COMMUNITY HEALTH CARE DEVELOPMENT PROCESS
DEFENITION / IMPORTANCE APROACHES TO COMMUNITY DEVELOPMENT
COMMUNITY
• are groups of people that may or may not spatially connected,
but who are share common interests, concerns or identities
(WHO).
• A social group determined by geographical boundaries and/
or common values and interests (WHO)
HEALTH
• Is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity. (WHO)
DEVELOPMENT
• Is a process that creates growth, progress, positive change or
the addition of physical, economic, environmental, social and
demographic components.
• A change, a process of unfolding from an un- manifested
condition to more advanced or effective condition.
• In these process the qualities reveals possibilities, capabilities
emerge, and potentials are realized
• A multi-dimensional process involving major changes in social
structures, population, attitudes and national institutions, as
well as the acceleration of economic growth, reduction of
inequality and eradication of absolute poverty.
• The goal of development is to have a better life. (Teodoro,
1978)
• According to NEDA:
o Development includes consumption of basic goods
and services such as health and education and the
generation of more productive employment and
reduction of inequalities in income and access.
COMMUNITY ASSESSMENT
• Provides the nurse a picture whether an individual, family,
groups or community is achieving the level of health possible
for them. It identifies specific deficiencies or guidance needed
and estimates the possible effect of the nursing interventions.
It is the first step in assisting the community with health
problems and concerns.
COMMUNITY DIAGNOSIS
• is an in-depth process of finding out the profiles, health status
of the community and the factors affecting the present status.
3 INDEPENDENT INTERACTING AND CONSTANTLY CHANGING
CONDITIONS
1. The health status of the community, including the population’s
level of vulnerability
2. Community health capability or the ability of the community to
deal with its health problems
3. Community action potential, or the patterns in which the
community is likely to work on its health problems
EARLIS
COMMUNITY DEVELOPMENT
• is a process designed to create a condition of economic and
social progress for the whole community with its active
participation and fullest possible reliance on the community
initiatives
• This is achieved through:
o Democratic procedures
o Voluntary cooperation
o Self-help
o Development of indigenous leadership
o Education
• Community development principle is committed to the
services of the people to become self-reliant.
• Therefore, the health of the community depends on its ability
to work toward common health goals and upon adequate
distribution of health resources to all members.
• Furthermore, organized community effort to prevent disease
and promote health is valuable and effective.
• A group of people in a community reaching a decision to
initiate a social action process (planned intervention) to
change their economic, social, cultural, or environmental
situation.
• Advocates “self-help”, voluntary participation and cooperation
of the people.
1. WELFARE APROACH
• This is an immediate and/ or spontaneous response to
ameliorate the manifestation of poverty, especially on the
personal level.
• Assumes that poverty is caused by bad luck, natural disasters
and certain circumstances, which are beyond the control of
the people.
• Assumes that poverty is God-given; destined, hence the poor
should accept their condition since they will receive their just
reward in heaven.
2. MODERNIZATION APPROACH
• This is also referred to as the project development
approach.
• Introduces whatever resources are lacking in a given
community.
• Also considered a national strategy, which adopts the
western mode of technological development.
• Assumes that development consists of abandoning the
traditional methods of doing things and must adopt the
technology of industrial countries.
• Believes that poverty is due to lack of education; lack of
resources such as capital and technology
3. TRANSFORMATORY / PARTICIPATORY APPROACH
• This is the process of empowering/ transforming the poor
and the oppressed sectors of society so that they can
pursue a more just and humane society.
• Believes that poverty is caused by prevalence of
exploitation, oppression, domination and other unjust
structure.
• Assumes that poverty is not God-given, rather it is rooted
in the historical past and is maintained by the oppressive
structure in society.
 COMMUNITY HEALTH CARE DEVELOPMENT PROCESS
ROLES OF COMMUNITY HEALTH WORKERS IN THE COMMUNITY
HEALTH CARE PROCESS
HUMAN RESOURCES FOR HEALTH – 4 H MAIN CADRES OF
COMMUNITY HEALTH PROVIDERS
1. BARANGGAY HEALTH WORKER (BHW)
• are frontline health workers who provide basic health
education and selected PHC services (e.g., maternal
and child health, environmental health, first aid) and link
clients to health facilities.
3. BARANGAY SERVICE POINT OFFICES (BSPO)
• provide selected FP services in some areas, although
the project under which they first operated, the National
Family Planning Outreach Project, concluded in the
1990s. There is little available policy information related
to BSPOs, although many continue to work throughout
the country.
• SELECTION CRITERIA / PROCESS
I. Information not available in policy

4. COMMNUTY HEALTH TEAM (CHT)

• SELECTION CRITERIA
I. At least 18 years old
II. Has undergone recommended 3-day DOH
BHW training Has delivered voluntary PHC
services for at least 1 year
III. Physically and mentally fit
• SELECTION PROCESS
I. Typically, the midwife, the BC, or another
BHW recruits BHWs.
II. Candidates must complete and submit a
registration form, supported with a birth
certificate; a certificate of attendance of a
training program; an endorsement from a
midwife or NGO that the BHW has rendered
voluntary services for; and a medical
certificate.
III. The BHW then submits the registration
application to the local health board for
approval
2. BARANGAY NUTRITION SCHOLAR (BNS)
• provide nutrition education, conduct nutrition-related
activities like child growth monitoring and micronutrient
supplementation, link clients to health facilities, manage
feeding programs, and collaborate with local
organizations to promote gardening and livestock-
raising.
• comprise BHWs, BNSs, BSPOs, midwives, and other
health workers. CHTs were established in 2010 in an
effort to help the country achieve UHC. CHT members
target poorer families to enroll them in the NHIP, improve
their access to health facilities, and provide them with
critical health and social services, such as nutrition
counseling, antenatal care, and FP
• SELECTION CRITERIA
I. Completed at least 2 years of high school
Respected in the community
II. Has experience working on health-related or
development-oriented activities in the
community
III. Able to work with local officials Able and willing
to regularly visit and/or monitor the families
under his/her care Good interpersonal and
communication skills
• SELECTION PROCESS
I. The M/CHO recruits and selects CHT
members from the existing pool of BHWs,
BNSs, and BSPOs, midwives, and members
of community-based groups.
II. Policy does not prescribe the exact process.

• SELECTION CRITERIA
I. 18–60 years old
II. At least a primary school graduate
III. Resident in the barangay for at least 4 years
Ability to speak the dialect
IV. Leadership skills
V. Willing to serve the barangay part- or full-time
for at least 1 year Willing to learn and to teach
what s/he has learned to the community
VI. Physically and mentally fit

• SELECTION PROCESS
I. A barangay screening committee at the
municipal/ city level, chaired by the BC,
submits a list of qualified applicants to a
municipal/city screening committee.
II. The committee selects the most qualified
applicants under NNC guidance.
III. The municipal/city administrative officer
submits the chosen candidate to the mayor for
approval.

EARLIS
 COMMUNITY HEALTH CARE DEVELOPMENT PROCESS
COMMUNITY HEALTH WORKERS (CHW) COMMUNITY ORGANIZING PARTICIPATORY RESEARCH (COPAR)

• are members of the community who work as volunteers. DEFENITION AND RELATED TERMS:
• They work in partnership with the health care system and may
share ethnicity, language, and socioeconomic status and life 1. Organizing
experiences with the community members they serve. • a process that brings people together and mobilizes them to
• CHWs are involved in a wide range of health care activities achieve a common goal or objectives.
such as first aid, some types of health screening, health
education, health promotion, community organization 2. Organization - group of organized groups
services and support to the health centers and mobile clinics.

COMMUNITY ORGANIZING PARTICIPATORY RESEARCH

PRIMARY RESPONSIBILITITES
• Motivate the community to be active, engaged participants in
their health management
• Talk about services and programs of the Department of Health
• Carry out a community profile survey and collect required
statistics annually
• Perform and/or organize community health education
activities
• Health promotion activities in homes, neighborhoods,
schools, churches, during clinics, etc. Presentations can be
done one – one or in groups
• Encourage pregnant women for prenatal care, and mothers to
take children for immunization
• Promote sanitation and hygiene
• Check and monitor BP, blood glucose, pregnancy tests (after
2 missed periods), monitor growth of children
• Provide appropriate referrals to health facilities and other
organizations/agencies
• Encourage community members to use health facilities
• Provide basic informal counseling support
• Diagnose and treat a limited range of common diseases (e.g.
diarrhea, head lice, Cold, Pink Eye)
• Prepare and submit reports on a monthly basis and as needed
to the district health educator
• Distribute health information materials e.g. posters, flyers, and
brochures to appropriate areas
SECONDARY RESPONSIBILITIES
• A social development approach that aims to transform the
apathetic, individualistic, and voiceless poor into a dynamic,
participatory and politically responsive community.
• A collective, participatory, transformative, liberated, sustained
and systematic process of building people organizations by
mobilizing and enhancing the capabilities and resources of the
people for the resolution of their issues and concerns towards
affecting change in their existing oppressive and exploitative
conditions.
ROSE, 1967
• A process by which community identifies its need and
objective. Develops confidence to take action in respect
to them and in doing so extends and develops
cooperative attitudes and practices in the community
A MANUAL OF EXPERIENCE, PCPD
• A continuous and sustained process of educating the
people to understand and develop their critical
awareness of their existing condition, working with the
people, collectively and efficiently on their immediate and
long term problems, and mobilizing to pursue to develop
their capability and readiness to respond and take action
on their immediate needs toward solving their long term
problems.

• Accompany the RHN or PHN team on mobile clinics
• Provide support services to visiting foreign health teams
working in the CHW’s community
• Accompany seriously ill patients to the hospital
• Support community members who are following a course of
prescribed treatment e.g. for Dengue, TB, HIV
• Responsible for the cleaning of the community health post in
preparation for visiting clinics (with supplies provided by the
responsible formal health facility)
NATIONAL RURAL CO CONFERENCE, 1994
• A collective, participatory, transformative, liberative,
sustained, and systematic process of building people’s
organizations by mobilizing and enhancing the
capabilities and resources of the people for the
resolution of their exploitative conditions

Community organizing
COMMUNUTY HEALTH WORKERS ACTIVITIES
• is a process whereby the community members develop the
• 12 Home visits per month by at least 80 % CHW capability to assess their health needs and problems, plan and
• 1 school visit per month implement actions to solve these problems, put up and sustain
• 1 community health session monthly organizational structures which will support and monitor
• Monitoring growth of babies monthly/bi-monthly implementation of Health initiatives by the people.
• Visits to newborns and moms (3 visits after baby arrives in
community • Health services and agencies of the community are brought
together to:
• Screening adolescents for pregnancy risks and referring them
1. Learn about the common problems
for appropriate services75% Attend monthly meetings
2. Identify these problems as their own
• Meet with catchment area team
3. Plan the kind of action needed to solve these problems
• Work with medical teams in communities
4. Act this basis
• Performing first aid
• 50 % referrals and counter referrals from and to CHW
• Weight and height of children 0 -3 years once a month.
• Weight and height of malnourish children 0 – 5 years twice a
month (Ms. Marley Ack to provide names at monthly
meetings)

EARLIS
 COMMUNITY HEALTH CARE DEVELOPMENT PROCESS
PURPOSE OF COMMUNTY ORGANIZING
1. Identify the needs of the community
2. Identify the resources available in the community
3. Mobilize the people and the community resources
4. Empowers people to participate in decision making process
5. Empowers people to implement action plan
6. Development of leaders among the people: By continually
spotting and developing leaders among the community
people, the organizing becomes more vigorous and more
relevant. Their efforts and activities become more effective
and stronger.
BASIC ASSUMPTIONS AND PRINCIPLES OF COMMUNITY
ORGANIZING
1. People especially the poor and the oppressed are open to
continuous movement and change
2. People have the capacity to change their situation if they are
socially aware and if they ac with commitment. Self-willed
changes have more meaning and permanence than imposed
changes
3. People need help in organizing themselves in order to deal
with needs and problems. Organizing work is class-based.
The focus is on the majority who are the primary forces of
production, the most vulnerable members of the community
4. Community organizing is expected to bring about structures
that enable power to reside in the people and work toward
self-reliance and self-determination
5. Basic trust on the people is essential in community organizing
work. It is the people’s right and responsibility to participate in
making and controlling important changes taking place in their
community. People have and can develop their innate
potential and capabilities to solve their problems. People have
the capacity and resources to manage their lives.
BENEFITS OF COPAR
1. It contributes to the establishments of an environment with
different community resources
a. natural, institutional, technical, financial, and
human resources – and can function with maximum
effectiveness.
2. It stimulates the various groups to examine their programs to
determine how well they are meeting their groups.
3. People are given a chance to study their problems, offer
solutions and give a chance to plan an action.
4. As a result of this working together a strong unity and
coherence is developed among various organizations and
leaders of the community represented so that they develop a
feeling of responsibility for making the program successful.
5. Community organization sets up action pattern to solve
problems.
IMPORTANCE OF COPAR
1. COPAR is an important tool for community development and
people empowerment as this helps the community workers to
generate community participation in development activities.
2. COPAR prepares people/clients to eventually take over the
management of a development program/s in the future.
3. COPAR maximizes community participation ad involvement;
community resources are mobilized for community services
EARLIS
MAJOR CONCEPTS OF COMMUNITY ORGANIZATION
1. Empowerment:
• Rappaport (1984) defined empowerment as a “process
by which individuals, communities and organizations
gain mastery over their lives.” Empowerment allows
communities to transform their lives and environment.
2. Community Competence:
• is an expected outcome of community development and
is closely related to the concept of empowerment.
• is the ability of the community to engage in effective
problem solving (Iscore, 1980).
• Condition essential for community competence
1. Commitment
2. Self-other awareness and clarify of situation
definition
3. Articulateness
4. Communication
5. Conflict containment and accommodation
6. Participation
7. Management of relations with the larger society
8. Machinery to facilitate participation interaction and
decision making
3. Participation and relevance
• Participation and relevance are two different concepts
that is intertwined with each other in order to have a
grasp of the whole picture.
• Participation
• refers to the need of the community members to be
active rather than passive in the learning process.
• Dewey (1946) and Lindeman (1926)
i. it is the process of enlarging the
understanding of people by making them
active and helping them make and
implement decisions for themselves.
• Ways to increase community participation in
community health projects:
1. Establishing work groups or task forces to work with
specific component of the project
2. Involving target group members in selection of
intervention strategies
3. Providing staff to carry out details and to offer
technical assistance and consultation as needed to
community members.
• Relevance
• the proposed change must be relevant to the
people. The people must experience a need for
change if change or learning is to occur. The
practitioner who starts with the community’s felt
needs and concerns is more likely to experience
success with change than the practitioner who tries
to impose an agency agenda from outside.
4. Selection of Community Issues:
• This involves separating problems that are troubling
but of minor importance from those that the
community feels strongly about. The best way to
select an issue is through the Problem-posing
dialogue method.
5. Community Organization in Practice:
▪ practitioners assist the community to identify its
problems and help in finding some solutions using
the strategies of community involvement to
increase its chances of success.
 COMMUNITY HEALTH CARE DEVELOPMENT PROCESS
MODELS OF COMMUNUTY ORGANIZATION Role of the Enabler-catalyst More technical An activist or
planner who encourages by gathering advocacy role and
Locality Dev’t. Social Planning Social Action problem solving, data, organizes groups
Assumptions This model is This model This model expressions of implements and manipulates
based on the emphasizes a assumes that a concerns, programs, and organizations and
assumption that a technical disadvantage organizational interacts with movements to
wide spectrum of approach to segment of the skills, and bureaucracies influence the
local people solving social population needs interpersonal political process
should be involved problems. to be organized, at relationships
in goal setting and Change is times in alliance
actions to believed to with others, to Power Collaborate in a Often the Viewed as an
maximize require expert make adequate structure common venture. sponsor or external target of
community planners, who , demands on the employer of the action or an
change using technical larger society. practitioner oppressor to be
abilities and coerced or
skills, including overturned.
the ability to
manipulate Boundary Client is the total Total Community
large (Definition) community. community or Segment
bureaucratic segment of a that is
organizations, community deprived.
can bring about (e.g.mentally ill,
complex aged. )
changes.
Clients Citizens of the Consumer of Victims of the
Emphasizes Self-help and Solving Redistribution of community. services. system.
development of community power, resources,
community problems and relationship
capabilities and (community and changes in
cooperation issues) basic institution
(empowerment) (community
competence).

Task Cooperation and Completing a Providing or PROCESS AND METHODS USED IN COPAR
system concrete task establishing new
capabilities and solving services, or getting a progressive cycle of Action-Reflection- Action
problems legislation passed
• which begins with small, local, and concrete issues
Views of the Increasing The community The community as identified by the people and the evaluation and reflection
planner participation and as having major a system of of actions taken by them.
local leadership social problems privileges and
such as power with a
physical or disadvantaged Consciousness Raising
mental, population and the
housing, or prob. is social • through experiential learning
some prob. of injustice, • is central to the COPAR process because it places
interest to the deprivation, emphasis on learning that emerges from concrete action
planner inequity or and which enriches succeeding action.
exploitation at the
hands of the
oppressors such Participatory & Mass- based
as the ‘power
structure,’ ‘big • it is primarily DIRECTED TOWARDS AND BASED IN
government,’ or
FAVOR OF THE POOR, the powerless and the
‘society’.
oppressed
Functions of The community Gathers The strategy is to
the planner overshadowed by facts about identify the issues
the larger a problem so people know group centered & not leader oriented
community and and who is the enemy
the problem is lack decides and then to • leaders are identified, emerge and are tested through
of relationships what to do organize mass
action rather than appointed or selected by some
and democratic about it action to pressure
problem-solving the enemy external force or entity
abilities.

Approach “Let’s meet and “Let’s gather ‘Let’s crystallize

talk this over.” the facts and the issue, organize
solve the mass action, and
problem.” pressure on the
selected targets.’

Change Consensus Consensus or Conflict or contest,

tactic through conflict such as
discussion confrontation and
and direct action or
communication negotiation.

EARLIS
 COMMUNITY HEALTH CARE DEVELOPMENT PROCESS
PHASES OF COPAR PROCESS
PRE-ENTRY PHASE
• Called as social preparation phase
• Initial phase of the organizing process where the
community/organizer looks for community to serve or help.
• it is considered the simplest phase in terms of actual outputs,
activities and strategies and time spent for it
• ACTIVITIES OF PRE-ENTRY PHASE
• Preparation of the staff:
o Statement of objectives and realization of COPAR
guidelines
o Development of criteria for site selection
o Site / area selection
o Setting of issues/ considerations related to site
selection
o Preliminary Social Investigation (PSI)
o Community consultations/ dialogues
o Networking with LGU’s, NGO’s and other
departments
1. AREA OR SITE SELECTION
o COMMUNITY SELECTION CRITERIA
1. The area must be economically
depressed
2. Must have a relative concentration of
poor families
3. Must have a population of 10,000 and
above
4. As much as possible no hospital but with
RHU and BHS
5. Accessibility of transportation must be
considered
6. No strong resistance from the community
7. Peace and order problem must be
considered
8. Rural community will be a top priority
9. Preferably with adjacent barangays
2. COMMUNITY PROFILING
o provides an overview of demographic
characteristics, community and health-related
services and facilities
o serves as initial database of the community
and it provides the basis for planning and
organizing community programs and activities
o help in determining the appropriate approach
and method of organizing specific to the
population group or sectors that will organized
EARLIS
ENTRY PHASE / INTEGRATION
• Immersion phase as it the activities done here includes the
sensitization of the people on the critical events in their life,
motivating them to share their dreams and ideas on how to
manage their concerns and eventually mobilizing them to take
collective action on these.
• this phase signals the actual entry of the community
worker/organizer into the community, he/she must be guided
by the following guidelines, however.
• GUIDELINES IN CONDUCTING INTEGRATION WORK
1. Recognizes the role and position of local authorities by
paying them a visit and informing them of your presence
and objectives in the community (courtesy call).
2. Present yourself according to the lifestyle in keeping with
that of the community i.e. personal appearance, speech,
behavior, the way you dress
3. Choose modest dwelling which is open to the majority of
the people in the community. If ever there is a need to
stay with a family in the community, the family should be
respected in the community.
4. Avoid raising expectations by adopting a low key
approach and profile.
5. Participate directly in production process
6. Make house calls and seek out people where they
usually in gather
7. Participate in some social activities
• ACTIVITY OF ENTRY PHASE
• Courtesy call to mayor, or the local government leader of
the selected site.
• Courtesy call to the barangay level.
• Meeting with the “will be” foster parents of health care
students.
• Appreciating the environment.
• Coordination/ dialogue/ consultation with other
community organizations
• Self-awareness and Leadership training (SALT), action,
planning
• General assembly.
• Preparation of survey forms.
• Actual survey.
• Analysis of the data gathered.
 COMMUNITY HEALTH CARE DEVELOPMENT PROCESS
CORE GROUP FORMATION PHASE
• Once the community health nurse identifies the potential
leaders, they are formed into a core group.
• The core group will be given the role of community organizer.
o Integration with the core group members
o Deepening social investigation
o Training and education
o Mobilizing the core group
• ACTIVITIES OF CORE GROUP FORMATION PHASE
o training on data validation (includes tabulation and
preliminary analysis of data)
o community validation
o presentation of the community study/diagnosis and
recommendations
o prioritization of community needs/problems for
action
o spot mapping
• To ensure the support and participation of the community
leaders, proper orientation briefing should be done. The
following preparation includes:
o What to prepare:
- Communication or letters signed by
the city/municipal health officer.
- Agenda
- Visuals for orientation
o Document proceedings of the meeting
o Plan for the conduct of community orientation
COMMUNITY ORGANIZATION AND CABALITY-BUILDING PHASE
• Entails the formation of more formal structures and the
inclusion of more formal procedures of planning,
implementing, and evaluating community-wide activities.
• It is at this phase where the organized leaders or group are
being given training (formal, informal, OJT) to develop their
AKS in managing their own concerns/programs
• Other community members are encourage to join and form a
community organization
o Pre-organization building activities
o Organizing the barrio health committee
o Setting up community organization
• Training and education for the organization
• ACTIVITIES
• Identifying problems.
• Spreading awareness and soliciting solution or
suggestion.
• Analysis of the presented solution.
• Planning of the activities.
• Organizing the people to build their own organization.
• Registration of the organization.
• Implementing of the said activities.
• Evaluation
EARLIS
SUSTENANCE AND STRENGTENING PHASE
• Occurs when the community organization has already been
established and the community members are already actively
participating in community-wide undertakings.
• At this point, the different committees set-up in the
organization-building phase are already expected to be
functioning by way of planning, implementing and evaluating
their own programs, with the overall guidance from the
community-wide organization
• Strategies used may include:
1. education and training
2. networking and linkaging
3. conduct mobilization on health and development
concerns
4. implementation of livelihood projects
5. developing secondary leaders
• ACTIVITIES
• Meeting with the organizational leaders.
• Evaluation of the programs.
• Re-implementing of the programs. (For unmet goals)
• Education and training.
• Networking and linking.
• Implementation of livelihood projects.
• Developing secondary leaders
PHASE-OUT PHASE
• the phase when the health care workers leave the community
to stand alone
• this phase should be stated during the entry phase so that the
people will be ready for this phase
• the organizations built should be ready to sustain the test of
the community itself because the real evaluation will be done
by the residents of the community itself
• ACTIVITIES
o Leaving the immersion site
o Documentation
COMMUNUTY ORGANIZING IS ALL ABOUT BUILDING
GRASSROOTS SUPPORT. IT’S ABOUT IDENTIFYING THE
PEOPLE AROUND YOU WITH WHOM YOU CAN CREASTE A
COMMON, PASSIONATE CAUSE. AND IT’S ABOUT IGNORING
THE CONVENTIONAL WISDOM OF COMPANY POLITICS AND
INSTEAD PLAYING THE GAME BY VERY DIFFERENT RULES