Ailyn Brillo Pineda

Community Health Nursing Practice Utilizing COPAR

 Dr. Alberto Romualdez, former DOH secretary

described the Philippine health status as “ on continuing shift towards positive change despite age-old problems..”
 Some infectious degenerative diseases are on the

rise  Correlation of poor health with low socio-economic status is well documented  Filipinos are still living in the remote areas, where it is difficult to deliver the health services they need  Scarcity and exodus of MD’s, RN’s and RM’s add to the poor delivery of the health care to the poor and deprived who comprise the majority of the country’s 80 million or so total population

INDICATORS Population Life Expectancy Crude Birth Rate Per 1000 population Crude Death Rate per 1000 population Infant Mortality Rate Maternal Mortality Rate Total Fertility Rate

MALE 41, 612, 133 72.78 years

FEMALE 41, 015,428 67.53 years

BOTH SEXES 82, 663,561 24.63

5.66; 4.8 in 1998 29 per 1000 live births 138 per 1000 live births 3.5

Age 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Total

Female Number 4,721,115 4,643,067 4,500,519 4,229,087 3,905,441 3,541,009 3,160,534 2,776,133 2,374,323 2,006,520 1,631,337 1,319,097 1,013,026 767,324 546,329 374,459 330,630 41,839,950 Percent 5.6 5.5 5.3 5 4.6 4.2 3.8 3.3 2.8 2.4 1.9 1.6 1.2 0.9 0.6 0.4 0.4 49.7 Number 4,937,632 4,832,467 4,792,979 4,418,572 3,983,027 3,557,779 3,141,953 2,756,653 2,374,463 2,006,056 1,629,315 1,296,672 963,875 704,079 475,228 298,154 232,487 42,401,391

Male Percent 5.9 5.7 5.7 5.2 4.7 4.2 3.7 3.3 2.8 2.4 1.9 1.5 1.1 0.8 0.6 0.4 0.3 50.3

Source: 1995 Census-Based National, Regional and Provincial Population Projections: National Statistics Office

AREA Philippines NCR (Metro Manila) CAR (Cordillera) Region 1 (Ilocos) Region 2 (Cagayan Valley) Region 3 (Central Luzon) Region 4 (Southern Tagalog) Region 5 (Bicol) Region 6 (Western Visayas) Region 7 (Central Visayas) Region 8 (Eastern Visayas) Region 9 (Western Mindanao) Region 10 (Northern Mindanao) Region 11 (Southern Mindanao) Region 12 (Central Mindanao) ARMM CARAGA Foreign Countries Residence not stated CARAGA

No. of Livebirths 1,766,440 303,631 33,017 101,310 59,585 200,361 299,872 117,979 123,299 153,080 61,873 55,931 59,659 103,555 44,231 39,616 9,327 114 9,327 Source: Philippine Health Statistics, 2000

5 Year Average (2000-2004) CAUSE No. 1. Acute Lower RTI and Pneumonia 2. Bronchitis/ Bronchiolitis 3. Acute Watery Diarrhea 4. Influenza 5. Hypertension 6. TB Respiratory 7. Diseases of the Heart 8. Malaria 9. Chickenpox 10. Dengue Fever  694,209 669,800 726,211 459,624 314,175 109,369 43,945 35,970 79,236 15,383 Rate 884.6 854.7 928.3 587.0 400.5 139.7 56.2 46.1 41.1 19.6 No.

2005* Rate 690,566 616,041 603,287 406,237 382,662 114,360 43,898 36,090 30,063 20,107 809.9 722.5 707.6 476.5 448.8 134.1 51.5 42.3 35.3 23.6

** Pneumonia only from 2000-2002 * reference year Last Update: June 29, 2009

MALE CAUSE Rate** 1. Acute Lower RTI and Pneumonia 2. Bronchitis/ Bronchiolitis 3. Acute Watery Diarrhea 4. Influenza 5. Hypertension 6. TB Respiratory 7. Chickenpox 8. Diseases of the Heart 9. Malaria 10. Dengue Fever  888.8 651.8 668.5 400.7 338.2 137.7 51.5 38.5 24.0 17.8

FEMALE Rate** 868.0 817.1 651.5 444.6 442.1 93.9 56.2 45.1 20.0 17.1

BOTH SEXES Number 776,562 719,982 577,118 379,910 342,284 103,214 46,779 37,092 19,894 15,838 Rate* 929.4 861.6 690.7 454.7 409.6 123.5 56.0 44.4 23.8 19.0

Source:  2004 Philippine Health Statistics ** rate/100,000 of sex-specific population  Last Update: February 11, 2008

AREA

Total Deaths

Philippines NCR (Metro Manila) CAR (Cordillera) Region 1 (Ilocos) Region 2 (Cagayan Valley) Region 3 (Central Luzon) Region 4 (Southern Tagalog) Region 5 (Bicol) Region 6 (Western Visayas) Region 7 (Central Visayas) Region 8 (Eastern Visayas) Region 9 (Western Mindanao) Region 10 (Northern Mindanao) Region 11 (Southern Mindanao) Region 12 (Central Mindanao)

366,931 63,413 5,041 26,469 13,250 40,534 54,804 24,867 35,589 29,403 16,250 9,650 10,700 20,045 7,543

AREA Philippines NCR (Metro Manila) CAR (Cordillera) Region 1 (Ilocos) Region 2 (Cagayan Valley) Region 3 (Central Luzon) Region 4 (Southern Tagalog) Region 5 (Bicol) Region 6 (Western Visayas) Region 7 (Central Visayas) Region 8 (Eastern Visayas) Region 9 (Western Mindanao) Region 10 (Northern Mindanao) Region 11 (Southern Mindanao) Region 12 (Central Mindanao) ARMM CARAGA Foreign Countries Residence not stated

Fetal Deaths 10,360 2,333 163 725 143 824 2,253 620 699 1,056 247 242 279 397 203 161 15 -

Cause  TOTAL 1. Complications related to pregnancy occurring in the course of labor, delivery and puerperium 2. Hypertension complicating pregnancy, childbirth and puerperium 3. Postpartum hemorrhage 4. Pregnancy with abortive outcome 5. Hemorrhage in early pregnancy

Number  1,732

Rate  1.0

Percent  100.0

819

0.5

47.3

510

0.3

29.4

263 138 2

0.2 0.1 0.0

15.2 8.0 0.1

Cause 1. Bacterial sepsis of newborn 2. Respiratory distress of newborn 3. Pneumonia 4. Disorders related to short gestation  and low birth weight, not elsewhere  classified 5. Congenital Pneumonia 6. Congenital malformation of the heart 7. Neonatal aspiration syndrome 8. Other congenital malformation 9. Intrauterine hypoxia and birth  asphyxia 10.Diarrhea and gastro-enterities of  presumed infectious origin

Number 3,161 2,298 2,013 1,610 1,510 1,444 1,146 1,012 971 900

Rate 1.9 1.4 1.2 1.0 0.9 0.9 0.7 0.6 0.6 0.5

Percent 14.6 10.6 9.3 7.4 7.0 6.7 5.3 4.7 4.5 4.2

Infant Mortality: Ten (10) Leading Causes Number & Rate/1000 Live births & Percentage Distribution Philippines, 2005

Cause

5 Year Average (2000-2004) Number Rate 83.3 63.9 48.4 41.4 42.0 34.2 22.6 17.0 18.2 No. 77,060 54,372 41,697 36,510 33,327 26,588 20,951 18,441 12,368

2005* Rate 90.4 63.8 48.9 42.8 39.1 31.2 24.6 21.6 14.5

1. Diseases of the Heart 2. Diseases of the Vascular system 3. Malignant Neoplasm 4. Pneumonia 5. Accidents 6. Tuberculosis, all forms 7. Chronic lower respiratory diseases 8.Diabetes Mellitus 9. Certain conditions originating in the perinatal period 10. Nephritis, nephrotic syndrome and nephrosis

66,412 50,886 38,578 32,989 33,455 27,211 18,015 13,584 14,477

9.166

11.5

11,056

3.6

Cause 1. Diseases of the Heart  2. Diseases of the Vascular system 3. Accidents 4. Malignant Neoplasms 5. Tuberculosis, all forms 6. Pneumonia 7. Chronic lower respiratory diseases 8. Diabetes Mellitus 9. Certain conditions originating in the  perinatal period 10. Nephritis, nephrotic syndrome and  nephrosis

No. 43,809 30,531 27,281 21,993 18,229 18,145 14,450 8,912 7,385 6,548

Rate 102.1 71.2 63.6 51.3 42.5 42.3 33.7 20.8 17.2 15.3

Cause 1. Diseases of the Heart  2. Diseases of the Vascular system 3. Malignant Neoplasms 4. Pneumonia 5. Diabetes Mellitus 6. Tuberculosis, All Forms 7. Chronic lower respiratory diseases 8. Accidents 9. Certain conditions originating in the  perinatal period 10. Nephritis, nephrotic syndrome and  nephrosis

No. 33,251 23,841 19,704 18,365 9,529 8,359 6,501 6,046 4,983 4,508

Rate 78.5 56.3 46.5 43.3 22.5 19.7 15.3 14.3 11.8 10.6

 Based on these statistics what are the challenges

that nurses, doctors or midwives and other health agencies face in relation to health profile and growth rate of the Philippine population?  What preventive measures can be done?  What can be done to promote and restore health?  What health education can be administered by the community health workers, doctors, nurses, midwives, etc.?  How can we improve the health care deliver system?  How can increase the number of health workers?  What can be done for people in the far flung areas to prevent the occurrence of diseases and health hazards?

Community Health Organizing Utilizing COPAR

Was developed and sponsored by the

Philippine Center for Population and Development (PCPD) To make health services available and accessible to depressed and underserved communities in the Philippines PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutions and agencies through programs and projects geared toward the social human development of rural and urban communities Formerly known as The Population Center

HRDP I
 Trained the faculty, medical/nursing students to

provide health care services to the far flung barrios because of lack of man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health  The PCPD provides seed money for the income generating projects  The CO uses his/her own strategy or method in developing the community  Short-term service

HRDP II
 The 2nd cycle uses the same strategy but the

program could not be sustained by the schools or hospitals and the income-generating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects  Both HRDP I and HRDP II have brought about some changes in the community life of the people  Established basic health infrastructure; basic health services were increased; there were trained workers and organized health groups to

HRDP III
 PCPD refined the program and resulted to what

is now called HRDP III, which has these unique features:
Comprehensive training of the staff and faculty of

the participating agency in which the community work was initiated Periodic training program and regular assistance to the participating agency were provided to strengthen the health outreach program to become community oriented PHC as the approach with which all nursing/medical students, their CI’s and indigenous health workers are trained for community health work and around which all other project inputs will revolve

 Community organizing as the main strategy to

be employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the community health programs  Organizing work in the communities were done in 3 phases  PAR as fascinating strategy for maximum community involvement through collective identification and analysis of community health problems and collective health action  Available funds to finance community initiated projects

Since Management Leadership and

Jurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts as leaders of the different levels of the students who were involved in COPAR Principles of management were applied in carrying out primary health care The community members, CHW’s and leaders were empowered to manage their own health projects Conducted seminars and trainings as well as

A social development

approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.

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 issues and concerns towards effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference)

A process by which a community

identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967)

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 the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their longterm problems (CO: A manual of experience, PCPD)

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 programs in the future. 3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.

People, especially the most oppressed,

exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change.  COPAR should be based on the interest of the poorest sectors of society  COPAR should lead to a self-reliant community and society.

 A progressive cycle of action-reflection action

which begins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them.  Consciousness- raising through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action.  COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed.  COPAR is group-centered and not leaderoriented. Leaders are identified, emerge and are tested through action rather than appointed or

Pre- entry Phase
 is the initial phase of organizing process where

the community/organizer looks for communities to serve/help  It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it  Activities include
 Community consultations/dialogues  Setting of issues/ considerations related to site

selection  Development of criteria for site selection  Site selection  Preliminary social investigation (PSI)

Entry Phase
 Social preparation phase  Activities done here includes:  Integration with the community  Sensitization of the community; information campaigns  Continuing social investigation  Core group formation:
 Development of criteria for the selection of CG

members  Defining the roles/functions/tasks of the CG

 Coordination /dialogue/consultation with other

community organizations  Self-awareness and Leadership training (SALT), action, planning
 This phase signals the actual entry of the

 Community Study/Diagnosis Phase (Research

Phase)
Selection of the research team Training on the data collection methods and

techniques; capability-building (includes development of data collection tools) Planning for the actual gathering of the data Data gathering Training on data validation (includes tabulation and preliminary analysis of data) Community validation Presentation of the community study/diagnosis/recommendations Prioritization of community needs/problems for action

 Community meetings to draw up guidelines for

the organizations of the CHO  Election of officers  Development of management systems and procedures, including delineation of the roles, functions and task of officers and members of the CHO  Team building/Action-Reflect Action (ARA)  Working out legal requirements for the establishment of the CHO  Organization of the working committees and task groups(e.g. education and training, membership of committees)  Training of the CHO officers/community leaders

Community Action Phase
 Organization and training of the community

health workers (CHW’s)
Development of criteria for the selection of CHW’s Selection of CHW’s Training of CHW’s

 Setting up of linkages/network referral systems  Initial identification and implementation of

resource mobilization schemes

Sustenance and strengthening phase
 Occurs when the community organization has

already been established and the community members are already actively participating in community-wide undertakings  Strategies used may include:
Education and training Networking and linkages Conduct of mobilization on health and development

concerns Implementation of livelihood projects Developing secondary leaders

Activities in Building People’s Organization

A CO becoming a par with the people in order

to:

 Immerse himself in the poor community  Understand deeply the culture, leaders, history,

rhythms and lifestyle in the community

Methods of Integration includes:
 Participation in direct production activities of

the people  Conduct of house visits  Participation in activities like birthdays, fiestas, wakes, etc  Conversing with people where they usually gather such as stores, water, walls, washing streams, or churchyards

 A systematic process of collecting, collating, analyzing

data to draw a clear picture of the community  Also known as the COMMUNITY STUDY  Pointers for the conduct of SOCIAL INVESTIGATION

 Use of survey or questionnaires is discouraged  Community leaders can be trained to initially assist the

community worker/organizer in SI  Data can be more effectively and efficiently collected through informal methods-house visits, participating in conversations in jeepneys and others  Secondary data should be thoroughly examined because much of the information might already be available  SI is facilitated if the CO/ community worker is properly integrated and has acquired the trust of the people  Confirmation and validation of community data should be done regularly

CO choose one issue to work in

order to begin organizing the people

Going around and motivating the

people on an one on one basis to do something on the issue that has been chosen

People collectively ratifying what they have

already decided individually The meeting gives the people the collective power and confidence Problems and issues are discussed

Means to act out the meeting that

will take place between the leaders of the people and government representatives It is a way of training the people to participate what will happen and prepare themselves for such eventually

Actual experience of the

people in confronting the powerful and the actual exercise of the people power

The people reviewing the steps 1-7 so to

determine whether they were successful or not in their objectives

Dealing with deeper, on going concerns to

look at the positive values CO is trying to build in the organization It gives the people time to reflect on the stark reality of life compared to the ideal

The people’s organization is the result of

many successive and similar actions of the people A final organizational structure is set up with elected officers and supporting members