INTRODUCTION TO HEALTH
LESSON 1
HEALTH : Philippine 1987 Constitution
Article II, Section 15
"shall protect & promote the right to
health of the people & instill health
consciousness among them.”
HEALTH
state of complete physical, mental & social
well being & not merely the absence of a
disease or infirmity-WHO.
as more than just a biological or
physiological manifestation of wellness
Social well-being implies not only is a
person free from any physically debilitating
illness but is also free from any
impediment that will obstruct him or her
from achieving his or her personal goals
and aspirations in life
For example, poverty can be an
impediment
COMMUNITY
As part of a community, the individual
must endeavor to become a productive
member of the community lest he or she
be ostracized from the community.
a person would thrive better, he or she is
part of a community he or she identifies
with.
The word community can be a vague term
among experts particularly in the field of
Sociology.
In a study by MacQueen (2001)
A community has five core elements:
1. Locus ( sense of place )
• something which can be located or
described
• thus-implying a sense of place, locale
or geographical boundaries.
• neighborhood, a village, a city or
country
2. Sharing ( of common interests and
perspectives)
• existence of "shared perspectives" and
common interests'
• values, ideologies, vision, activities,
jargons, passions, opinions, interests,
history, even skin color and sexual
identity.
3. Joint Action
• “source of community cohesion and
identity"
• "naturally to the creation of
community”
• joint actions of people through
socializing, hanging out, conversing.
volunteering together, praying
together, working together and
getting things done together.
4. Social ties
• “interpersonal relationships”
foundation of the community.
• Types of relationships include family,
parents, siblings, cousins; roommates,
house- hold; lovers, partners; friends,
neighbors, acquaintances; CO-
workers, role models and support
groups, among others.
• create ties with other people
5. Diversity
• the concept of diversity goes beyond
more than just culturally based ethnic
distinctions.
• "larger societal view of community
and made reference to differences in
interpersonal interaction"
• "communities within a community" or
interwoven groups brought about by
 variations in interactions among
members of the community.
COMMUNITY DEVELOPMENT
United Nations broadly defines
community developmeny as a
“process where community members come
together to take collective action &
generate solutions to common problem.”
very vital especially in the aspect of
national development and sustainable
progress.
The development of a nation depends on
the rate of progress made at the
community level.
means by which individual members of a
community are empowered to create
sustainable growth and progress based on
justice and equity
process requires active participation and
contribution of the members
process geared towards changing
institutions and structures that will nurture
equitable progress at all social aspects.
In order to bring about change, change at
the community level may be the right
approach.
After all, the problems people face are
mostly social and not individual or
personal.
System is an organized collection of units
interacting in various forms in order to
accomplish specific function or goal.
A system may be simple or complex. It can
be open (interacting with other systems)
or closed.
The community can be further dissected
into other forms of systems such as the
health system, political system, or social
class system which can either be based on
ethnicity, religious affiliation or economic
class.
COMMUNITY HEALTH
The field of community health is a sub-set
of Public Health.
Charles Edward Amory Winslow (1920)
“the science and art of preventing disease,
prolonging life and promoting physical
health & efficiency through organized
community efforts of sanitation of the
environment, the control community
infections, the education of the individual
in principles of personal hygiene, the
organization of medical & nursing service
for the early diagnosis & preventive
treatment of disease & the development of
the social machinery which will ensure to
every individual in the community a
standard of living adequate for the
maintenance of health".
Public health was always then
associated with Environmental Sanitation
due to the biological link between
unsanitary living conditions and practices
with diseases (Germ Theory).
Winslow also believed that public health is
also concerned with the prevention of
development of non-infectious diseases or
lifestyle-related diseases including mental
disorders and diseases associated with
poverty.
Marc Lalonde (1981)
a canadian minister of national Health &
Welfare.
working document "A new perspective on
the Health of Canadians" a Health Field
Concept which is a framework in analyzing
problems in the public health field.
the "health field" can be broken up into
four broad elements:
• Human Biology
• Environment
• Lifestyle
• Health Care Organization.
Human Biology
element as aspects of health, both physical
and mental, which are developed within
the human body
"as a consequence of the basic biology of
man and the organic make-up of the
individual"
Environment
matters related to health which are
external to the human body and over
which "the individual has little or no
control."
Lifestyle
"aggregation of decisions by individuals
which affect their health and over which
they more or less have control."
Health Care Organization
most of the society's efforts in improving
health have been focused solely
“quantity, quality, arrangement, nature
and relationships of people and resources
in the provision of health care.”
LEVELS OF HEALTH CARE
There are three levels of health care:
1. Primary,
2. Secondary
3. Tertiary
Primary care services provided by health
care professional acting as first point of
contact or consultation of the patients
w/in a healthcare system.
• services in barangay / village,
midwife/public health nurses
• the first point of contact would be the
family physician or a general
practitioner (primary care physicians)
• deals w/ preventive care, performing
strategies & interventions
• maternal & child health services
(immunizations, family planning,
antenatal and perinatal care)
Primary care services are usually available
at rural health units or barangay health
stations, although they can also be given at
hospitals.
Secondary care - provided by medical
specialists & other medical professionals
whom a primary care professional has
referred to.
this requires more specialized type of
services and more complex.
Types of services provided are more
complex in nature than the ones being
provided for at the primary level.
Tertiary care is more specialized and
advanced.
Services are far more advanced
considering that the medical cases referred
to this level are far more complex
• the number of patients being catered
are fewer than those compared w/
primary & secondary because medical
cases are more difficult & diagnostics
procedures are complicated &
advanced.

• Cancer mgt, surgical procedures like
neurosurgeries.
REFERRAL PROCESS
The process by which a patient is
transferred from one level or point of care
to another.
• begins at home
• the patient according to his/her
understanding of his/her illness,
chooses to seek care from a health
care professional, performs self
medication or self care and or seek
alternative routes of treatment.
• two way process, which means a
patient recovered from illnesses will
continue receiving care at home must
be referred back to the immediate
health facility - Return referral
process.
DELAYS
• First delay - a delay of seeking care
• Second delay - a delay in the
transport of patients from the health
facility to higher level of care.
• Third delay - a delay if the patient may
not be able to receive urgent and
appropriate care due to unavailability
of med specialist or supplies.
Community Health Epidemiology &
Human Behavior
LESSON 2
COMMUNITY HEALTH NEEDS
ASSESSMENT (WHO)
The following are the factors as cited from
WHO'S Community Health Needs
Assessment (2001) published by the WHO
Regional Office for Europe:
1. Physical environment - in which
people live, such as the quality of the
air they breathe and the water they
drink;
2. Social environment - the level of
social and emotional support people
receive from friends and/or family;
3. Poverty- a significant factor
worldwide, which shortens and
reduces enjoyment of life;
4. Behaviour and lifestyle - for example,
smoking causes lung cancer and
coronary heart. disease so a reduction
in this behaviour will reduce the
disease;
5. Family genetics and individual
biology- if you come from a healthy
family you have a better chance of
staying well.
These factors remind us that Public Health
or Community Health is not just a matter
of presence or absence of a disease.
COMMUNITY PROFILING DATA
In collecting information about the
community through a community
profiling, certain data must be considered
in order to get a bigger picture about the
community's health status.
In the same document from WHO, the
following data are recommended to be
considered when one does community
profiling.
A. WORK AND LEVELS OF EMPLOYMENT
AND UNEMPLOYMENT
in a community are fundamental to health
for the following three reasons:
Occupational diseases. All work affects
health, both positively and negatively.
However, some work is known to cause
disease, such as silicosis in mine and
quarry workers and machinery accidents
among farm workers. New work- related
illnesses are also being recognized, such as
repetitive strain injury for keyboard
operators.
Income levels. The amount of income
people earn has an important influence on
their health, affecting their ability to
choose a healthy lifestyle and to access
health services. Levels of income also have
an impact on the local economy within a
community.
Self Worth. At the same time, the status of
an occupation affects how people feel
about themselves. People's level of
satisfaction at work contributes to their
well-being. Many define people by their
work or lack of it. The unemployed may
feel excluded, and lack of paid
employment has been shown to contribute
to poor health.
B. POVERTY AND INCOME.
Poverty can be absolute (i.e. inadequate
to sustain health) or relative (i.e. how poor
one person is compared to another). In
health terms, it is not only the level of
poverty that counts but also the gap
between richest and poorest.
Health inequality
A large gap results in a big difference in
health and life expectancy between rich
and poor. It is one of the most significant
factors affecting health across the world
and therefore information on this issue will
be essential.
C. ENVIRONMENT
The surroundings where people live and
work in directly affect their health. A
number of factors should be monitored
here.
Pollution of air and water causes disease
and death and this is evident throughout
the world, whether it is lead in petrol or a
chemical spill from a factory, or drinking
water contaminated by sewage.
Good sanitation eliminates some diseases
such as cholera and dysentery completely,
and where it is absent, gastrointestinal
illnesses are quickly evident. In
communities lacking basic sanitation,
threats to health arise from the
contamination of water supplies by human
excreta.
The lack of a home affects all aspects of
health - shelter from the weather, an
environment to sustain a family, a place to
feel safe. The availability and type of
housing reflect local history, culture, the
economy and political climate. The type,
quality and suitability of housing have an
important affect on health. Consider the
distance of homes from work, pharmacies,
schools and shops.
Transport systems are important to
record, as they can influence people's
access to services, social support networks
and employment. Transport may also have
an impact on health through accidents,
noise and air pollution.
Social support is essential for the well
being of a community. There are a number
of elements that need to be taken into
consideration when describing the extent
of social cohesion in a community.
Family and friendship networks provide
people with the emotional support that is
fundamental to well-being. Social
networks can be hard to describe and
quantify. The best way is to ask local
people. It may be possible for them to
describe social networks through flow
diagrams, maps, drawings, stories and
drama.
Migration causes disruption to a
population, as large numbers of people
move location. It is often the younger
working-age population who emigrate, and
this is a loss to the population left behind
while a gain to the community they move
to. Migration of workers may be daily,
weekly or longer. Population movements
can be traumatic owing to the upheaval
caused, especially if forced by armed
conflict, threat of discrimination or severe
economic necessity.
Marginal groups are outside the dominant
community, yet may form a distinct
population themselves. Some groups, such
as religious sects, travelers and gypsies
may choose to remain outside mainstream
society. Others, such as the homeless, may
be forced into that position. Access to
health care is often more difficult for both
these groups, who may have greater need
for services.
The opportunities for non-work social
activities are signposts that can be used to
indicate the extent of social cohesion and
support in a community. Such activities
reinforce a community's identity and the
emotional wellbeing of individuals.
3 FACTORS AFFECT THE HEALTH OF A
COMMUNITY
Destabilizing factors that can affect the
health status of a community such as war,
economic recession and natural disasters
such as earthquakes, floods or drought
affect health directly through their impact
on mortality, disease patterns and lifestyle
change.
• Physical Factors - geography,
environment, community size,
industrial development
• Social and cultural factors - traditions,
norms, beliefs, economy, politics,
income, livelihood
• Individual Factors – behavior
Community organizing (Minkler and
Wallerstein (1997))
"the process of by which community
groups are helped to identify common
problems or goals, mobilize resources and
in other ways develop and 3 implement
strategies for reaching the goals they
collectively have set.”
There are various types of Community
Organization. According to Rothman an
Tropman (1987), categories of community
organization consist of three distinct
models practice:
1. Locality Development - process-
oriented, creating a consensus and
sense of cooperation.
2. Social Planning - task-oriented,
emphasizing rational-empirical
problem-solving
3. Social Action - both task and process-
oriented
4. Community organizing
STEPS IN COMMUNITY ORGANIZING:
1) Problem Identification
2) Interface with Community
3) People Organization
4) Community Profile and Assessment
5) Goal-setting and Formulation of
Strategies
6) Implementation of Agreed Strategies
or Solutions
7) Monitoring and Evaluation
8) Sustaining Gains, Addressing Emerging
Problems
EPIDEMIOLOGICAL STUDY
Epidemiology - study of the distribution
and determinants of diseases & injuries in
human populations.
The goal of epidemiology is to limit
disease, injury, and death in a community
by intervening to prevent or limit
outbreaks or epidemics of disease and
injury
• Attack rate - the proportion of those
who became ill after specified
exposure
Case Fatality Rate
percentage of cases that result in death. It
measures the severity of the disease and is
proportionate to the virulence of a disease
agent.
Notifiable Diseases reported IMMEDIATELY
(w/in 24hrs)

RATES
Rate is the number of events in a given
population over a specific period or at
given point in time. An example of rate
would be birth rate, mortality rate and
Notifiable Diseases reported WEEKLY
morbidity rate.

To determine the existence of an outbreak

during a particular time at a particular
place.

Rates can be expressed as crude or

specific. Crude rates use total population
as the denominator (e.g. crude birth rate,
crude death rate).
Birth rate average annual number of births
during a year per 1,000 persons in the
population at the mid year. aka Crude
Birth Rate (The dominant factor in
determining the rate)
"zero-case reporting" policy which means
even if a community has no reported case
of any of the notifiable diseases or events,
the health workers still have to report it as
"zero case".
LIFE SPAN vs LIFE EXPECTANCY
Life span - refers to the number of years a
person lives,

Morbidity rate Life expectancy - refers to the numbers of

• Incidence rate - number of new cases
of a disease in a population at risk in a
given time period.
• Prevalence rate - total number of
cases of disease existing in a
population.
years a person is expected to live from a
specified starting point.
• DALE - disability adjusted life
expectancy
• HALE - health adjusted life expectancy
SURVEYS
Survey is a method of gathering any type
of information or data from a sample of
individuals. By sample it is meant that the
data is only taken from a portion of the
total population under study.
The National Household Targeting System
for Poverty Reduction (NHTS) is a data
bank and an information management sys
tem which identifies who and where the
poor are in the country.
CENSUS
A Census is the opposite of a survey It is
the counting of data gathered from the
entire population. It is a regularly occurring
and official count of the human population
certain local administrative unit.
The agency that conducts the Census is
the National Statistics Office
BEHAVIOR CHANGE
According to Bandura (1986), people's
behaviors are driven by external factors
and not by inner forces.
In his Social Cognitive Theory, Bandura
explains that human functioning can be
explained by a triadic interaction of
behavior, personal and environmental
factors (reciprocal determinism
Another theory that explains behavior is
the Theory of Planned Behavior suggests
that behavior is dependent on one's
intention to perform the behavior.
Another framework that can explain
behavior is the Transtheoretical Model or
also known as the Stages of Change
Model. According to the theory, a person
undergoes at least six stages of change or
transformation.
Prochaska, Johnson, and Lee (1998)
suggest a series of activities that have
received empirical support, which help
individuals progress through the stages:
1. Consciousness-Raising increasing
awareness of the causes (providing
educational materials, confrontation,
media campaigns, feedback, etc.)
2. Dramatic Relief producing an
emotional experience which is
followed by a reduced affect if some
action can be taken (personal
testimonies, media campaigns, drama)
3. Self reevaluation inviting individuals
to make cognitive and emotional
assessments of their self image (clarify
values, provide healthy models, using
imagery)
4. Environmental reevaluation
assessments of how the presence or
absence of a behavior might impact
one's social environment
(documentaries, personal stories,
family interventions)
ELEMENTS OF DIFFERENT BEHAVIOR
CHANGE FRAMEWORKS

LESSON 3
Health Leadership and Governance
The Philippine health care system is a
devolved health system. A devolved set up
is also referred to as “decentralized".
There at least 4 levels of administrative
division. Each level is also referred to as
local government unit (LGU).
The President of the Republic being the
over-all Chief Executive oversees these
administrative regions.
• Province
• City
• Municipality
• Barangay.
Autonomous Regions - special
administrative division:
• Cordillera Autonomous Region
(CAR)
• Autonomous Region for Muslim
Mindanao (ARMM).
Philippine Local Government
Prior to the enactment of the Local
Government Code, the National
Government, headed by the Chief
Executive Officer in the presence of the
President, oversees the implementation of
health programs, through the Department
of Health, down to the barangay or village
level. Health workers were hired, paid for
and supervised by the Department of
Health.
A municipality or city has a Municipal or
City Health Officer who heads the Main
Health Office in the local government unit.
The staff of the Health Office includes :
public health nurses
• midwives
• medical technologist
• dentist
• pharmacist
• other paramedical support staff
•
Midwives would manage the Barangay
Health Stations.
Barangay health workers working as
volunteers in each barangay.
At the Provincial Level, the Provincial
Health Officer takes charge of the
Provincial Health Office and the Provincial
Hospitals.
Pre-Devolution Health System in the
Philippines
Implementation of Decentralization
began in January 1993 with the transfer of
funding, facilities, and staff to some 1600
Local Government Units (LGUs), as
specified in the 1991 Local Government
Code, Primary health care services, more
than 600 hospitals, other health facilities
and approximately 46,000 health
personnel were devolved.
A 1984 World Bank review analysis found
the Philippine system to be excessive-
excessively centralized, with fragmentation
and duplication between central and field
units, and weak linkages be-tween rural
programs and centrally run disease specific
campaigns. Some adjustments Some
adjustments were made in response, but
Decentralization and Health in the
Philippines and Indonesia: An Interim
Report 4 a comprehensive 1993 review
pointed to worrisome features of the
health scene
• sizable mortality differentials and
trend reversals in some regions
• poor nutritional status in low
income households
• slow fertility decline
• and low levels of consumer
satisfaction with government
facilities" (Herrin, et. al., 1993).
Post-Devolution Health System in the
Philippines
In Decentralization, Health workers no
longer report to the Department of Health
but report to their corresponding local
chief executives. For example, municipal
health workers report to their Municipal
Mayor being the over-all local chief
executive. Provincial health workers report
to the Provincial Governor. Chiefs of
hospitals of provincial and district hospitals
report to the Governor except the chiefs of
hospitals of facilities retained by the
Department of Health. They are also
referred to as Regional Hospitals since they
report to the Regional Director of the
Regional Office of the Department of
Health.
Health devolution in 1991 has brought
about massive changes in the structure of
the public health system. In terms of scope
of health personnel, finances, facilities and
responsibilities devolved to LGUs, the
Philippine decentralization of health
services is one of the most radical in the
developing world.
A large part of the devolved health
services is borne by provinces and
municipalities, the latter having no prior
experience with health decentralization.
• Provincial Governments - responsible
for medical, hospital & support
services.
• Municipal governments - responsible
for administration of Primary Health
Care & other National Programs Field
services
• City Governments - responsible for
Health offices, City Hospitals, in highly
urbanized cities (except Nat'Capital
region)
• Barangay Governments - responsible
for the maintenance of RHU & BHS
facilities
While LGUs gained significant powers and
responsibilities in the area of health
service delivery, various issues and
problems came out, among them financial
constraints like the inadequacy of the IRA
and its skewed distribution, health
personnel issues, lack of local prioritization
for health, local competence on health,
etc. Some of the problems
According to the(WHO),Leadership and
governance is an essential part of a health
system. It is one of building blocks of a
health system as identified by the WHO.
The other five building blocks include:
Health Human Resource, Access Medicine
and Technology, Health Service Delivery,
Health Information and Health Financing.
It is important that these 6 building blocks
are established, strengthened and
monitored in order for a health system to
produce better health outcomes especially
among the most vulnerable groups.
The leadership and governance of health
systems, also called stewardship, is
arguably the most complex but critical
building block of any health system. It is
about the of the government in health and
its relation to other actors whose activities
impact on health. This involves overseeing
and guiding the whole health system
As shown in the figure taken from WHO,
Leadership and Governance is the "wheel
in the middle of the wheel". It drives the
rest of the building blocks. Without
leadership and governance, the rest of the
building blocks won't work.
The standards of the health system is it has
the capacity to provide equitable access to
essential quality health services, provide
financial risk protection and consequently
can produce better health outcomes for
the community increasing their levels of
health above what is expected.
This has huge implication on a devolved
health system wherein Leadership and
Governance falls largely in the hands of
political leaders who are not necessarily
health proficient
Local Health Board
mandated by the Philippine Republic Act of
7160 aka: Local Government Code of 1991

By law, the following should be members
of the Local Health Board:
A. Provincial Health Board
• Headed by Governor as Chairman
• the Provincial Health Officer as vice-
chairman
• the Chairman of Committee on Health
of the Sagguniang Panlalawigan
(Provincial Council) as representative
from private sector or
nongovernmental organizations.
B. City Health Board
• Headed by City Mayor as chairman
• City Health Officer as vice-chairman
• the Chairman of Committee on Health
of the Sagguniang Panlalawigan (City
Council) as representative from
private sector or non-governmental
organizations.
C. Municipal Health Board
• headed by Municipal Mayor as
chairman
• Municipal Health Officer as vice-
chairman
• the Chairman of Committee on Health
of the Sagguniang Panlalawigan
(Municipal Council) as representative
from private sector or non-
governmental organizations.
Functions of the Local Health Board
o to Propose to the sanggunian
(Council) concerned in accordance
with standards & criteria set by DOH
(annual budgetary allocations for
operation & maintenance of health
facilities & services w/in municipality,
city, or province)
o to Serve as an advisory committee to
the sanggunian (Council) concerned
on health matters such as application
of local appropriations for public
health purposes
o Consistent with the technical &
administrative standards of DOH ,
create committees, personnel
selection & promotion, bid & awards,
grievance & complaints, personnel
discipline, budget review, operations
review & similar functions.
According to DOH standards and by law, a
local health board must meet at least once
a month or as often as necessary.
Recently, innovations have been
introduced such as expanding the local
health board to include other important
stakeholders and replicating the health
board at the barangay level (barangay
health board) in order to increase
ownership, engagement and accountability
of barangay officials when it comes to
community-based health initiatives and
programs
The process of change can be difficult and
will require the engagement of different
stakeholders but the process has to start
somewhere and it begins with the leader.
I. The leader recognizes the problem
either through personal observation or
through feedback from the
community. The leader then decides to
make a personal response.
• Field visits & community assemblies
• Situational Analysis / Community
Diagnosis
• Problem Tree Analysis / Casual Loop
Analysis/ Inter- relationship diagraphs
II. The leader formulates a vision that is
an anti-thesis to the recognized
problem.
 • The vision comes in the form of a
solution to the problem or the desired
state of reality which can be acquired
once the problem is resolved.
• The vision can guide the action plans
which contain the activities and
strategies that can lead to the
accomplishment of the vision.
III. The leader consolidates his or her
resources, both internal and external,
that can help achieve the vision.
A technical way of consolidating resources
is to do inventory of one's strengths,
weaknesses, opportunities and threats.
Also known as a SWOT analysis,
identification of SWOTs is important
because they can inform later steps in
planning to achieve the objective.
Users of SWOT analysis need to ask and
answer questions that generate
meaningful information for each category
(strengths, weakness- es, opportunities,
and threats) to make the analysis useful
and find their competitive| advantage.
IV. Monitoring and evaluation is an
integral part of the change process. It
provides information on where one is
in relation to the goal. This
information is also referred to as
indicator.
least three types of indicators to be
monitored:
Input Indicator measures resources
invested for a particular strategy or
activity. Examples: number of health
workers deployed, budget in pesos,
number of eligible participants.
Process Indicator measures ways in which
the activities and strategies are conducted,
An example would be error rates.
Output Indicator measures the
quantifiable end-results of the strategy or
intervention including the efficiency of
production of the results. Examples:
number of patients seen, number of
children immunized, length of hospital
stay, etc.
V. The leader constantly communicates
the vision with the community and
regularly gets their feedback.
Communication is very important
especially in community organizing and
mobilization. It can be both a source of
tension and a source of solution for the
challenges that confront the community
members.
Communication is simply defined as the
process of transferring information from
one person or place to another.
In the process of Communication, the
following elements are involved:
1. Sender - it is the person that transmits
the message
 2. Receiver - refers to the intended
person who receives and interprets
the message
3. Message - it is composed of words or
symbols convey the idea being
transmit- ted by the sender. It can be
verbal or non-verbal.
4. Channel - It is the method or medium
by which the message is transmitted.
5. Context - It is the setting or situation
in which the communication takes
place, defining the message and
process of transmittal.
6. Noise - It refers to anything that
interferes in the transmittal of the
message.
When the receiver sends a response
feedback back to the sender, the response
is called a feedback
Communication is key especially in
planning and implementing strategies that
can improve the health outcomes of the
community.
VI. A leader ensures that the skills and
knowledge are transferred to others in
order to ensure sustainability of
interventions and bigger ownership of
the programs by the people.
Leaders beget leaders. It is important that
leaders must be able to form another
generation of leaders that can continue or
if not even improve on what has been
initiated. The transfer of skills and
knowledge, even values and ethics, is very
important. One way of transferring these is
when leader mentors or coaches other
people, especially those who have the
potential of becoming leaders.
Peterson and Hicks (1996) suggest steps in
how to do coaching by leaders. In their
book, "Leader as Coach", they suggest
strategies that target common
development barriers:
1. Forge a Partnership: build trust and
understanding so people want to work
with you. With trust, people will be
more willing to hear and act on what
you have to say. With understanding,
you will know what matters to each
other.
2. Inspire Commitment: building insight
and motivation so people focus their
energy on goals that matter. You
cannot motivate people directly, but
you can achieve commitment to
development when people
understand themselves and the
personal payback from working
toward organizational objectives.
3. Grow Skills: build new competencies
to ensure people know how to do
what is required. When you know
what the person needs to develop,
your task is to help them find the best
ways to acquire those new skills.
4. Promote Persistence: build stamina
and discipline to make sure learning
lasts on the job. People require daily
effort to change old habits and put
new behaviors into action. You can
help people persist until their new
behaviors be- come natural.
5. Shape the Environment: build
organizational support to reward
learning and remove barriers. Change
is easier and the results last longer
when the organization's values and
rewards are aligned with coaching and
development.
 One must do both but according to
American writer Warren Bennis, "failing
organizations are usually over-managed
and under-led."

The world today is wanting for genuine

leadership, leadership that is grounded on
values and ethics.

In community health where leaders

In the 1980's, John Whitmore, along with
Alan Fine and Graham Alexander,
developed the GROW model in coaching.
GROW stands for Goal, Reality, Options,
Will.
1) Establishing the GOAL - the goal can
either be a technical problem that
needs to be solved or a behavior that
one must achieve or acquire.
together with their community members
initiate the change process, it is important
that leaders lead "from the heart", guided
by the vision that has been built together
with the community.
Values are manifested in action and by the
decisions a leader makes. After all "when
your values are clear to you, making
decisions becomes easier" according to
Roy E. Disney.

2) Examining the Current REALITY the

individual must be able to de- scribe
what is happening at the moment
especially relative to the goal that is
previously identified.

3) Exploring OPTIONS - one must

determine what are the possibilities
that can be done in order to achieve
the goal.

4) Establishing the WILL - knowing what

to do may not be sufficient. The key to
accomplishing the goal is to commit to
achieving the goal. The person must
be motivated enough to see it
through.

Leadership is "doing the right things"

which is different from Management
which is doing things right"