W.H.O.

DEFINITION OF CHN
• Special field of nursing that combines
the skills of nursing and public health
for the promotion of health, the
improvement of the conditions in the
social and physical environment,
rehabilitation of illness and disability
FREEMAN DEFINITION OF CHN

• It is a service rendered by a
professional nurse…in places of work
for the promotion of health,
prevention of illness, care of the sick
at home and rehabilitation
 JACOBSON DEFINITION OF CHN

• It is a learned practice discipline with

the ultimate goal of contributing, and
in collaboration with others, to the
promoton of the client’s optimum level
of functioning through teaching and
delivery of care
 CHN
PHILOSOPHY
• It is based on the worth and dignity of
man
GOAL
• The ultimate goal of community
health services is to raise the level of
health of the citizenry
 CHN CONCEPTS
• The primary focus is on health
promotion
• CH Nursing is extended to benefit not
only the individual but the whole
family and the community
• CH Nurses are generalists in terms of
their practice through life’s continuum
 CHN CONCEPTS
• Contact with clients may continue
over a long period of time
• Knowledge from biological and social
sciences, ecology, clinical nursing,
and CH organizations be utilized
• Dynamic process of APIE is implicit in
the practice
 CHN OBJECTIVES
• To participate in the development of
an over-all health plan for the
community and in its implementation
and evaluation
• To provide quality nursing services to
the individuals, families and
communities, utilizing as basis the
standards set for CH nursing practice
 CHN OBJECTIVES
• To participate in the development of
an over-all health plan for the
community and in its implementation
and evaluation
• To provide quality nursing services to
the individuals, families and
communities, utilizing as basis the
standards set for CH nursing practice
 CHN OBJECTIVES
• To coordinate nursing services with
various members of the health team,
community leaders, GOs and NGOs
in achieving the aims of public health
services within the community
 CHN OBJECTIVES
• To participate in/and or conduct
researches relevant to community health
and CH nursing services and disseminate
their results for improvement of health
care
• To provide CH Nursing Personnel with
opportunities for continuing education and
professional growth through staff
development
 CHN
• CH Nursing is based on the needs of
the client.
• CH Nurse must understand fully the
objectives and policies of the agency
she represents.
• Family is the unit of service
• CH Nursing must be available to all
 CHN
• The primary responsibility is health
education
• CH Nurse works as a member of the
health care team
• Periodic evaluation of CH Nursing
services must be done
• Professional growth is a personal
responsibility
 CHN
• Utilize available community health
resources
• Utilize existing groups in the
community
• Accurate recording and reporting
• There must be provision for educative
supervision
hrdp
 HEALTH RESOURCE
DEVELOPMENT PROGRAM III
• Developed and sponsored by
Philippine Center for Population and
Development, Inc. (PCPD, Inc)
• Purpose:
- to make health services available
and accessible to depressed and
underserved communities in the
Philippines
 PCPD, Inc.
• It is a non-stock, non-profit private
institution
• Serves as a resource center assisting
institution and agencies through programs
and projects geared toward the social
human development of rural and urban
communities
• Formerly Population Center Foundation
HRDP
3 cycles
 HRDP I
• Trained the faculty members,
medical/nursing students to provide health
care services to the far-flung barrios
because of lack of manpower for health
services
- simultaneously, there was the
fulfillment of the curricular requirements
of students for public health
 HRDP I
• PCPD provides seed money for the
income-generating projects
• The Community Organizer uses his/her
own strategy or method in developing the
community
• Considered to be a short-term service
 HRDP II
• Uses the same strategy but the
program could not be sustained by
the schools or hospitals
• The income-generating projects
eventually became a hindrance to the
goal of achieving the health program
 HRDP II
Why income-generating projects
became a hindrance to the goal of
achieving the health program?
- Because the people tended to be
more interested in the income
generated by the projects
 EFFECTS OF HRDP I AND II TO
THE COMMUNITY
• Established basic health
infrastructures
• Increased basic health services
• There were trained health workers
and organized health groups to take
care of the health needs of the people
 HRDP III: Unique Features
• Comprehensive training of the staff and
faculty members 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.
 HRDP III: Unique Features
• PHC as the approach with which all
nursing/medical students, their
Clinical Instructors and indigenous
health workers are to be trained for
community health work and around
which all other project inputs will
revolve
 HRDP III: Unique Features
• Community organizing as the main
strategy to be employed in preparing
the communities to develop their
community health care system and
the establishment of community
health organization to manage the
community health programs
 HRDP III: Unique Features
• Organizing work in the communities
was done in three phases. The
participating agency worked only in
one community on the first year. A
thorough assessment and summing
up of field of experience in the first
community done before the entry to
three communities on the 7th month.
 HRDP III: Unique Features
The experiences on these 3
communities are assessed before
entering the last 3mcommunities on
the 14th month.
 HRDP III: Unique Features
• Participatory Action Research (PAR)
as facilitating strategy for maximum
community involvement, through
collective identification and analysis
of community health problems and
collective health action
 HRDP III: Unique Features
• Available funds to finance community
initiated projects; thereby enabling the
communities to gain hands-on
experience in managing community
health projects.
(PCPD 1992)
 HRDP III
• It aimed to develop an effective
primary health care system in
underserved communities through the
improvement of the capabilities of
health training institutions:
a. to provide community outreach
services
 HRDP III
b. To train and to organize
community residents in the
management of their health
concerns
 HRDP III: GOAL
It is the delivery of health care to the
far-flung communities which can not
be reached by the health care
agencies. Through the development
of available health care givers and the
local residents, the primary health
care can be delivered to the
community members.
 HRDP III: STRATEGY
The strategy used was the
COMMMUNITY ORGANIZING and
PARTICIPATORY ACTION
RESEARCH to activate the
involvement of community members
 HRDP III: PARTICIPATING
INSTITUTIONS DURING ITS
IMPLEMENTATION
1. De La Salle University, College of Medicine,
Dasmarinas, Cavite
2. Liceo de Cagayan, College of Nursing,
Cagayan de Oro City
3. Saint Paul University, College of Nursing,
Tuguegarao City
4. Sacred Heart College of Nursing, Lucena
City
 PHC
PHC IN THE PHILIPPINES
• Practiced even before 1978 when the
WHO declared PHC in Alma Ata
• What is PHC in the Philippines
now? How is it? Where are the
accomplishments?
 PHC: Definition
• It is the key in achieving an acceptable
level of health through-out the world in
the foreseeable future as part of social
development and in the spirit of social
justice
- PHC Report of the International
Conferences on PHC, Alma Ata, USSR,
Geneva (WHO: September 1978)
 WHO (1978) ON PHC
• PHC is people-oriented
• Its success rests on people
• It identified 4 pillars (where actions
for health for all must be based):
1. Political and societal commitment
and determination to move towards
health for all as the main social
target for the coming decades.
 WHO (1978) ON PHC
2. Community participation – the active
involvement of people and the
mobilization of social forces for health
development
3. Intersectional cooperation between the
health section and other development
sectors such as education,
communication, industry, public works,
transportation, and housing
 WHO (1978) ON PHC
4. System support to ensure that
essential health care and scientifically
sound affordable health technology
are available to all people.
 WHO (1978): OBJECTIVES OF
PHC
1. To enable the people to seek better
health at home, in school, in fields,
and in factories;
2. To enable the people to prevent
injury and diseases, instead of
relying on doctors to repair damages
that can be avoided;
 WHO (1978): OBJECTIVES OF
PHC
3. To enable the people to exercise the
right and responsibility in shaping
the environment and bringing about
conditions that make it possible and
easier to live a healthy life
4. To enable the people and exercise
control in managing health and
related systems and to ensure that
 WHO (1978): OBJECTIVES OF
PHC
… the basic pre-requirements for
health and access to health care are
available to all people.
LET US EVALUATE OUR OWN
ADOPTED COMMUNITIES:
“As members of the health team,
were we able to meet these
objectives?”
 PRINCIPLES OF PHC
1. Accessibility, availability, and
acceptability of health services;
2. Provision of quality basic and
essential health services;
3. Community Participation
4. Self-Reliance
 PRINCIPLES OF PHC
5. Recognition of interrelationship
between health and development
6. Social Mobilization
7. Decentralization
 ACCESSIBILITY, AVAILABILITY,
ACCEPTABILITY OF HEALTH SERV ICES
• Health services must be delivered where
the people are
• Use of indigenous/resident volunteer
workers as health care providers with a
ratio of one community health worker per
10-20 household
• Use of traditional (herbal) medicine
together with the essential drugs
 PROVISION OF QUALITY BASIC AND
ESSENTIAL HEALTH SERVICES
• Training design and curriculum based on
community needs and priorities, task
analysis of CHWs are competency based
• AKS developed are on promotive,
preventive, curative, and rehabilitative
health care
• Regular monitoring and periodic
evaluation of CHW performances by the
community and health staff
COMMUNITY PARTICIPATION
• Awareness building and consciousness
raising on health and health-related issues
• Planning, implementation, monitoring and
evaluation done through small group
meetings (10-12 household cluster)
• Selection of CHWs by the community
• Community building and community
organizing
COMMUNITY PARTICIPATION
• Formation of health committees
• Establishment of a community Health
Worker Organization at the parish
municipality level
• Mass health campaign and mobilization to
combat health problems.
 SELF-RELIANCE
• Community generates support (Cash,
Kind, Labor) for the health program
• Use of local resources (human, financial,
material)
• Training of community in leadership and
management skills
• Incorporation of income-generating
projects, cooperatives, small scale
industries
RECOGNITION OF INTERRELATIONSHIP
BETWEEN HEALTH AND DEVELOPMENT
• Convergence of health, food, nutrition/water,
sanitation, and population services
• Integration of PHC into national, regional,
provincial, municipal, barangay development
plans
• Coordination of activities with economic
planning, education, agriculture, industry,
housing, public works, communication, and
social services
 SOCIAL MOBILIZATION
• Establishment of an effective health
referral
• Multisectoral and interdisciplinary linkages
• Information, education, and
communication support using multi-media
• Collaboration between GOs and NGOs
 DECENTRALIZATION
• Re-allocation of budgetary resources
• Re-orientation of health professionals
on PHC
• Advocacy for political will and support
from the national leadership down to
the barangay level
ESSENTIAL ELEMENTS OF PHC

1. Education on the prevailing health

problems and the methods of
preventing and controlling diseases;
2. Prevention and control of local
endemic diseases;
3. Promotion of food supply and proper
nutrition;
ESSENTIAL ELEMENTS OF PHC

4. Adequate and safe supply of water

and basic sanitation;
5. Maternal-child health including family
planning;
6. Immunization against infectious
diseases
ESSENTIAL ELEMENTS OF PHC

7. Appropriate treatment of common

diseases and injuries;
8. Provisions of essential drugs and
herbal medicines
Community organizing and
participatory action research
 CO-PAR
• It has been the strategy used by the
HRDP III in implementing the PHC
delivery in depressed and
underserved communities to become
self-reliant
 COMMUNITY ORGANIZING
Accdg. To HRDP III DESCRIPTION:
• Continuous and sustained process of
educating the people to let them
understand and develop their
critical awareness of the existing
conditions;
 COMMUNITY ORGANIZING
Accdg. To HRDP III DESCRIPTION:
• It is working with the people collectively
and efficiently, discover their immediate
and long term problems;
• Mobilizing the people to develop their
capabilities and readiness to respond
and take action on their immediate needs
towards the solution of their long-term
problems
 OBJECTIVES OF COMMUNITY
ORGANIZING (PCPD)
• To make people aware of social realities
toward the development of local initiative,
optimal use of human, technical and
material resources, and strengthening of
people’s capacities
• To form structures that hold the people’s
basic interests as oppressed and deprived
sectors of the community and as people
bound by the interest to serve the people
 OBJECTIVES OF COMMUNITY
ORGANIZING (PCPD)

• To initiate the responsible actions

intended to address holistically the
various community health and social
problems.
COMMUNITY ORGANIZING AS APPLIED
TO PHC
• It is defined as the process and
structures to which members of the
community are tapped to become
organized for participation in health
care and community development
activities
• The community members organized
themselves to get better health care...
COMMUNITY ORGANIZING AS APPLIED
TO PHC

… and improve their health as part of

larger effort, to increase their power
and achieve greater social and
economic equality within a larger
social system
 COMMUNITY ORGANIZING AS A
PROCESS

• It is the sequence of step whereby

the members of the community work
together to critically assess and
evaluate community conditions to
improve these conditions
 COMMUNITY ORGANIZING AS A
STRUCTURE

• It refers to the particular group of

community members that work
together for common health and
health-related problems
 EMPHASES OF COMMUNITY
ORGANIZING TO PHC

1. The community works to solve their

own problem
2. The direction is internal rather than
external.
3. The development of the capacity to
establish a project is more
important than the project.
 EMPHASES OF COMMUNITY
ORGANIZING TO PHC

4. There is a consciousness-raising to
perceive health and medical care
within the total structure of society.
 PARTICIPATORY ACTION
RESEARCH (PCPD 1990)
• It is an investigation on problems and
issues concerning life and environment of
the underprivileged by way of research
collaboration with the underprivileged
whose representatives participate in the
actual research as researchers
themselves, doing research of their own
problem.
 PARTICIPATORY ACTION
RESEARCH (PCPD 1990)
OBJECTIVE:
• To encourage consciousness of the
suffering and develop competence
for changing their own situation,
and helping in the organization-
building by harnessing both human
and natural resources in responding
to community needs.
 PAR (accdg. to Partners in Action
Research 1997)
• PAR is a community-directed
process of gathering and analyzing
information or an issue for the
process of taking actions and
making changes
 PAR
ESSENTIAL ELEMENT:
• Participation

BENEFICIARIES OF THE RESEARCH:

• The main actors in the research process.
- it enables the community to experience
a collective consciousness of their own
situations
 PAR
• It involves:
- research
- education
- actions
> to empower people to determine the
cause of their problems, analyze
these problems, and act by
themselves in responding to their
own problems
 PAR
• In PAR, there is an outside
researcher, a professional one who
through immersion and integration on
the community becomes a committed
participant and learner in the
community
 CHARACTERISTICS: Traditional vs PAR

TRADITIONAL PAR
• Research for the • Research seek
purpose of social
identifying and transformation.
meeting individual
needs within
existing social
system.
 CHARACTERISTICS: Traditional vs PAR

TRADITIONAL PAR
• Cmty. problems or • The research
needs are defined by problems are defined
experts or the by the community
external researchers members
to cmty. groups and themselves who are
considered neutral or viewed as “experts of
non-biased. their own reality”
 CHARACTERISTICS: Traditional vs PAR

TRADITIONAL PAR
• The research problem • The cmty. group
is studied by the undertakes the
researchers who investigation or
control the research research process
process from data collection to
analysis. External
researchers work
alongside the cmty.
group.
 CHARACTERISTICS: Traditional vs PAR

TRADITIONAL PAR
• Recommendations • The community
for the community are formulates
based on the recommendation
researcher’s findings and an action plan
and analysis based on research
outcome,
 PRE-ENTRY PHASE
• It is the initial phase of the 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
 PRE-ENTRY PHASE
• Community consultations/dialogues
• Setting of issues/considerations related to
site selection
• Development of criteria for site selection
• Preliminary Social Investigation (PSI)
• Networking with LGUs, NGOs, and other
departments within the HRDP-NGO
 ENTRY PHASE
• It is some times called the social
preparation phase
• The activities done here includes the
sensitization of the people on the critical
events in their life, motivating them to
share their dreams, ideas on how to
manage their concerns and eventually
mobilizing them to take collective action on
these
 ENTRY PHASE
• This phase signals the actual entry of
the community worker/organizer into
the community who must be guided
by the following guidelines:
a. Recognize the role of local
authorities by paying them visits
to inform them of their presence
and activities
 ENTRY PHASE
b. His appearance, speech, behavior
and lifestyle should be in keeping
with those of the community
residents without disregard of their
being role model
b. Avoid raising the consciousness of the
community residents; adopt a low-key
profile
 ENTRY PHASE
• Integration with the community
• Sensitization of the community/Information
campaigns
• Continuing social investigation
• Core Group formation
- Development of criteria for selection
- Defining roles/functions/tasks of the CG
 ENTRY PHASE
• Coordination/Dialogue/Consultation
with other community organizations
• Self-Awareness and Leadership
Training (SALT)/Action Planning
COMMUNITY STUDY/DIAGNOSIS
PHASE (Research Phase)
• Selection of the research team
• Training on data collection methods
and techniques/Capability-building
(includes development of data
collection tools)
• Planning for the actual gathering of
data
COMMUNITY STUDY/DIAGNOSIS
PHASE (Research Phase)
• Data gathering
• Training on data validation (includes
tabulation and preliminary analysis of
data)
• Community validation
• Presentation of the community
study/diagnosis and recommendations
COMMUNITY STUDY/DIAGNOSIS
PHASE (Research Phase)
• Prioritizations of community
needs/problems for action.
 COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
• Community meetings to draw up
guidelines for the organization of the CHO
• Election of officers
• Development of management systems
and procedures including delineation of
the roles, functions, and tasks of officers
and members of the CHO
 COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
• Team building/Action-Reflection-
Action (ARA)
• Working out legal requirements for
the establishment of CHO
• Organization of working
committees/task groups (education
and training, membership of
committees)
 COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE

• Training of the CHO

Officers/Community leaders
COMMUNITY ACTION PHASE
• Organization and training of CHWs
- Development of criteria for the
selection of CHWs
- Selection of CHWs
- Training of CHWs
• Setting up of linkages/network referral
systems
COMMUNITY ACTION PHASE
• Plan for health services/intervention
schemes and community
development projects
• Initial identification and
implementation of resource
mobilization schemes
 SUSTENANCE AND
STRENGTHENING SCHEME
• Formulation and ratification of
constitution and by-laws
• Identification and development of
secondary leaders
• Setting-up and institutionalization of
financing scheme for community
health program/activities
 SUSTENANCE AND
STRENGTHENING SCHEME
• Formalizing and institutionalization of
linkages, networks and referral
systems
• Development and implementation of
viable management systems and
procedures, committees, continuing
education/training of leaders, CHWs,
community residents
 SUSTENANCE AND
STRENGTHENING SCHEME
• Continuing education and upgrading
of community leaders, CHWs, and
CHO members
• Development of medium/long-term
community health and development
plans