February 12, 2023

JAYE ANNE A. COLLADO, MD, DFM

Community Rotation Consultant-in-charge
Department of Family and Community Medicine
§ 4 points: What are the 4 major COPC Steps?
§ 1 point: What consideration is critical in each COPC Step?
§ 5 points: What are the 5 phases of community diagnosis?
 Community Diagnosis

Identify target population Identify the health needs

Reassessment Prioritizing

COPC Detailed problem

Evaluation assessment
Cycle

Implementing Intervention planning

intervention
1. Define the community of interest
2. Identify the health problem COMMUNITY INVOLVEMENT
3. Develop and implement interventions is critical to each step
4. Conduct ongoing evaluation

Community oriented primary care: A practical assessment. Institute of Medicine,

Washington DC: National Academy Press, 1984
§ A strategy
whereby elements of primary health care and of community medicine are
systematically developed and brought together in a coordinated practice.
(Abramson & Kark, 1983)
§ Continuous process by which primary care is provided to a defined community on
the basis of its assessed health needs through the planned integration of public
health practice with the delivery of primary care services. (F. Mullan, et. al 2002)
§ Aims to improve the health of the community, not just those receiving direct patient
care services.
§ Based on principles in the fields of epidemiology and public health in addition to
primary medicine and preventive care.
§ Health practitioners, health professionals, and community leaders comes together
to address the specific health needs within diverse communities on a local and
global level.
Williams & Walsh2015
§ Primary health care addresses the main health problems in the community, providing
promotive, preventive, curative, and rehabilitative services: ELEMENTS
§ Education concerning prevailing health problems and the methods of preventing and
controlling them,
§ prevention and control of Locally endemic diseases
§ provision of Essential drugs
§ Maternal and child health care, including family planning
§ EPI/immunization against the major infectious diseases
§ promotion of food supplies and proper Nutrition
§ appropriate Treatment of common diseases and injuries
§ an adequate supply of safe water and basic Sanitation

Abramson & Kark 1983

§ Health care focused on population groups rather than on individual
patients; has its roots in the disciplines of public health and medical
administration.
§ Centered on the community as a whole and on the groups of which
communities are composed.
Abramson & Kark 1983
1. The provision of primary clinical care for individuals and families in the
community, with special attention to the continuity of care. Suitable
arrangements need to be made for consultative services, specialist care, and
hospitalization.

2. A focus on the community as a whole and on its subgroups when appraising

needs, planning and providing services, and evaluating the effects of care.

Abramson & Kark 1983

• a “true” community, in the sociological sense
• a defined neighborhood
• workers in a defined factory or company, students in a defined school, etc.
• people registered as potential users of a physicians' group practice, health maintenance
organization, neighborhood health center, or other defined service
• users of a defined service, or repeated users of the service.

Abramson & Kark 1983

1. The use of epidemiologic and clinical skills as complementary functions.

2. Definition of the population for which the service is or feels responsible.

3. Defined programs to deal with the health problems of the community or its subgroups,
within the framework of primary care.

4. Involvement of the community in the promotion of its health.

5. Accessibility that is not limited to geographic accessibility.

Abramson & Kark 1983

TABLE 1. Summary of
the Complementary
Functions of Clinical
and Epidemiologic Skills
in Development of
Community Oriented
Primary Health Care

Abramson & Kark 1983

 Community Diagnosis

Identify target population Identify the health needs

Reassessment Prioritizing

COPC Detailed problem

Evaluation assessment
Cycle

Implementing Intervention planning

intervention
§ Appraisingthe health status of a community, analysis of health-related statistics
and information on health determinants.
§ Determines existing problems, the resources and extent of the gap between
these 2 factors.
§ Relies both on quantitative and qualitative data
§ Analyzes population’s health status and existing health problems as well as the
distribution of health conditions and their underlying causes.

Textbook of Family Medicine Vol 2, Leopando, 2016

 1. Exploration phase
2. Planning phase
3. Data collection phase
4. Data analysis phase
5. Conclusion and evaluation phase

Textbook of Family Medicine Vol 2, Leopando, 2016

 § Know the target community, its leader and members.
§ Meet with the community leader to obtain permission to perform
data- gathering.
§ Describe the potential benefits of a community diagnosis.
§ Ocular inspection of the entire community.

Textbook of Family Medicine Vol 2, Leopando, 2016

§ Plan data-gathering activity.
§ SURVEYING is the data-gathering method commonly used in a community diagnosis.
§ Important to formulate a survey form that is not only exhaustive but also appropriate for the
target community.
§ Guide questions:
1. Why is the survey being done?
2. Where will it take place in the community? (assign “clusters” or groups of households for each
survey team)
3. Who is to be interviewed? (identify the target group)
4. When is the survey expected to happen? (create a schedule for the entire data- gathering
activity)
5. What will be covered in the survey?
6. What will be the instruments needed to measure the health status.

Textbook of Family Medicine Vol 2, Leopando, 2016

A. CENSUS- gathering data from the entire population.

B. SAMPLE SURVEY- extract information from just a subset of the population.

C. EXPERIMENTS- a controlled study/ simulation used to demonstrate/ determine

cause-effect relationships between 2 variables.

D. OBSERVATIONAL STUDY- to determine cause-effect relationships however the

researcher has no direct control on the variables under the study.

Textbook of Family Medicine Vol 2, Leopando, 2016

§ All
relevant data gathered from the community are sorted out and
analyzed based on certain pre-set parameters and indicators.
1. Population
2. Health status
3. Social indicators
4. Economic indicators
5. Environment
6. Health sector
7. Primary healthcare knowledge
8. Perception of community health problems

Textbook of Family Medicine Vol 2, Leopando, 2016

 1. POPULATION 2. HEALTH STATUS
a) Total population a. Top causes of morbidity
b) Geographical distribution b. Top causes of mortality
c) Age and sex structure
c. Top causes of hospitalization
d) Vital indices
i. Crude birth rate d. Top causes of consultation
ii. Crude death rate e. Nutrition
iii. Infant mortality rate
iv. Maternal mortality rate f. Immunization
v. Under-five mortality rate
vi. Swaroop’s index
e) Population’s projection

Textbook of Family Medicine Vol 2, Leopando, 2016

 3. SOCIAL INDICATORS 4. ECONOMIC INDICATORS
a. Educational status a. Employment and unemployment
b. Household size b. Gross national product
c. Religious affiliation c. Income per capita
d. Telecommunication facilities d. Inflation rate
e. Dwelling units e. Occupation
f. Civil status f. Sources of income per household
g. Membership in a community
organization

Textbook of Family Medicine Vol 2, Leopando, 2016

 5. ENVIRONMENT 6. HEALTH SECTOR
a. Safe water supply a. Human resources for health
b. Human waste management b. Health financing
c. Health information management
c. Industrial waste management
d. Leadership and governance in health
d. Food safety management
e. Health service delivery
f. Access to medical products and technologies

7. Primary healthcare knowledge

8. Perception of community health problems

Textbook of Family Medicine Vol 2, Leopando, 2016

 § Organize identified problems according to their level of urgency in the community.
§ Prioritization of problems can help the community leader in effectively deciding what
health issues must be addressed first.
§ Set of criteria in determining the priority health problems in a community which explore
4 potential weak areas in the provision of optimal health services:
1. Vulnerability to technology
2. Magnitude of the problem
3. Social concern
4. Existing health policies

Textbook of Family Medicine Vol 2, Leopando, 2016

 1. VULNERABILITY TO TECHNOLOGY
a) Existence of effective technology in the community
b) Feasibility of implementation of technology in terms of cost,
manpower and the organizational capability to utilize such
technology
c) Geographical application of technology in terms of distribution,
accessibility, and availability
d) Multiplicity of the effects of technology in terms of directly and
indirectly affecting multiple diseases and other health conditions.

Textbook of Family Medicine Vol 2, Leopando, 2016

 2. MAGNITUDE OF THE PROBLEM BASED ON
STATISTICAL INDICATORS:
a) Mortality
b) Morbidity
c) Incidence
d) Prevalence
e) Case fatality rate

Textbook of Family Medicine Vol 2, Leopando, 2016

 3. SOCIAL CONCERN
a) Cultural taboo
b) Religious stand on certain health issues
c) Superstitious beliefs

4. EXISTING HEALTH POLICIES and its effective (or ineffective)

enforcement in the community.

Textbook of Family Medicine Vol 2, Leopando, 2016

 Community Diagnosis

Identify target population Identify the health needs

Reassessment Prioritizing

COPC Detailed problem

Evaluation assessment
Cycle

Implementing Intervention planning

intervention
§ What are the most important health issues facing the
community and how should they be prioritized based upon
objective data and perceived need?
§ By the health care professionals and community members.
§ Objective, transparent, and follow predetermined criteria.
§ What are the most effective and efficient interventions for
addressing the selected health problem based upon an
evidenced based assessment?
 Community Diagnosis

Identify target population Identify the health needs

Reassessment Prioritizing

COPC Detailed problem

Evaluation assessment
Cycle

Implementing Intervention planning

intervention
§ What strategies will be used to implement the intervention?
§ Disease prevention, health promotion, treatment, and rehabilitation
§ The activities may be of various kinds:
§ clinical and individual health care in office practice and home calls;
§ laboratory and other special investigations;
§ household visits and other group situations for household surveys, health
education, and stimulation of family and community interest and involvement
§ initiating and maintaining interagency functioning promotive of the community
health programs
§ use of health recording procedures suitable for community analysis, as well
as for individual care.
 Community Diagnosis

Identify target population Identify the health needs

Reassessment Prioritizing

COPC Detailed problem

Evaluation assessment
Cycle

Implementing Intervention planning

intervention
§ How can the success of the intervention be evaluated?
§ Desirable and undesirable changes in health status
§ Community response, the community's satisfaction, and in terms of economic
efficiency

§ Decision making for future action

§ The
situation is reappraised and new decisions are made for continuation or
modification of program.
C I
O
Community Diagnosis
N
V
Identify target population Identify the health needs

M O
M Reassessment Prioritizing
L
U V
COPC
N E
Detailed problem
Evaluation assessment
Cycle

I M
E
T Implementing
intervention
Intervention planning
N
Y T
§4 points: What are the 4 major COPC Steps?
§1 point: What consideration is critical in each COPC Step?
§ 5 points: What are the 5 phases of community diagnosis?