Issues
• Community Health Assessment Toolkit
• Purpose
• Hospitals and community stakeholders go through a process to
distinguish the most pressing community health needs based on the
data collected. The identified priority health needs will be addressed
through the implementation strategies.
• Key Components
• Identify criteria for prioritization
Hospitals are at their discretion to develop prioritization criteria and
processes. A set of criteria should be determined to guide the prioritization
process. Typically, three to six priorities are selected, based on:
• Magnitude of the problem
• Severity of the problem
• Need among vulnerable populations
• Community’s capacity and willingness to act on the issue
• Ability to have a measurable impact on the issue
• Availability of hospital and community resources
• Existing interventions focused on the issue
• Whether the issue is a root cause of other problems
• Trending health concerns in the community
• Additional prioritization criteria can include:
• The importance of each problem to community members
• Evidence that an intervention can change the problem
• Alignment with an organization’s existing priorities
• Hospital’s ability to contribute finances and resources to address the
health concern
• Potential challenges or barriers to addressing the need
• The opportunity to intervene at the prevention level
Select community health priorities
•
Priorities can be selected as part of an established process informed by contributing
partners, including community stakeholders, health departments, social service agencies,
policy makers and hospital leadership. Action steps to be considered are:
• Select a prioritization committee – Members can be from hospitals, community
stakeholder organizations and other organizations/institutions with specialized knowledge
or constituents.
• Discuss the data – Present the qualitative and quantitative data to the prioritization
committee. Make sure that the data are presented in a format that is accessible for the
individuals on the committee. Foster an environment for open dialogue to discuss the
identified health needs thoroughly.
• Review community assets – Reflect back on your asset map to identify what resources
exist in your community to address the need. Take stock of what resources (staffing,
in-kind, financial, etc.) in your hospital could potentially be leveraged to address that
need.
• Select priorities – Decide which approach you want to use to determine priority needs.
TECHNIQUES DESCRIPTION

Multi-voting technique Decide on priorities by agreeing or disagreeing in group

discussions and continuing process/rounds until a final list is
developed.

Strategy lists Determine if the health needs are of “high or low importance”
by placing an emphasis on problems whose solutions have
maximum impact, with the possibility of limited resources.

Nominal group technique Rate health problems from 1 to 10 through group discussion.

Hanlon method List those health needs viewed as priorities based on baseline
data, numeric values and feasibility factors.

Prioritization matrix Weigh and rank multiple criteria for prioritization with numeric
values to determine health needs with high importance
• Build consensus around priority needs – If you select priorities that vary from
community recommendations, justify the reasons for making those choices.
Consider the consequences of not addressing an issue and how that can
affect the community’s well-being in the future. In the case of overlapping
health needs, consider consolidating into a single priority.
• Validate selected priorities – Conduct discussion groups with members of
your hospital’s steering committee and community members for additional
input. Make sure the selected priority needs align with hospital and
community sentiment.
• Present priorities to senior leadership and the hospital’s board of trustees for
approval – Align your hospital’s population health management strategy with
the community health priorities.
• Describe which needs were not prioritized
It may not be possible to address all community health needs at once. If there
are significant needs that are not prioritized or will not be addressed, you
should be able to describe what the needs are and why you have chosen not
to address them.
Community Diagnosis Process
• 1. Collecting background information of various communities
•

• 2. Selecting a target community

•

• 3. Initial Planning:
• - Establishing the Community diagnosis survey objectives,
• - Scope of the survey (how much detailed information is needed? how big area should it
cover? E.g. Ward level, VDC level, district level),
• - Selection of appropriate indicators
• - Selecting appropriate time of the year (seasonality might affect results)
• - Identifying resources (human resources, financial resources, etc.)