COMMUNITY HEALTH CARE DEVELOPMENT

· Approaches to development:

1. Welfare Approach- DOLE OUT APPROACH

- assumes that poverty is God-given and that poverty is destined
- believes that poverty is caused by bad luck
- GOVERNMENT IS RESPONSIBLE FOR ITS CITIZEN
EX. GIVING OF AYUDA/4 P’s/PHILHEALTH

2. Modernization Approach/ aka PROJECT DEVELOPMENT APPROACH

- when the community began to accept and utilize technology and industrialization
- assumes that development can be attained by abandoning the traditional methods/practices and adopt
the technology of industrial countries
- poverty is due to lack of education, resources and technology

3. Transformatory/Participatory Approach
- focused on empowering the poor and oppressed sectors of society so that they can pursue a just and
human society – it’s because of ignorance of the ppl.
- poverty is not God-given: rather it is rooted in the historical past and is maintained by the oppressive
structures in the society.
- meron ng end goal or development.
TRANSACTIONAL-community investment
TRANSITIONAL- community involvement
TRANSFORMATIONAL- community integration- letting them do until it becomes a habit. Kasama sa lifestyle.

THE HEALTH RESOURCES DEVELOPMENT PROGRAM (HRDP) & COMMUNITY ORGANIZING PARTICIPATORY
ACTION RESEARCH (COPAR) MODEL
HRDP
Definition:
- a model for establishing & implementing effective, sustainable & participatory PHC programs in DDU
communities
- it entails development & mobilization of students & faculty of paramedical institutions, & enrichment of
health -oriented curriculum & reorienting the health education of future health workers to be more responsive
& relevant to the current community health needs
Ø Program initiated by the Population center Foundation as its contribution to the development of alternative
health care system in the Philippines.
Ø Based on a belief that potential health manpower exists in the form of students, faculty, and hospital/clinic
staff who can be mobilized to work with people to act on their own health problem.
Ø A model for PHC
- more on academic purposes

Community Organizing (CO)

Ø A promising tool for achieving the PHC goals of self-reliance and self-determination
Ø A continuous and sustained process of educating the people to understand and develop their critical
awareness of their existing conditions, working with people collectively and efficiently on their immediate and
long- term problems, and mobilizing the people to develop the capability and readiness to respond and take
action on their immediate needs toward solving their long-term problems
Objectives:
1. To make people aware of the social realities toward the development of local initiative and
strengthening people's capabilities
2. To form structures that upholds the people’s basic interests
3. To initiate responsible actions to address the community health and social problems
COMMUNITY ORGANIZER
THE PUBLIC NURSE/COMMUNITY HEALTH NURSE
1. enabler: guides, facilitates, leads, advices, and assists representatives in community and work together to
assess needs and solve problems.
2. advocator- directly represents other members to stand in their behalf in a estranged, disadvatanges, less
powerful situations and sectors of the community.
3. developer/builder- nurtures and develops the community ability to adapt to social conditions, and supports
local efforts to develop distinctive human and organizational potentials by boosting

Participatory Action Research (PAR)

Ø An investigation of the problems and issues concerning the life and environment of the underprivileged in
society by way of a research collaboration with the underprivileged, whose representatives participate in the
actual research process as equal partners in studying their own problem
Ø Conceived as an innovation over the traditional research approach. Unlike PR. traditional research considers
people as objects of research rather than active collaborators of change and development. Also, the traditional
research caters only to the interest of the academes and development agencies, veers away from dependence
of the outside researchers.
Central Element:
ü Participation – is an active process whereby the expected beneficiaries of the research are the main actors in
the research process
STRATEGIES
1. Strengthening the integration of PHC, COPAR, Adult teaching learning concepts, strategies &
methodologies in the health science curricula.
2. Systematization of the student’s exposure program.
3. Development of CHO which can sustain health development program.
4. Community-capability building through leadership & health skills trainings.
5. Provision of health services by the faculty, students & the trained BHW

COPAR – a social development approach that aims to transform the apathetic, individualistic, voiceless poor
into dynamic, participatory & politically responsive community.

Ø A collective, participatory, transformative, liberative, sustained & systematic process of building people’s
organizations by mobilizing & enhancing the capabilities & resources of the people for the resolution of their
issues & concerns towards affecting change to their existing oppressive & exploitative conditions

Objectives: (Self-reliance & People Empowerment)

1. To make people aware of social realities toward the development of local initiative, optimal use of human,
technical & material resources & strengthening of people’s capabilities.
2. To form structures that uphold the people’s basic interest as oppressed, deprived sections of the
community, & as a people bound by the interest to serve the people.
3. To initiate responsible actions intended to address holistically the various community health & social
problems.

IMPORTANCE
1. Help community workers to generate community participation in development activities.
2. Prepares people to eventually take over the management of a development program in the future.
3. Maximizes community participation & involvement & community resources are mobilized for community
services.
PRINCIPLES
1. People, especially the most oppressed, exploited & deprived sectors are open to change, have the capacity
to change & are able to bring about change. Power must reside in the people:
ü Development is from people to people.
ü People’s participation should always be present.
2. COPAR should be based on the interests of the poorest sectors of society.
3. COPAR should lead to a self-reliant community & society.
PROCESSES/METHODS USED IN COPAR

1. Progressive Cycle of Action-Reflection-Action Session (ARAS)

- begins with small, local, concrete issues identified by the people & the evaluation & reflection of the action
taken by them
2. Consciousness-raising through experiential learning
- is central to the COPAR process because it places emphasis on learning that emerges from concrete action
that enriches succeeding actions
3. Participatory & mass-based - primarily directed toward the mobilization of the poor, the powerless &
oppressed sector of the community
4. Group-centered & not leader oriented
- leaders are identified, emerge & tested through action rather than appointed or selected by some external
force.

CRITICAL STEPS/ACTIVITIES IN COPAR

1) INTEGRATION – health workers become one with the people in order to:
Ø Immerse himself in the poor community
Ø Understand deeply the culture, economy, leaders, history, rhythms & lifestyle in the community.
METHODS OF INTEGRATION
1. Participation in direct production activities of the people.
2. Conduct house-to-house visits.
3. Participation in social activities like birthday, fiesta, wakes, weddings, seasonal rituals, benefit dances, etc.
4. Conversing with people where they usually gather such as in stores, water wells, washing streams or in
church yards.
5. Helping out in household chores

2) SOCIAL INVESTIGATION – Community study

- a systematic process of collecting, collating, analyzing data to draw a clear picture of the community
Pointers in conducting Social Investigation:
Ø Use of survey questionnaire is discouraged.
Ø Community leaders can be trained to initially assist the community workers/CO in doing SI.
- Data can be more effectively & efficiently collected through informal methods (house-to-house visit,
participating in conversation)
- Secondary data should be thoroughly examined because much of the information might already be
available.
Ø SI is facilitated if the CO is properly integrated & has acquired the trust of the people.
Ø Confirmation & validation of community data should be done regularly

3) TENTATIVE PROGRAM PLANNING

- CO to choose one issue to work on in order to begin organizing the people

4) GROUNDWORK
- Going around & motivating the people on a one-on-one basis to do something on the issue that has been
chosen

5) THE MEETING
- People collectively ratify what they have already decided individually.
- it gives people the collective power & confidence
- problems & issues are discussed

6) ROLE PLAY
- To act out the meeting that will take place between the leaders of the people & the government
representative
- a way of training the people to participate what will happen & prepare themselves for such events

7) MOBILIZATION/ACTION
- actual experience of people
- carrying out the plans & activities

8) EVALUATION
- People review step 1-7 to determine whether they were successful or not in their objectives

9) REFLECTION
- dealing with deeper ongoing concern to look at the positive side
- CO is trying to build an organization
- it gives people time to reflect on the reality of life compared to the ideal

10) ORGANIZATION
- the people’s organization is the result of many successive & similar actions of the people
- a final organizational structure is set-up with elected officers & supporting members.

PHASES OF COPAR
1. PRE-ENTRY PHASE
- initial, simplest phase of the organizing process in terms of actual outputs, activities & strategies.
- CO looks for communities to serve or to help
- takes 1-2 months to complete
2 main activities:
Ø Selection of Project Site
Ø Identification of Host Family/Staff House
Preliminary social investigation

Other activities:
· Train faculty and students in COPAR
· Formulate plan for institutionalizing COPAR
· Revise/enrich curriculum and immersion program
· Coordinate participants of other departments
· Formulate criteria and guidelines for site selection
· Do initial networking with local government
· Conduct preliminary social investigation
· Make long list/short list of potential communities
· Do ocular survey of short-listed communities
· Interview barangay officials, leaders, and key informants
· Choose sites/community for the immersion programs
· Coordinate with local government/NGOs for assistance
· Develop community profiles for secondary data
· Develop survey tools
· Pay courtesy call to community leaders
· Choose foster families based on guidelines

CRITERIA FOR SITE SELECTION:

ü It must have a population of 100-200 families.
ü The area is relatively socio-economically depressed
ü It must have a relative concentration of poor people.
ü There is no strong resistance from the community.
ü There must be no serious peace and order problem.
ü There must be no similar group or organization holding the same program
Preliminary Social Investigation
- initial gathering of data about potential sites, focusing on the data necessary to determine the site that best
conforms with the criteria set
Social Investigation- a systematic and scientific process of collecting, collating, synthesizing and analyzing data
to draw a clear picture of the community

Guidelines for Choosing the Final barangay

1. Conduct of ocular survey
2. Conduct of informal interviews with key persons and informants
3. Assess whether our services are in fact needed in the area
4. Validate the secondary collected

* It is essential to inform concerned authorities so that project endorsement and support to the program can
be secured

Identification of Host Family

- community work becomes more effective if we live in the area
- Ensures round-the-clock integration and experiencing the community

Criteria in Choosing Host Family

1. Should be strategically located in the barangay
2. Should belong to the majority of the group in the community (poor sector)
3. Should be respected by both the formal and informal leaders
4. Should have a house where neighbors, especially the poor are welcome
5. No member of the host family will be displaced

2. THE ENTRY PHASE

Ø Most crucial phase
Ø Also called Social Preparation phase for it allows the community to be actively involved in the entire
implementation of the program.
Ø Success will depend on:
1. how much the project implementors have integrated with the community people.
2. their understanding of the place & events
3. their willingness & readiness to commit oneself towards the program.

Guidelines for Entry in the Community

1. Recognize the role of the authorities
2. Appearance, speech, behavior and lifestyle should be in keeping with those of the community residents
3. Avoid passing expectations off the community residents
* There are five interrelated and simultaneous activities that can be carried out in the entry phase

Integration with the Community

Integration – the process of establishing rapport with the people in a continuing effort to imbibe community
life by living with them and undergoing the same experience, sharing their hopes, aspirations and hardships
towards building mutual trust and cooperation (Ferrer, 1982).
Ø The success of activities in the latter parts of the organizing process greatly depend on how much the
community organizer has integrated with the community.

Methods of Integration
a. Participation in direct production activities
b. Participation in social activities
c. Conversing with people where they usually gather
d. Doing household chores
Identification of Potential Leaders or Core Group Formation
- a process of selecting and training the core group which is considered critical in community organizing

Potential leaders – considered the future CO’s and possible partners in the management and in the delivery of
basic health services

Core Group – group of individuals who possess leadership potentials to be formed/ organized into a cohesive
working group

ACTIVITIES:

1. Integrate with community residents

ü Integration is the process of establishing rapport with the people in a continuing effort to imbibe the
community life by living with them & undergoing the same experience, sharing their hopes, aspirations &
hardships towards building mutual trust & cooperation
2. Conduct deepening Social Investigation
Social Investigation
· is the systematic process of collecting, collating & analyzing data to draw a clear picture of the
community;
· an investigation was already made at the beginning phase of organizing but an in-depth investigation is
needed to better view how the community & its people perform in general

3. Dissemination information/sensitize community residents on the program & PHC.

ü information campaign can be done in small group discussions, house-to-house visit, in informal social
gatherings.
ü side by side with the organization campaign is the delivery of basic health services done simultaneously

4. Formulate criteria for selection of Core Group Member

ü people themselves will formulate criteria
ü core group members are selected by the community residents during the assembly.
ü Sample of criteria:
a. they must be respected members of the community.
b. credible & loved by the community
c. they must belong to the poor sector in the community.
d. they must be responsible, committed individuals, willing to work for social change & transformation.
e. willing to serve for others without waiting for anything in return.
f. they must be willing to learn.
g. they must possess a good communication skills & able to express himself to others in a group

5. Define roles & function of the core group members

Roles & Functions:
a. Social preparation of the community for health & development work.
b. Organizing a community research team for the conduct of community assessment diagnosis.
c. Setting up the CHO & facilitate the identification of potential CHW.
d. Scrutinizing & mobilizing the community to act on their own & participate in the delivery of essential
health services.
Note:
1. Core group is not a permanent group.
2. Number of members has no limit as long as the member is willing to fulfill the function.
3. Some can be elected to become CHWs.
4. Selection of members should be well represented from all sectors

6. Deliver essential basic health services

ü a good opportunity to build rapport to the community
7. Continue Social Investigation
ü SI is a continuous process

8. Conduct team building activities/sensitization/informal education among CGM

9. Presentation of baseline survey results to community

ü so that people will be able to understand the general scenario of their community.
ü present creatively

10. Conduct Self-awareness Leadership Training (SALT) among the CGM/potential leaders
ü for the growth & development of the community
ü conduct training during the most convenient time of the people

11. Consult community to create CHO

CHO – is charged with the management of relevant & appropriate health programs
- ensure the collective participation in decision-making, planning, implementation & evaluation of
community project
- establish a network of linkages/network for mobilizing external support
- generate resources for maintaining & sustaining health programs or activities
- raising the community’s consciousness in health & other broader issues
- mobilizing the people to act on their health problems & issues affecting them.
- they are being elected

Community Study/ Diagnosis Phase

- research phase
ACTIVITIES:
a. Selection of research team
b. Train community research team

Community Research Team – is a small adhoc body composed of residents selected by the community to look
into the causes of problems; train on data collection methods & techniques, development of data collection
tools & training on capability-building
c. Planning for the actual gathering of data
d. Data gathering

e. Training on data validation

-includes data tabulation & preliminary analysis of data

f. Community validation
g. Presentation of the study & recommendation

3. COMMUNITY ORGANIZATION & CAPABILITY BUILDING PHASE/ORGANIZATION BUILDING PHASE

- signals the start of community self-management because it entails the formation of more formal
structures & the inclusion of more formal procedures of planning, implementing, & evaluating community-wide
activities.
ACTIVITIES:
a. Community meetings to draw up guidelines for the organization of the CHO.
b. Election of CHO officers
c. Development of management systems & procedures
d. Team building
e. Working out legal requirements for the establishments of CHO.
f. Organization of working committees/task group
g. Training of CHO officers & community leaders

Community Action Phase

ACTIVITIES:
a. Organization & training of CHWs.
b. Setting-up of linkages/network referral system
c. Initial identification & implementation of resource mobilization schemes.

4. SUSTENANCE & STRENGTHENING PHASE

ü the community can already stand on its own.
ü people can sustain the program even without the help of project implementors.
ü trained leaders & workers take the over-all management of the program.
ACTIVITIES:
a. Formulation & ratification of constitution & by-laws
b. Identification & development of secondary leaders.
c. Setting-up & institutionalization of financing scheme
d. Assess/re-plan community health programs.
e. Formalizing & institutionalization of linkages, networks & referral system
f. Development & implementation of viable management systems & procedures, committees, continuing
education, training of leaders, CHWs & community residents.

HRDP-COPAR STAFF
1. Project Director – School Head
2. Project Manager – Dean
3. Community Organizer
4. Coordinator of Student Community Immersion
5. Health Services Coordinator
6. Training Coordinator
7. Financial Officer
8. Bookkeeper
9. Secretary