PUBLIC HEALTH

 Ecological (environmental) in perspective(VIEWPOINT), multi-sectoral (division) in scope and collaborative (2

WAY) in strategy
 It aims to improve the health of community through an organized (planned) community effort
 The science and art of preventing disease, prolonging life and promoting health through the organized efforts and
informed choices of society, organizations, public and private communities and individuals.
 It is concerned with threats to the overall health of a community based on population health analysis.
 Public health is typically divided into epidemiology, biostatistics and Health services. Environmental, social,
behavioral, and occupational health and other important subfields.
 1. It deals with preventive rather than curative aspects of health.
 2. It deals with population level- rather than individual-level health issues.
COMMUNITY
 It is a group of people withcommon characteristics orinterests living together withina territory or
geographical(physical) boundary.
 Community as ClientWorld Views on Community :
1. Family, community and society
2. Contradictions Conflicts
3. Change
o Family, community and society
o A. Individual :
 a. Patient : an individual who is sick. b. Client : an individual who is well/not sick.
o B. Family :
 A. Role/Relationship : Parents; Bi-parenting

 *Mother is expected to have the ABILITY to provide care and usually takes the role
of keeping the family well and healthy by combining :
 1. Knowledge
 2. Attitudes
 3. Skills

 * Ex: During Martial Law there was a food blockade giving nutrition
problems to some places resulting to political insecurity and the CH nurses
introduced some alternatives in :
 1. Food and nutrition
 2. Food preservation
 3. Food technology
o C. Community : * CHN serves up to this level only. * Everything that affects the individual
affects the family and eventually the community.
o Contradictions / Conflicts :People in the community are always in constant conflict and faced with
contradictions :
o 1. Individual : intrapersonal conflicts (conflict within the person/personal conflicts)
o 2. Family : interfamilial conflicts (conflict within the family/interpersonal conflicts)
o 3. Community : intercommunity (interfamilial conflicts)
o 4. Society : intra-societal conflicts (intercommunity conflicts)
1. 11. Note : People tend to have negative perspectives. In the Philippines, negative regional stereotyping is very
common such as : a. Ilocanos : kuripot ---(positive : call them resourceful) b. Kapampangans : mayabang ---
(positive : maybe they are assertive/artistic) c. Bicolanos : malibog---(positive : could be loving/warm hearted) d.
Bisaya : aswang ---(positive : they are mysterious/interesting people) e. Mindanaoans : mamamatay tao (Muslims
esp)-- -(positive : brave/courageous)* In CHN, we try to avoid negative perspectives, look for the source of the
conflicts and try to find solutions. We must try to adapt positive perspectives in order to achieve a positive
development (effect upward and onward movement).
o Change :
o is inevitable (unavoidable) because a community is dynamic (active, full of life) and is always
changing (not static).* A CH worker should constantly assess the community to come up with
suitable interventions (actions are responsive to the people„s needs).
CHARACTERISTICS

 The community has a defined geographical boundaries which has the beginning and the end.
 The boundaries of a small community such as hamlet, village etc are distinct whereas that of a large
community such as town, city etc are indistinct.
 The community is composed of people who live together in the defined boundaries of the community.
 The community people have common psychological characteristics i.e., there is similarity in language,
life style, customs and traditions etc. • They share common interests, values, moral norms and codes.
The people in the community interact with each other and have free communication.
 The community has organized social structure and system and common organization which carry various
functions such as housing, food, agriculture, animal husbandry, health, education, marketing, banking etc
FUNCTIONS

 it provides space for housing, shelter, socialization and recreation.

 It provides means and facilities for livelihood.
 Community provides opportunity for employment.
 It takes care off socialization and education of its members.
 It provides safety and security for its members by enforcement of norms and legislation formulated by the
society.
 It provides opportunities for people participation and communication.

COMMUNITY HEALTH NURSING AS A SETTING IN CHN PRACTICE

* Place where people under usual or normal conditions are found :
1. Home : You render Family Health Nursing
2. Workplace : You render Occupational Health Nursing
3. Schools : You render School Health Nursing

* Outside of purely curative institutions such as hospitals.

* Are usually centers for wellness where you do health promotion and disease prevention.
COMMUNITY HEALTH
 includes both private and public efforts of individuals, groups, and organizations to promote, protect, & preserve
the health of those in the community.
THE COMMUNITY HEALTH IMPACT MODEL

 Community health improvement requires focused effort by multiple sectors, and it helps to have an organizing
model.
 Community Health Solutions developed the Community Health Impact Model™ as a comprehensive and flexible
framework for designing community health improvement strategies.
 It can be used by a single organization or by multiple community stakeholders to design initiatives that address
community needs in a collaborative context.
 is based on a core principle that community health
improvement works best when multiple sectors
collaborate for collective impact on individual and
community health. The model begins with community
health needs assessment and selection of objectives for
creating a healthy community. Community health
initiatives may be developed to address various
dimensions of environmental and social factors, health
promotion and prevention, and clinical care. All
initiatives are evaluated for their impact on individual and
community health.
Community Organization Model
The Community Organization Model is a participatory decision-making process that empowers communities to improve
health. It emphasizes active participation from the community in identifying key health issues and strategies to address
them. Communities focus on their strengths and collectively mobilize to develop programs to achieve health goals.
Characteristics of the Community Organization Model include:

 Understanding the context and root causes of health issues

 Collaborative decision making and problem solving
 Focusing efforts on specific issues
 Actively engaging participation from various groups and organizations within the community
 Developing and maintaining capacity and power to produce lasting change
 Providing feedback to the community
Charles-Edward Amory Winslow
 Is the father of public health
 “Public health is the science and art of
preventing diseases, prolonging life and
promoting health and efficiency through
organized community efforts for the
sanitation of environment
 the control of diseases, the education of
individuals in personal hygiene, the
organization of medical and nursing
services for early diagnosis and
preventive treatment of diseases and
 the development of social machinery to
ensure for every individual a standard of
living adequate for maintenance of health,
so organizing these benefits as to enable
every citizen to realize the birth right of
health and longevity”

COMMUNITY HEATH NURSING

• “Community health Nursing is a unique blend/(mix) of nursing and community health, woven into a service
which when properly developed and implemented can have a tremendous impact on human health”
OBJECTIVE OF COMMUNITY HEALTH
The objective of community health is to provide need based comprehensive services which include the following.

 Promotion and protection of health i.e. PRIMARY LEVEL PREVENTION.

 Early diagnosis and treatment and control of further spread of disease i.e. SECONDARY LEVEL
PREVENTION.
 Control of disability and rehabilitation ie. TERTIARY LEVEL OF PREVENTION.

The major emphasis is on primary level prevention with the active involvement of people (as majority of the
health problems are preventable by simple measures).
 THESE MEASURES ARE :
• Safe drinking water. • Good nutrition.
• Safe disposal of waste material. • Health checkup and mass screening.
• Maintaining general cleanliness. • Early diagnosis and mass treatment.
• Immunization of children. • Health Education.
• Traffic control.
COMMUNITY AS A CLIENT
• In community health the whole community is a client and the services are focused and hence it is important to:
1. Know the community (COMMUNITY IDENTIFICATION).
2. Identify the health needs of the community (COMMUNITY DIAGNOSIS).
3. Understand underlying factors affecting health problems.
4. Plan and implement comprehensive services.
COMMUNITY IDENTIFICATION • “ Is a process of exploring and knowing a defined community for assessing its
health status and determining the possible factors affecting the health of people in the community”
THIS IMPLIES TO EXPLORE & KNOW
• Geographical area, housing pattern • Beliefs, attitude, values and customs
and climate. etc.
• Population characteristics. • Community environment.
• Life style of people. • Institutional facilities.
• Leadership pattern. • Voluntary organizations.
• Family type, family size, & caste • Channels of communication,
group. telecommunication networks, travel modes.
THESE INFORMATIONS ARE OBTAINED BY:
• Making observation visits of the community.
• Formal and informal meetings and conversation with community people, leaders, organized groups etc.
• Discussion with health personnel and other workers in the community.
• Review of records.
• Formal sample survey of the community.
COMMUNITY IDENTIFICATION HELPS TO
• Prepare community map showing geographical boundaries, housing patterns, streets, roads, important
landmark : Health centre, school, post office etc.
• Know and describe community profile as per various categories of information collected. • Identify
health needs and health problems of the community.
COMMUNITY DIAGNOSIS
 • Is a written statement of health needs and health problems which are determined by analysis of data
collected for community identification.
• Following community identification, health needs and problems are prioritized for planning and
implementing community health actions/community health treatment.
COMMUNITY TREATMENT/COMMUNITY HEALTH ACTIONS
• Refers to “various health and health related activities which are planned and implemented to deal with
identified health problems and health needs”
COMMUNITY HEALTH ACTIONS ARE PLANNED CONSIDERING
• Nature of problems. • Felt needs & problems of the community.
• Effects of problems on health of people at • Community resources and capabilities.
large.
• Health agency’s objectives and policies.
AIMS OF COMMUNITY HEALTH NURSING
• Reduction of risk factors to reduce morbidity and mortality rate.
• Strengthening self care activities to promote the health and prevent the occurrence of disease.
• Maintain the quality of life to live productive life.
• Improving standard of living to protect the health against diseases.
GOALS OF COMMUNITY HEALTH NURSING
1. To promote and preserve health. 4. To promote quality of living.
2. To restore health when it is impaired. 5. To develop self care abilities.
3. To minimize suffering and distress.
OBJECTIVES OFCOMMUNITY HEALTH NURSING
• To increase the competency of individuals, families, groups and community to deal with their own health and
nursing needs.
• To strengthen community resources.
• To control environment and develop resistance to environmental conditions.
• To prevent and control communicable and non communicable diseases. • To provide specific services to
mothers, children, workers, elderly, eligible couples and handicaps etc.
• To conduct research and training programmes. • To supervise, guide and help health personnel in carrying out
their functions.
PRINCIPLES OF COMMUNITY HEALTH NURSING
1. Community health nursing services should be planned according to the need of the community.
2. Community nurses should function in collaboration and coordination with other personnel to achieve optimum
community health.
3. Community health services should be provided to all individuals irrespective to age, gender, caste, creed or
colour.
 4. Community health nurse should involve the individual, family and community in plans for achieving their
health.
. 5. Community health nursing personnel should be qualified either a diploma or graduate or post graduate in
nursing.
6. Community health nurse should create an awareness among community through education to promote the
health of the community.
7. Appraisal and evaluation of community health services by community health nurse helps in taking the
remedial steps to overcome the problem of the community.
8. Community health nurse should follow up to find out the unmet needs of the community.
9. Community health nurse should be given opportunity for future education and continuing education
programme.
10. Leaders or influential people of the community need to be involved in carrying out health related activities.
11. Community health services should be provided directly or indirectly to individuals, family or community.
Family is the basic unit and the health of one member affects the health of the others in the family.
12. Community health services should be provided on a continuous basis so as to improve the health status of the
community.
13. Community health nurse assists the family or community in making decisions related to health matters.
14. Community health nurse should not yield any bad reputation to the profession by accepting bribe or gift.
15. There should not be any interference by community health nurse in an individual’s political or religious
matters.
16. Community health nurse should maintain the record with proper guidelines. Health problems existing in the
community need to be reported to health authority so as to get appropriate resources and assistance to eliminate
the problem.
17. Community health nurse should follow ethics while working in the community. 18. Community health nurse
hould establish a professional not personal relationship with individual, family or community.
19. The working atmosphere of community health nurse should be free from frustration, stress or conflicts at job.
20. Health authorities should define the objectives and purposes in relation to various programmes in order
achieve success.
 What is Health?
 Health: As officially defined by the World Health Organization, a state of complete physical, mental, and
social well-being, not merely the absence of disease or infirmity.

Importance of Quality in Healthcare

Quality in healthcare delivery cannot be defined simplistically nor measured by
applying a formula. It is an amalgamation of multiple factors that encompass the
practices, policies, processes, etc. of the caregiver and the outcomes of these on
multiple elements involved in this process. The final gradation is the level of
satisfaction, which yet again is a volatile matter, subject to varying grades given by
the care receiver. The effort by an institution is mainly to strive to deliver the best of
all.

WHAT IS A COMMUNITY ACTION PLAN?

“A healthy community is a form of living democracy: people working together to address what matters to them”.

The community action plan is one of the participatory tools used to build the capacity of community members in taking
action in accordance with the problems, needs, and potential of the community (see also problem analysis and decision
making, both categories on Decision Making section).

The community action plan is a road map for implementing community change in sanitation and water management by
clarifying what will be done, who will do it and how it will be done. The plan describes what the community wants to
achieve, what activities are required during a specified time period, what resources (money, people and materials) are
needed to be successful.

The community action plan should become a framework for implementing the activities that are decided by the
community itself. The focus is more on the process of understanding and overcoming problems in order to rebuild the
people's lives rather than just physical development such as building houses, providing clean water or toilet facilities. It is
important to understand that the community should be the main actors in preparing their own community action plan.
Producing the action plan helps people to take realistic and concrete steps toward participatory development planning in
order to improve the sanitation and water system. By bringing everyone together to think and discuss about resources and
group involvement, this tool increases awareness (see PPT) about the skills and resources already available in the
community.

Advantages
 Strong participation of the local community regarding sanitation and water issues
 By implementing community action plans, the solution for problems comes from the community itself and
hence considers primarily their needs and priorities
 Guarantees that all relevant groups participate in the activities, particularly the women and other community
groups that are often forgotten
 Guarantees the acceptance and support of the solution by the local community
Disadvantages
 Requires time and resources to integrate all the relevant stakeholders in the process
 Finding consensus among all the community members can take ages or might be impossible
 Community action plans are not going to be developed without strongly motivated and encouraged local
community members
General Principles of Community Action Plans
 It is a process for action; not a blueprint for future development.
 The solution for problems comes from the community itself and the role of the facilitator is more on formulating the
problems in the community.
 It is not determined from outside the community but grows/emerges from the affected community.
 Avoid activities such as lecturing or teaching the people; but concentrate more on workshops as a form of discussion with
the community.
 Guarantee that all relevant groups participate in the activities, particularly the women and other community groups that
are often forgotten.
 Facilitate input from all groups; do not allow one group or leader to dominate the discussion.
 Remember that one issue might appear to be not very important for one group, but is important for another group.
 Avoid too many pictures and text; it is better to absorb and remember several points rather than make a long list.
 Use simple language and avoid difficult terms.
 Make the material as simple as possible.

The stages in formulating a community action plan can be described as the following:

 Opening: Introduction and Socialisation: This first stage intends to provide a common understanding of the importance of
having a good action plan, and a common understanding of why an action plan is needed.
 Social and Environmental Mapping financing: This stage is meant to gain an understanding of the latest conditions in the
community life that is the social, economic, as well as environmental conditions. By developing a map, the community
will be able to get a better picture of problems and priorities (see also understand your system).
 Identifying the Problems, Needs, and Resource Potential: This stage defines the problems that are actually faced by the
community, the needs that must be fulfilled in order to overcome the (sanitation and water management) problems, and
the financial resources (see PPT) available to accomplish the needs. This process of identification should be done
carefully in order to avoid becoming just a task of making a “wish list”, and should be viewed as a process of
understanding the current situation and what must be done to overcome the situation as fast as possible.
 Determining the Priority in Problems and Needs: In this stage the problems and needs are ranked by the community
members according to their level of urgency (see preference ranking), their importance for the development of community
life, and the opportunity to overcome and to fulfil (viewed in terms of the availability of local resources as well as external
resources that might be reached).
 Formulating the Choice of Strategy: In this stage, the strategy is developed and the approach chosen that is the most
feasible to be used in overcoming the problems and fulfilling the needs on the priority list (see also deciding).
 Formulating the Choice of Action: In this stage, it is determined which action has to be taken in implementing the chosen
strategy and approach.
 Formulating the Implementation Plan: This stage is used to formulate a schedule and the division of tasks in carrying out
the action chosen (see also stakeholder strategy plan).
 Formulating the Monitoring and Evaluation Plan: This stage is used to formulate a plan and system of monitoring and
evaluating the execution of activities.
 Implementation, Monitoring and Evaluation: This final stage consists of carrying out the action, and at the same time
monitoring and evaluating. For more information on these individual steps, see also implementation).

Considerations for Completing a Community Action Plan

The following points should be taken into consideration in completing a community action plan:

 Partnerships among people. In order to accomplish the goals and objectives in the plan how to improve the sanitation
and water system of your area, many people will have to be integrated and have to fully participate in doing the work. It is
important that the involved people develop good relations and trust among each other (see also stakeholder analysis
starting by stakeholder identification factsheet).
 Budget. Financial resources are usually necessary to develop and carry out a community action plan for sanitation and
water management. Therefore, it is important to develop a budget that describes the expenses for carrying out the action
plan. What you include in the budget should match the proposed strategies and activities (see financing and sources of
funding).
 Close alignment with the community’s mission and vision. The vision that was developed during the community
assessment process reflects where the community wants to be headed. The mission is the purpose of your group. During
 the writing of the action plan, the writers work from the vision and the mission to identify several major goals (priority or
strategic) that must be reached. These, in total, work toward the vision and the mission.
 A feasible plan does not have to be “perfect”. More important than a “perfect” action plan for sanitation and water
management is one that is feasible for the community partnership to complete within a reasonable period of time. The
action plan is a working document that can be reviewed as the group implements it. It is a starting point that people can
continue to update and revise as community groups learn over time and through their evaluation, how to accomplish their
goals.

Applicability

When local community members are keen to change and improve their sanitation and water system respectively
management, they first need a community action plan which describes what the community wants to achieve, what
activities are required and what resources are needed to be successful.

A community action plan is required and should be applied whenever community members want to be the engine of the
change regarding sanitation and water issues. It is of prime importance to strongly integrate local people in the planning of
their water and sanitation system in order to achieve a sustainable solution which is highly accepted and supported by the
local community.