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Ailyn Brillo Pineda
Community Health Nursing Practice Utilizing COPAR
Dr. Alberto Romualdez, former DOH secretary described the Philippine health status as “ on continuing shift towards positive change despite age-old problems..”Some infectious degenerative diseases are on the riseCorrelation of poor health with low socio-economic
status is well documentedFilipinos are still living in the remote areas, where it
is difficult to deliver the health services they needScarcity and exodus of MD’s, RN’s and RM’s add to
the poor delivery of the health care to the poor and deprived who comprise the majority of the country’s 80 million or so total population
INDICATORS MALE FEMALE BOTH SEXES
Population 41, 612, 133 41, 015,428 82, 663,561
Life Expectancy 72.78 years 67.53 years
Crude Birth RatePer 1000 population
24.63
Crude Death Rate per 1000 population
5.66; 4.8 in 1998
Infant Mortality Rate
29 per 1000 live births
Maternal Mortality Rate
138 per 1000 live births
Total Fertility Rate
3.5
Age Female Male
Number Percent Number Percent
0-4 4,721,115 5.6 4,937,632 5.9
5-9 4,643,067 5.5 4,832,467 5.7
10-14 4,500,519 5.3 4,792,979 5.7
15-19 4,229,087 5 4,418,572 5.2
20-24 3,905,441 4.6 3,983,027 4.7
25-29 3,541,009 4.2 3,557,779 4.2
30-34 3,160,534 3.8 3,141,953 3.7
35-39 2,776,133 3.3 2,756,653 3.3
40-44 2,374,323 2.8 2,374,463 2.8
45-49 2,006,520 2.4 2,006,056 2.4
50-54 1,631,337 1.9 1,629,315 1.9
55-59 1,319,097 1.6 1,296,672 1.5
60-64 1,013,026 1.2 963,875 1.1
65-69 767,324 0.9 704,079 0.8
70-74 546,329 0.6 475,228 0.6
75-79 374,459 0.4 298,154 0.4
80+ 330,630 0.4 232,487 0.3
Total 41,839,950 49.7 42,401,391 50.3
Source: 1995 Census-Based National, Regional and Provincial Population Projections: National Statistics Office
AREA No. of Livebirths
Philippines 1,766,440
NCR (Metro Manila) 303,631
CAR (Cordillera) 33,017
Region 1 (Ilocos) 101,310
Region 2 (Cagayan Valley) 59,585
Region 3 (Central Luzon) 200,361
Region 4 (Southern Tagalog) 299,872
Region 5 (Bicol) 117,979
Region 6 (Western Visayas) 123,299
Region 7 (Central Visayas) 153,080
Region 8 (Eastern Visayas) 61,873
Region 9 (Western Mindanao) 55,931
Region 10 (Northern Mindanao) 59,659
Region 11 (Southern Mindanao) 103,555
Region 12 (Central Mindanao) 44,231
ARMM 39,616
CARAGA 9,327
Foreign Countries 114
Residence not stated -
CARAGA 9,327
Source: Philippine Health Statistics, 2000
CAUSE 5 Year Average (2000-2004) 2005*
No. Rate No. Rate
1. Acute Lower RTI and Pneumonia
694,209 884.6 690,566 809.9
2. Bronchitis/ Bronchiolitis
669,800 854.7 616,041 722.5
3. Acute Watery Diarrhea
726,211 928.3 603,287 707.6
4. Influenza 459,624 587.0 406,237 476.5
5. Hypertension 314,175 400.5 382,662 448.8
6. TB Respiratory 109,369 139.7 114,360 134.1
7. Diseases of the Heart
43,945 56.2 43,898 51.5
8. Malaria 35,970 46.1 36,090 42.3
9. Chickenpox 79,236 41.1 30,063 35.3
10. Dengue Fever 15,383 19.6 20,107 23.6
** Pneumonia only from 2000-2002* reference yearLast Update: June 29, 2009
CAUSE MALE FEMALE BOTH SEXES
Rate** Rate** Number Rate*
1. Acute Lower RTI and Pneumonia
888.8 868.0 776,562 929.4
2. Bronchitis/ Bronchiolitis
651.8 817.1 719,982 861.6
3. Acute Watery Diarrhea
668.5 651.5 577,118 690.7
4. Influenza 400.7 444.6 379,910 454.7
5. Hypertension 338.2 442.1 342,284 409.6
6. TB Respiratory 137.7 93.9 103,214 123.5
7. Chickenpox 51.5 56.2 46,779 56.0
8. Diseases of the Heart
38.5 45.1 37,092 44.4
9. Malaria 24.0 20.0 19,894 23.8
10. Dengue Fever 17.8 17.1 15,838 19.0
Source: 2004 Philippine Health Statistics** rate/100,000 of sex-specific population Last Update: February 11, 2008
AREA Total Deaths
Philippines 366,931
NCR (Metro Manila) 63,413
CAR (Cordillera) 5,041
Region 1 (Ilocos) 26,469
Region 2 (Cagayan Valley) 13,250
Region 3 (Central Luzon) 40,534
Region 4 (Southern Tagalog) 54,804
Region 5 (Bicol) 24,867
Region 6 (Western Visayas) 35,589
Region 7 (Central Visayas) 29,403
Region 8 (Eastern Visayas) 16,250
Region 9 (Western Mindanao) 9,650
Region 10 (Northern Mindanao) 10,700
Region 11 (Southern Mindanao) 20,045
Region 12 (Central Mindanao) 7,543
AREA Fetal Deaths
Philippines 10,360
NCR (Metro Manila) 2,333
CAR (Cordillera) 163
Region 1 (Ilocos) 725
Region 2 (Cagayan Valley) 143
Region 3 (Central Luzon) 824
Region 4 (Southern Tagalog) 2,253
Region 5 (Bicol) 620
Region 6 (Western Visayas) 699
Region 7 (Central Visayas) 1,056
Region 8 (Eastern Visayas) 247
Region 9 (Western Mindanao) 242
Region 10 (Northern Mindanao) 279
Region 11 (Southern Mindanao) 397
Region 12 (Central Mindanao) 203
ARMM 161
CARAGA 15
Foreign Countries -
Residence not stated -
Cause Number Rate Percent
TOTAL 1,732 1.0 100.0
1. Complications related to pregnancy occurring in the course of labor, delivery and puerperium
819 0.5 47.3
2. Hypertension complicating pregnancy, childbirth and puerperium
510 0.3 29.4
3. Postpartum hemorrhage
263 0.2 15.2
4. Pregnancy with abortive outcome
138 0.1 8.0
5. Hemorrhage in early pregnancy
2 0.0 0.1
Cause Number Rate Percent
1. Bacterial sepsis of newborn 3,161 1.9 14.6
2. Respiratory distress of newborn 2,298 1.4 10.6
3. Pneumonia 2,013 1.2 9.3
4. Disorders related to short gestation and low birth weight, not elsewhere classified
1,610 1.0 7.4
5. Congenital Pneumonia 1,510 0.9 7.0
6. Congenital malformation of the heart 1,444 0.9 6.7
7. Neonatal aspiration syndrome 1,146 0.7 5.3
8. Other congenital malformation 1,012 0.6 4.7
9. Intrauterine hypoxia and birth asphyxia
971 0.6 4.5
10.Diarrhea and gastro-enterities of presumed infectious origin
900 0.5 4.2
Infant Mortality: Ten (10) Leading Causes Number & Rate/1000 Live births & Percentage Distribution
Philippines, 2005
Cause
5 Year Average (2000-2004)
2005*
Number Rate No. Rate
1. Diseases of the Heart 66,412 83.3 77,060 90.4
2. Diseases of the Vascular system
50,886 63.9 54,372 63.8
3. Malignant Neoplasm 38,578 48.4 41,697 48.9
4. Pneumonia 32,989 41.4 36,510 42.8
5. Accidents 33,455 42.0 33,327 39.1
6. Tuberculosis, all forms 27,211 34.2 26,588 31.2
7. Chronic lower respiratory diseases
18,015 22.6 20,951 24.6
8.Diabetes Mellitus 13,584 17.0 18,441 21.6
9. Certain conditions originating in the perinatal period
14,477 18.2 12,368 14.5
10. Nephritis, nephrotic syndrome and nephrosis
9.166 11.5 11,056 3.6
Cause No. Rate
1. Diseases of the Heart 43,809 102.1
2. Diseases of the Vascular system 30,531 71.2
3. Accidents 27,281 63.6
4. Malignant Neoplasms 21,993 51.3
5. Tuberculosis, all forms 18,229 42.5
6. Pneumonia 18,145 42.3
7. Chronic lower respiratory diseases 14,450 33.7
8. Diabetes Mellitus 8,912 20.8
9. Certain conditions originating in the perinatal period
7,385 17.2
10. Nephritis, nephrotic syndrome and nephrosis
6,548 15.3
Cause No. Rate
1. Diseases of the Heart 33,251 78.5
2. Diseases of the Vascular system 23,841 56.3
3. Malignant Neoplasms 19,704 46.5
4. Pneumonia 18,365 43.3
5. Diabetes Mellitus 9,529 22.5
6. Tuberculosis, All Forms 8,359 19.7
7. Chronic lower respiratory diseases 6,501 15.3
8. Accidents 6,046 14.3
9. Certain conditions originating in the perinatal period
4,983 11.8
10. Nephritis, nephrotic syndrome and nephrosis
4,508 10.6
Based on these statistics what are the challenges that nurses, doctors or midwives and other health agencies face in relation to health profile and growth rate of the Philippine population?
What preventive measures can be done?What can be done to promote and restore health?What health education can be administered by the
community health workers, doctors, nurses, midwives, etc.?
How can we improve the health care deliver system?
How can increase the number of health workers?What can be done for people in the far flung areas
to prevent the occurrence of diseases and health hazards?
Community Health Organizing Utilizing COPAR
Was developed and sponsored by the Philippine Center for Population and Development (PCPD)
To make health services available and accessible to depressed and underserved communities in the Philippines
PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutions and agencies through programs and projects geared toward the social human development of rural and urban communities
Formerly known as The Population Center Foundation
HRDP ITrained the faculty, medical/nursing students
to provide health care services to the far flung barrios because of lack of man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health
The PCPD provides seed money for the income generating projects
The CO uses his/her own strategy or method in developing the community
Short-term service
HRDP IIThe 2nd cycle uses the same strategy but the program
could not be sustained by the schools or hospitals and the income-generating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects
Both HRDP I and HRDP II have brought about some changes in the community life of the people
Established basic health infrastructure; basic health services were increased; there were trained workers and organized health groups to take care of the needs of the community
HRDP IIIPCPD refined the program and resulted to what is
now called HRDP III, which has these unique features:Comprehensive training of the staff and faculty 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
PHC as the approach with which all nursing/medical students, their CI’s and indigenous health workers are trained for community health work and around which all other project inputs will revolve
Community organizing as the main strategy to be employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the community health programs
Organizing work in the communities were done in 3 phases
PAR as fascinating strategy for maximum community involvement through collective identification and analysis of community health problems and collective health action
Available funds to finance community initiated projects
Since Management Leadership and Jurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts as leaders of the different levels of the students who were involved in COPAR
Principles of management were applied in carrying out primary health care
The community members, CHW’s and leaders were empowered to manage their own health projects
Conducted seminars and trainings as well as health education and services needed by community(exposure and immersion 6-8 weeks)
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 people’s 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)
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.
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.
COPAR should be based on the interest of the poorest sectors of society
COPAR should lead to a self-reliant community and society.
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- raising 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 leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity.
Pre- entry Phase is the initial phase of 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
Activities include Community consultations/dialogues Setting of issues/ considerations related to site selection Development of criteria for site selection Site selection Preliminary social investigation (PSI) Networking with LGU’s, NGO’s and other departments
Entry Phase Social preparation phase Activities done here includes:
Integration with the community Sensitization of the community; information
campaigns Continuing social investigation Core group formation:
Development of criteria for the selection of CG members Defining the roles/functions/tasks of the CG
Coordination /dialogue/consultation with other community organizations
Self-awareness and Leadership training (SALT), action, planning
This phase signals the actual entry of the community worker/organizer into the community
Community Study/Diagnosis Phase (Research Phase)Selection of the research teamTraining on the data collection methods and
techniques; capability-building (includes development of data collection tools)
Planning for the actual gathering of the dataData gatheringTraining on data validation (includes tabulation and
preliminary analysis of data)Community validationPresentation of the community
study/diagnosis/recommendationsPrioritization of community needs/problems for action
Community meetings to draw up guidelines for the organizations of the CHO
Election of officersDevelopment of management systems and
procedures, including delineation of the roles, functions and task of officers and members of the CHO
Team building/Action-Reflect Action (ARA)Working out legal requirements for the
establishment of the CHOOrganization of the working committees and task
groups(e.g. education and training, membership of committees)
Training of the CHO officers/community leaders
Community Action PhaseOrganization and training of the community
health workers (CHW’s)Development of criteria for the selection of CHW’sSelection of CHW’sTraining of CHW’s
Setting up of linkages/network referral systemsInitial identification and implementation of
resource mobilization schemes
Sustenance and strengthening phaseOccurs when the community organization has
already been established and the community members are already actively participating in community-wide undertakings
Strategies used may include:Education and trainingNetworking and linkagesConduct of mobilization on health and development
concernsImplementation of livelihood projectsDeveloping secondary leaders
Activities in Building People’s Organization
A CO becoming a par with the people in order to:Immerse himself in the poor communityUnderstand deeply the culture, leaders, history,
rhythms and lifestyle in the communityMethods of Integration includes:
Participation in direct production activities of the people
Conduct of house visitsParticipation in activities like birthdays, fiestas,
wakes, etcConversing with people where they usually gather
such as stores, water, walls, washing streams, or churchyards
Helping out in the household chores like cooking, washing the dishes, etc
A systematic process of collecting, collating, analyzing data to draw a clear picture of the community
Also known as the COMMUNITY STUDYPointers for the conduct of SOCIAL INVESTIGATION
Use of survey or questionnaires is discouraged Community leaders can be trained to initially assist the
community worker/organizer in SI Data can be more effectively and efficiently collected
through informal methods-house visits, participating in conversations in jeepneys and others
Secondary data should be thoroughly examined because much of the information might already be available
SI is facilitated if the CO/ community worker is properly integrated and has acquired the trust of the people
Confirmation and validation of community data should be done regularly
CO choose one issue to work in order to begin organizing the people
Going around and motivating the people on an one on one basis to do something on the issue that has been chosen
People collectively ratifying what they have already decided individually
The meeting gives the people the collective power and confidence
Problems and issues are discussed
Means to act out the meeting that will take place between the leaders of the people and government representatives
It is a way of training the people to participate what will happen and prepare themselves for such eventually
Actual experience of the people in confronting the powerful and the actual exercise of the people power
The people reviewing the steps 1-7 so to determine whether they were successful or not in their objectives
Dealing with deeper, on going concerns to look at the positive values CO is trying to build in the organization
It gives the people time to reflect on the stark reality of life compared to the ideal
The people’s organization is the result of many successive and similar actions of the people
A final organizational structure is set up with elected officers and supporting members
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