Community Organizing Participatory

Action Research (COPAR)

Definitions of COPAR

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 peoples 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 long-term problems
(CO: A manual of experience, PCPD)
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 programs in the future.
3. COPAR maximizes community
participation and involvement;
community resources are mobilized for
community services.
Principles of COPAR
1. 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.
2. COPAR should be based on the interest
of the poorest sectors of society
3. COPAR should lead to a self-reliant
community and society.

COPAR Process

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 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 selected by some external
force or entity.
Critical Steps in COPAR
1. Integration
2. Social Investigation
3. Tentative program planning
4. Groundwork
5. Meeting
6. Role Play
7. Mobilization or action
8. Evaluation
9. Reflection
10. Organization

4 Phases of COPAR

1. Pre-Entry Phase
Is the intial phase of the organizing
process where the community organizer
looks for communities to serve and help.
Acitivities include:

Preparation of the Institution

Train faculty and students in COPAR.

Formulate plans for institutionalizing
COPAR.
Revise/enrich curriculum and immersion
program.
Coordinate participants of other
departments.
Site Selection

Initial networking with local government.

Conduct preliminary special investigation.
Make long/short list of potential
communities.
Do ocular survey of listed communities.

Respected by both formal and informal

leaders.
Neighbors are not hesitant to enter the
house.
No member of the host family should be
moving out in the community.

2. Entry Phase
Criteria for Initial Site Selection

Must have a population of 100-200

families.
Economically depressed. No strong
resistance from the community.
No serious peace and order problem.
No similar group or organization holding
the same program.

sometimes called the social

preparation phase. Is crucial in
determining which strategies for
organizing would suit the chosen
community. Success of the activities
depend on how much the community
organizers has integrated with the
commuity.

Identifying Potential Municipalities

Guidelines for Entry

Make long/short list of potential

municipalities

Identifying Potential Community

Do the same process as in selecting

municipality.
Consult key informants and residents.
Coordinate with local government and
NGOs for future activities.

Recognize the role of local authorities by

paying them visits to inform their
presence and activities.
Her appearance, speech, behavior and
lifestyle should be in keeping with those
of the community residents without
disregard of their being role model.
Avoid raising the consciousness of the
community residents; adopt a low-key
profile.

Activities in the Entry Phase

Choosing Final Community

Conduct informal interviews with

community residents and key informants.
Determine the need of the program in the
community.
Take note of political development.
Develop community profiles for
secondary data.
Develop survey tools.
Pay courtesy call to community leaders.
Choose foster families based on
guidelines

Integration. Establishing rapport with

the people in continuing effort to imbibe
community life.
o living with the community
o seek out to converse with people where
they usually congregate
o lend a hand in household chores
o avoid gambling and drinking
Deepening social investigation/community
study
o verification and enrichment of data
collected from initial survey
o conduct baseline survey by students,
results relayed through community
assembly

Identifying Host Family

House is strategically located in the

community.
Should not belong to the rich segment.

Core Group Formation

Leader spotting through sociogram.

Key Persons. Approached by most

people
Opinion Leader. Approached by key
persons
Isolates. Never or hardly consulted
3. Organization-building Phase

Biostatistics

Entails the formation of more formal

structure and the inclusion of more formal
procedure of planning, implementing, and
evaluating community-wise activities. It is
at this phase where the organized leaders
or groups are being given training
(formal, informal, OJT) to develop their
style in managing their own
concerns/programs.

Key Activities

Community Health Organization (CHO)

o preparation of legal requirements
o guidelines in the organization of the
CHO by the core group
o election of officers
Research Team Committee
Planning Committee
Health Committee Organization
Others
Formation of by-laws by the CHO

4. 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. At this point, the different
committees setup in the organizationbuilding 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.

Implementation of livelihood projects.

DEMOGRAPHY - study of population

size, composition and spatial distribution
as affected by births, deaths and
migration.
Sources: Census complete
enumeration of the population

2 Ways of Assigning People

1. De Jure - People were assigned to the
place where assigned to the place they
usually live regardless of where they are
at the time of census.
2. De Facto - People were assigned to the
place where they are physically present
at are at the time of census regardless, of
their usual place of residence.
Components
1. Population size
2. Population composition
o Age Distribution
o Sex Ratio
o Population Pyramid
o Median age - age below which
50% of the population falls and
above which 50% of the
population falls. The lower the
median age, the younger the
population (high fertility, high
death rates).
o Age Dependency Ratio - used as
an index of age-induced
economic drain on human
resources
o Other characteristics:

occupational groups

economic groups

educational attainment

ethnic group
2

Key Activities

Population Distribution
o Urban-Rural - shows the
proportion of people living in
urban compared to the rural
areas
o Crowding Index - indicates the
ease by which a communicable
disease can be transmitted from
1 host to another susceptible
host.
o Population Density - determines
congestion of the place

Vital Statistics

Training of CHO for monitoring and

implementing of community health
program.
Identification of secondary leaders.
Linkaging and networking.
Conduct of mobilization on health and
development concerns.

The application of statistical measures to

vital events (births, deaths and common
illnesses) that is utilized to gauge the
levels of health, illness and health
services of a community.

Types of Vital Statistics

Fertility Rate or Birth Rate - the ratio of live
births in an area to the population of that area;
expressed per 1000 population per year
1. Crude Birth Rate
Total # of livebirths in a given calendar
year
X 1000
Estimated population as of July 1 of the same
given year

the study of the occurrence and

distribution of health conditions such as
disease, death, deformities or disabilities
on human populations

1. Patterns of disease occurrence

2. General Fertility Rate

Total # of livebirths in a given calendar
year
X 1000
Total number of reproductive age

Epidemic

A situation when there is a high incidence

of new cases of a specific disease in
excess of the expected.

when the proportion of the susceptible

are high compared to the proportion of
the immunes

Mortality Rate or Death Rate = The ratio of total

deaths to total population in a specified community or
area over a specified period of time. The death rate is
often expressed as the number of deaths per 1,000 of
the population per year. Also called fatality rate.

Epidemic potential

an area becomes vulnerable to a

disease upsurge due to causal factors
such as climatic changes, ecologic
changes, or socio-economic changes

1. Crude Death Rate

_Total # of death in a given calendar year_
X 1000
Estimated population as of July 1 of the same
calendar year

Endemic

habitual presence of a disease in a given

geographic location accounting for the
low number of both immunes and
susceptibles.E.g. Malaria is a disease
endemic at Palawan.

The causative factor of the disease is

constantly available or present to the
area.

2. Infant Mortality Rate

Total # of death below 1 yr in a given
calendar year
X 1000
Estimated population as of July 1 of the same
calendar year
3. Maternal Mortality Rate
Total # of death among all maternal cases in
a given calendar year
X 1000
Estimated population as of July 1 of the
same calendar year
Morbidity Rate = The rate of incidence of a
disease; the relative incidence of a particular disease
1. Prevalence Rate
Total # of new & old cases in a given
calendar year
X 100
Estimated population as of July 1 of the same
calendar year
2. Incidence Rate
Total # of new cases in a given calendar
year_
X 100
Estimated population as of July 1 of the same
calendar year
3. Attack Rate
Total # of person who are exposed to the
disease
X 100
Estimated population as of July 1 of the same
calendar year
Epidemiology

the study of distribution of disease or

physiologic condition among human
population s and the factors affecting
such distribution

Sporadic

disease occurs every now and

then affecting only a small number of
people relative to the total population

intermittent
Pandemic

global occurrence of a disease

Steps in Epidemiological Investigation:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of
the disease
3. Relate to characteristics of the group in
the community
4. Correlate all data obtained

DEPARTMENT OF HEALTH (DOH)

Vision

Health for all Filipinos

Mission

Ensure accessibility & quality of health

care to improve the quality of life of all
Filipinos, especially the poor.
National Objectives
1. Improve the general health status of the
population (reduce infant mortality rate,
reduce child morality rate, reduce
maternal mortality rate, reduce total

2.

3.

4.
5.

6.

7.

fertility rate, increase life expectancy &

the quality of life years).
Reduce morbidity, mortality, disability &
complications from Diarrheas,
Pneumonias, Tuberculosis, Dengue,
Intestinal Parasitism, Sexually
Transmitted Diseases, Hepatitis B,
Accident & Injuries, Dental Caries &
Periodontal Diseases, Cardiovascular
Diseases, Cancer, Diabetes, Asthma &
Chronic Obstructive Pulmonary Diseases,
Nephritis & Chronic Kidney Diseases,
Mental Disorders, Protein Energy
Malnutrition, and Iron Deficiency Anemia
& Obesity.
Eliminate the ff. diseases as public health
problems:
1. Schistosomiasis
2. Malaria
3. Filariasis
4. Leprosy
5. Rabies
6. Measles
7. Tetanus
8. Diphtheria & Pertussis
9. Vitamin A Deficiency & Iodine
Deficiency Disorders
Eradicate Poliomyelitis
Promote healthy lifestyle through healthy
diet & nutrition, physical activity &
fitness, personal hygiene, mental health
& less stressful life & prevent violent &
risk-taking behaviors.
Promote the health & nutrition of families
& special populations through child,
adolescent & youth, adult health,
womens health, health of older persons,
health of indigenous people, health of
migrant workers and health of different
disabled persons and of the rural & urban
poor.
Promote environmental health and
sustainable development through the
promotion and maintenance of healthy
homes, schools, workplaces,
establishments and communities towns
and cities.

Basic Principles to Achieve Improvement in

Health
1. Universal access to basic health services
must be ensured.
2. The health and nutrition of vulnerable
groups must be prioritized.
3. The epidemiological shift from infection to
degenerative diseases must be managed.
4. The performance of the health sector
must be enhanced.
Primary Strategies to Achieve Goals
1. Increasing investment for Primary Health
Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.

Millennium Development Goals (MDGs)

The Millennium Development Goals (MDGs)
are eight international development goals that
were officially established following
the Millennium Summit of the United Nations in
2000, following the adoption of the United
Nations Millennium Declaration. All 193 United
Nations member states and at least
23 international organizations have agreed to
achieve these goals by the year 2015. The goals
are:
1. Eradicating extreme poverty and hunger,
2. Achieving universal primary education,
3. Promoting gender
equality and empowering women,
4. Reducing child mortality rates,
5. Improving maternal health,
6. Combating HIV/AIDS, malaria, and other
diseases,
7. Ensuring environmental sustainability,
and
8. Developing a global partnership for
development.

DOH PROGRAMS
BOTIKA NG BARANGAY (BnB)
Botika ng Barangay (BnB) - refers to a
drug outlet managed by a legitimate community
organization (CO) / non-government organization
(NGO) and/or the Local Government Unit (LGU),
with a trained operator and a supervising
pharmacist specifically established in accordance
with this Order. The BnB outlet should be initially
identified, evaluated and selected by the
concerned Center for Health Development (CHD),
approved by the PHARMA 50 Project Management
Unit (PMU) and specially licensed by the Bureau
of Food and Drugs (BFAD) to sell, distribute, offer
for sale and/or make available low-priced generic
home remedies, over-the-counter (OTC) Drugs
and two (2) selected, publicly-known prescription
antibiotics drugs (i.e. Amoxicillin and
Cotrimoxazole).
The establishment of the Botika ng
Barangay (BnB) in the communities, including the

insurgent areas, ensures accessibility of lowpriced generic over-the-counter drugs and eight
(8) prescription drugs as recommended by the
National Drug Formulary Committee. Under
Memorandum # 31 and its amendment, as much
as 40 essential medicines that address common
diseases can be made available in BnBs
depending on the morbidity and mortality profiles
of the community. And the policies surrounding
the BnB (AO 144) ensure that such can be
sustained in the medium term.
II. Objectives
The objectives of this Order are as follows:
1.
To promote equity in health by ensuring
the availability and accessibility of
affordable, safe and effective, quality
essential drugs to all, with priority for
marginalized, underserved, critical and hard
to reach areas.
2.
To integrate all related issuances of the
DOH that provides rules and regulations in
the establishment and operations of BnBs;
and
3.
To define the roles and responsibilities of
the different units of the DOH and other
partners from the different sectors in
facilitating and regulating the establishment
of BnBs.

reminding couples that planning size of their

families have a direct bearing on the quality
of their children's and their own lives.
Intended Audience: Men and women of
reproductive age (15-49) years old) including
adolescents
Area of Coverage: Nationwide
Mandate: EO 119 and EO 102
FOOD FORTIFICATION PROGRAM
Objectives:
1. To provide the basis for the need for a food
fortification program in the Philippines: The
Micronutrient Malnutrition Problem
2. To discuss various types of food fortification
strategies
3. To provide an update on the current situation
of food fortification in the Philippines
Fortification as defined by Codex
Alimentarius
the addition of one or more essential nutrients to
food, whether or not it is normally contained in
the food, for the purpose of preventing or
correcting a demonstrated deficiencyof one or
more nutrients in the population or specific
population groups

FAMILY PLANNING
Vitamin A, Vitamin A Deficiency (VAD) and
A national mandated priority public health
its Consequences
program to attain the country's national health

Vitamin A - an essential nutrient as

development: a health intervention program and
retinol needed by the body for normal sight,
an important tool for the improvement of the
growth, reproduction and immune
health and welfare of mothers, children and other
competence
members of the family. It also provides

Vitamin A deficiency - a condition

information and services for the couples of
characterized by depleted liver stores & low
reproductive age to plan their family according to
blood levels of vitamin A due to prolonged
their beliefs and circumstances through legally
insufficient dietary intake of vit. A followed
and medically acceptable family planning
by poor absorption or utilization of vit. A in
methods.
the body
The program is anchored on the following basic

VAD affects childrens proper growth,

principles.
resistance to infection, and chances of

Responsible Parenthood which means

survival (23 to 35% increased child
that each family has the right and duty to
mortality), severe deficiency results to
determine the desired number of children
blindness, night blindness and bitots spot
they might have and when they might have
them. And beyond responsible parenthood is
Prevalence of Vitamin A Deficiency:
Responsible Parenting which is the proper
1993, 1998, 2003, 2008
ubringing and education of chidren so that
(DOST FNRI, NNS)
they grow up to be upright, productive and
Physiological State
1993
1998
2003
civic-minded citizens.

Respect for Life. The 1987 Constitution6 months - 5 yrs.

35.3
38.0
40.1
states that the government protects the
Pregnant
16.4
22.2
17.5
sanctity of life. Abortion is NOT a FP method:

Birth Spacing refers to interval between

Lactating
16.4
16.5
20.1
pregnancies (which is ideally 3 years). It
WHO Cut off Point to be considered a public
enables women to recover their health
health problem = >15%
improves women's potential to be more
productive and to realize their personal
Iron and Iron Deficiency Anemia (IDA) and
aspirations and allows more time to care for
its consequences
children and spouse/husband, and;

Iron - an essential mineral and is part of

Informed Choice that is upholding and

hemoglobin, the red protein in red blood
ensuring the rights of couples to determin
cells that carries oxygen from the lungs to
the number and spacing of their children
the cells
according to their life's aspirations and

2008

15.2
9.5
6.4

Iron Deficiency Anemia - condition

where there is lack of iron in the body
resulting to low hemoglobin concentration of
the blood

IDA results in premature delivery,

increased maternal mortality, reduce ability
to fight infection and transmittable diseases
and low productivity
Prevalence of anemia by age, sex and
physiologic state: Philippines, 2008

Status of the Philippine Food Fortification

Program

Status and Recommendations for the

Sangkap Pinoy Seal Program

There are 139 processed food products

with SangkapPinoySeal with 83% with
vitamin A, 29% with iron and 14% with
iodine (2008)

37% of the products are snack foods

Iodine and Iodine Deficiency Disorders
(IDD)

Most of the products FDA analyzed are

Iodine -a mineral and a component of

within the standard
the thyroid hormones

Based on 2003 NNS Households

Thyroid hormones - needed for the

awareness of SPS- and FF-products is 11%
brain and nervous system to develop &
and 14%, respectively, in 2008 awareness is
function normally
11.6%

Iodine Deficiency Disorders refers to

Although awareness is low, usage of SPSa group of clinical entities caused by

products is 99.2%
inadequacy of dietary iodine for the thyroid
Recommendations:
hormone resulting into various condition e.g.

Review voluntary fortification standards

goiter, cretinism, mental retardation, loss of
as standards were developed prior to
IQ points
mandatory fortification
Progress in the Philippines towards the

Conduct in-depth analysis of the

Elimination of IDD, 1998-2008
coverage of SangkapPinoySeal of the 2008
Achievements NNS

Update list of Sangkap Pinoy Seal

Indicator
Goal* 199 200
products as some companies have stopped
8
3
using the seal in their products

Intensify promotions of Sangkap Pinoy

Proportion of Households using Iodized
56.
>90
9.7
Seal
Salt, %
0
Median Urinary Iodine, ug/L
6-12 yrs.

100200

71

201

Lactating Women

100200

111

Pregnant Women

150249

142

Proportion < 50g/L, %

6-12 yrs.

< 20
35.8 11.4

Lactating Women

23.7

Pregnant Women

18.0

*ICC-IDD 2007
Policy on Food Fortification
ASIN LAW
Republic Act 8172, An Act Promoting Salt
Iodization Nationwide and for other purposes,
Signed into law on Dec. 20, 1995
FOOD FORTIFICATION LAW
Republic Act 8976, An Act Establishing the
Philippine Food Fortification Program and for
other purposes mandating fortification of flour,
oil and sugar with Vitamin A and flour and rice
with iron by November 7, 2004 and promoting
voluntary fortification through the SPSP, Signed
into law on November 7, 2000

Status and Recommendation on Flour

Fortification with Vitamin A and Iron

Based on FDA monitoring all local flour

millers are fortifying with vitamin A and iron

94% and 92% of all samples tested by

FDA in 2009 were fortified with vitamin A
and iron respectively while 77% and 99%
were fortified with vitamin A and iron
respectively. In 2010 decrease in vitamin A
due to non-fortified imported and market
samples flour.

58% of samples from local mills for

vitamin A and 67% of imported flour for iron
were fortified according to standards.
Recommendations:

Review fortificantsfor iron and possible

other micronutrients to be added to wheat
flour

Continue monitoring wheat fortification

Assist flour millers to improve quality of

fortification

Need to show impact of flour fortification

Status and Recommendations on Mandatory
Fortification of Refined Sugar with Vitamin
A

Non fortification by industry due to the

unresolved issue of who will bear the cost of
fortification brought about by the
quedansystem of transferable certificates of
sugar ownership.

Lack of premix production

Fortification of refined sugar would

benefit mainly those in the high income
group.
Recommendations:

Continue discussions with sugar industry

to explore a compromise for fortification ie.
fortification of washed sugar

Review policy on mandatory fortification

of refined sugar

FDA started implementing localization of

ASIN Law with General Santos City as the
1stto have a MOA with FDA on localization
Recommendation:

FDA to expand localization of ASIN Law

Set up iodine titration for testing iodine

in salt

Continue to intensify monitoring

particularly imported and takal salt

Status and Recommendations on Rice

Fortification with Iron

NFA is fortifying 50% of its rice in 2009

and 2010

With the non fortification of NFA rice,

private sector has an excuse for non
fortification of its rice.

There is limited commercial/private

sector iron rice premix and iron fortified rice
production and distribution mostly in
Mindanao (Region XII and XI) with Gen San
having the only commercial iron rice premix
plant in the Philippines and Davao City
implementing mandatory rice fortification in
food outlets

NFA conducted communications

campaign for its iron fortified rice thru the
so called I-rice campaign though issues
remain on the acceptability of its product
Recommendation:

Review of mandatory fortification of rice

with iron

Food Fortification Day Theme 2010:

EO 382 declares November 7 as the
National Food Fortification Day

Status and Recommendations on Cooking

Oil Fortification with Vitamin A

Based on the samples analyzed by FDA

in 2009 and 2010, more than 90% are
fortified (91% in 2009 and 94% in 2010)

Samples monitored were labeled and

packed

FDA is not monitoring "takal"

Recommendations:

To increase frequency of monitoring by

FDA and other agencies such as PCA and
LGUs, to ensure all oil refiners and
repackersare monitored at least once a year

Monitoring of takal oil, use of test kit

Monitoring imported oil, FDA and BOC to

coordinate

Review policy of mandatory fortification

of oil to possibly limit to those mostly used
by at risk population (coconut and palm oil)
Status and Recommendations on Salt
Iodization

Based on the 2008 NNS, 81.1% of

households were positive for iodine using
Rapid Test Kit (RTK)

In the same survey for Region III, 55.7%

were positive for RTK but only 34.2% and
24.2% have iodine content >5ppm and
>15ppm respectively using WYD Tester

For FDA monitoring in 2010, 88% were

>5ppm while 44% were >15ppm

NATIONAL TUBERCULOSIS CONTROL

PROGRAM
In 2007, there are 9.27 million incident
cases of TB worldwide and Asia accounts
for 55% of the cases. Through the
National
TB
Program
(NTP),
the
Philippines achieved the global targets of
70% case detection for new smear
positive TB cases and 89% of these
became successfully treated. The various
initiatives undertaken by the Program, in
partnership with critical stakeholders,
enabled the NTP to sustain these targets.
Nonetheless, emerging concerns like drug
resistance and co-morbidities need to be
addressed to prevent rapid transmission
and future generation of such threats.
Coverage should also be broadened to
capture the marginalized populations and
the vulnerable groups namely, urban and
rural
poor,
captive
populations
(inmates/prisoners),
elderly
and
indigenous groups.
Last 2009, the National Center for
Disease Prevention and Control of the
Department of Health led the process of
formulating
the 2010-2016
Philippine
Plan
of
Action
to
Control
TB (PhilPACT) that serves as the guiding
direction for the attainment of the
Millenium Development Goals (MDGs).
Learning
from
the Directly-Observed
Treatment Shortcourse (DOTS) strategy,
the eight (8) strategies of PhilPACT are
anchored on this TB control framework.
Moreover, these strategies are also
attuned with the Governments health
reform agenda known as Kalusugang
Pangkalahatan
(KP) to
ensure
sustainability and risk protection.

Vision: TB-free Philippines

2.

Goal: To reduce by half TB prevalence

and mortality compared to 1990 figures
by 2015

3.

Ensure provision of quality TB services

4.

Reduce out-of-pocket expenses related to

TB care

Objectives:
The NTP aims to:
1.

Reduce local variations in TB control

program performance

Scale-up and sustain coverage of DOTS

implementation