Community DiagnosisCommunity Diagnosis

BY;BY;

SIMRAN GILHOTRA [128]SIMRAN GILHOTRA [128]

SHWETA [126]SHWETA [126]

Definition of Community Definition of Community DiagnosisDiagnosis

Community diagnosis generally refers to Community diagnosis generally refers to the identification and quantification of the identification and quantification of health problems in a community as a health problems in a community as a whole in terms of mortality and morbidity whole in terms of mortality and morbidity rates and ratios, and identification of their rates and ratios, and identification of their correlates for the purpose of defining correlates for the purpose of defining those at risk or those in need of health those at risk or those in need of health care. care.

The Community Diagnosis ProcessThe Community Diagnosis Process

““A means of examining aggregate and A means of examining aggregate and social statistics in addition to the social statistics in addition to the knowledge of the local situation, in order to knowledge of the local situation, in order to determine the health needs of the determine the health needs of the community”community”

GoalGoal The mission of community diagnosis is to:The mission of community diagnosis is to:

Analyze the health status of the communityAnalyze the health status of the community Evaluate the health resources, services, and systems Evaluate the health resources, services, and systems

of care within the communityof care within the community Assess attitudes toward community health services Assess attitudes toward community health services

and issuesand issues Identify priorities, establish goals, and determine Identify priorities, establish goals, and determine

courses of action to improve the health status of the courses of action to improve the health status of the communitycommunity

Establish an epidemiologic baseline for measuring Establish an epidemiologic baseline for measuring improvement over time.improvement over time.

Steps of community diagnosisSteps of community diagnosis

1. listening to people1. listening to people

- listen to community leaders ,women groups,panchayat - listen to community leaders ,women groups,panchayat members .members .

as peoples opinion matter most. as peoples opinion matter most.

2. Observations on community2. Observations on community

- provides direct evidence of extent of health problems - provides direct evidence of extent of health problems or needs of the area.or needs of the area.

3.Examination of the community3.Examination of the community

-examination and review of available service data .-examination and review of available service data .

4. Tentative diagnosis 4. Tentative diagnosis

-from info derived from above steps ,we can come to -from info derived from above steps ,we can come to conclusion of community diagnosis. It can be changed to conclusion of community diagnosis. It can be changed to final diagnosis by having supplementary info from final diagnosis by having supplementary info from investigations.investigations.

5.Survey and investigations in community 5.Survey and investigations in community

-eg, eligible couple survey ,facility survey.-eg, eligible couple survey ,facility survey.

6.Monthly meetings and sector meetings 6.Monthly meetings and sector meetings

-health workers and anganwadi workers meet once a -health workers and anganwadi workers meet once a month.month.

7.Community therapy [treatment of community]7.Community therapy [treatment of community]

-includes-includes

;iron and folic acid supplementation;iron and folic acid supplementation

;adolescent health in school;adolescent health in school

;trained birth attendents fr safe home delievery;trained birth attendents fr safe home delievery

;surveillance of diseases;surveillance of diseases

;safe abortion at phc level;safe abortion at phc level

;contaception services;contaception services

;treatment of environment or modification of environment;treatment of environment or modification of environment

8.Follow up of community8.Follow up of community

9.Evaluation of the therapy9.Evaluation of the therapy- The results of evaluation can be generated at each level The results of evaluation can be generated at each level

ie, subcentre, PHC, CHC.ie, subcentre, PHC, CHC.

10.Replanning of the services10.Replanning of the services

-results of evaluation should be fed back to the system fe -results of evaluation should be fed back to the system fe improving services and replanning of services.improving services and replanning of services.

Community is diagnosed using:Community is diagnosed using:

Health IndicatorsHealth Indicators

Indicators of healthIndicators of health are variables used are variables used for the assessment of community health.for the assessment of community health.

Characteristics of Indicators:Characteristics of Indicators: a. should be a. should be validvalid, , i.e., they should actually measure what they are i.e., they should actually measure what they are

supposed to measure;supposed to measure;

b. should be b. should be reliablereliable and objective, i.e., the answers should be the and objective, i.e., the answers should be the same if measured by different people in similar circumstances;same if measured by different people in similar circumstances;

c. should be c. should be sensitivesensitive, , i.e., they should be sensitive to changes in i.e., they should be sensitive to changes in the situation concerned,the situation concerned,

d. should be d. should be specificspecific, , i.e., they should reflect changes only in the i.e., they should reflect changes only in the situation concerned,situation concerned,

e. should be e. should be feasiblefeasible, , i.e., they should have the ability to obtain i.e., they should have the ability to obtain data needed, and;data needed, and;

f. should be f. should be relevantrelevant, , i.e., they should contribute to thei.e., they should contribute to theunderstanding of the phenomenon of interest.understanding of the phenomenon of interest.

Classification of health IndicatorsClassification of health Indicators

Mortality indicatorsMortality indicators Morbidity indicators Morbidity indicators Disability rates Disability rates Nutritional status Nutritional status

indicatorsindicators Health care delivery Health care delivery

indicators indicators Utilization rates Utilization rates

Indicators of social and Indicators of social and mental health mental health

Environmental indicatorsEnvironmental indicators Socio-economic Socio-economic

indicators indicators Health policy indicators Health policy indicators Indicators of quality of lifeIndicators of quality of life Other indicatorsOther indicators

Mortality IndicatorsMortality Indicators Mortality RatesMortality Rates

- - The traditional measures of health status. The traditional measures of health status.- Widely used because of their ready availabilityWidely used because of their ready availability.( death certificate is a .( death certificate is a

legal requirement in many countries)legal requirement in many countries) Crude death ratesCrude death rates Specific death rates: age/disease Specific death rates: age/disease Expectation of lifeExpectation of life Infant mortality rateInfant mortality rate Maternal mortality rateMaternal mortality rate

Proportionate mortality ratioProportionate mortality ratio Case Fatality rateCase Fatality rate Neonatal mortality indicatorsNeonatal mortality indicators Post neonatal mortality indicatorsPost neonatal mortality indicators Perinatal mortality rate.Perinatal mortality rate.

Morbidity IndicatorsMorbidity Indicators

Morbidity ratesMorbidity rates - Data on morbidity are preferable, - Data on morbidity are preferable,

although often difficult to obtain.although often difficult to obtain.

Incidence and prevalenceIncidence and prevalence Notification ratesNotification rates Attendance rates: out-patient Attendance rates: out-patient

clinics or health centers.clinics or health centers. Admission and discharge ratesAdmission and discharge rates Hospital stay duration ratesHospital stay duration rates

Disability IndicatorsDisability Indicators

Disability ratesDisability rates No. of days of restricted activityNo. of days of restricted activity Bed disability daysBed disability days Work/School loss days within a specified Work/School loss days within a specified

period.period. Expectation of life free of disabilityExpectation of life free of disability

Nutritional IndicatorsNutritional Indicators

Nutritional Status Nutritional Status IndicatorsIndicators

- It is an indicator of positive health- It is an indicator of positive health

Anthropometrics measurementsAnthropometrics measurements Height of children at school entryHeight of children at school entry Prevalence of low birth weightPrevalence of low birth weight Clinical surveys: Anaemia, Clinical surveys: Anaemia,

Hypothyroidism, NightblindnessHypothyroidism, Nightblindness

Health Care Delivery IndicatorsHealth Care Delivery Indicators

Health Care Delivery Health Care Delivery IndicatorsIndicators

- Reflect the Equity / Provision of - Reflect the Equity / Provision of health carehealth care

Doctor / Population ratioDoctor / Population ratio Doctor / Nurse ratioDoctor / Nurse ratio Population / Bed ratioPopulation / Bed ratio Population / per health centerPopulation / per health center

Utilization IndicatorsUtilization Indicators

Health care utilization Health care utilization RatesRates

- - Extent of use of health servicesExtent of use of health services

- Proportion of people in need of service - Proportion of people in need of service who actually receive it in a given who actually receive it in a given periodperiod

Proportion of infants who are Proportion of infants who are fully immunized in the 1fully immunized in the 1stst year year of life. of life. i.e..immunization coverage.i.e..immunization coverage.

Proportion of pregnant women Proportion of pregnant women who receive ANC.who receive ANC.

Hospital-Beds occupancy rate.Hospital-Beds occupancy rate. Hospital-Beds turn-over ratioHospital-Beds turn-over ratio

Social/Mental Health IndicatorsSocial/Mental Health Indicators

Indicators of Social and Indicators of Social and Mental HealthMental Health

- Valid positive indicators does not often - Valid positive indicators does not often existexist

- Indirect measures are commonly used- Indirect measures are commonly used

Suicide & Homicide ratesSuicide & Homicide rates Road traffic accidentsRoad traffic accidents Alcohol and drug Alcohol and drug

abuse.abuse.

Environmental IndicatorsEnvironmental Indicators

Environmental health Environmental health IndicatorsIndicators

- Reflect the quality of environment- Reflect the quality of environment

Measures of PollutionMeasures of Pollution The proportion of people The proportion of people

having access to safe water having access to safe water and sanitation facilitiesand sanitation facilities

Vectors densityVectors density

Socio-economic IndicatorsSocio-economic Indicators

Socio-economic Socio-economic IndicatorsIndicators

- Is not a direct measure of health - Is not a direct measure of health status.status.

- For interpretation of health care - For interpretation of health care indicators.indicators.

Rate of population increaseRate of population increase Per capita GNPPer capita GNP Level of unemploymentLevel of unemployment Literacy rates - femalesLiteracy rates - females Family sizeFamily size Housing condition e.g. No. of Housing condition e.g. No. of

persons per roompersons per room

Health Policy IndicatorsHealth Policy Indicators

Health Policy IndicatorsHealth Policy Indicators - - Allocation of adequate resources.Allocation of adequate resources.

Proportion of GNP spent on Proportion of GNP spent on health services.health services.

Proportion of GNP spent on Proportion of GNP spent on health related activities.health related activities.

Proportion of total health Proportion of total health resources devoted to primary resources devoted to primary health carehealth care

Other IndicatorsOther Indicators

Other health Other health indicatorsindicators

Indicators of quality of life.Indicators of quality of life. Basic needs indicators.Basic needs indicators. Health for all indicators.Health for all indicators.

CLINICAL DIAGNOSISCLINICAL DIAGNOSIS Made by doctor.Made by doctor. Concerned wth individual Concerned wth individual

case.case. Concerned wth only sick Concerned wth only sick

people.people. Doctor examines the Doctor examines the

patient .patient .

COMMUNITY DIAGNOSISCOMMUNITY DIAGNOSIS Made by epidemiologist.Made by epidemiologist. Concerned wth defined Concerned wth defined

population. population. Concerned wth both sick Concerned wth both sick

and healthy people.and healthy people. Epidemiologist conduct Epidemiologist conduct

surveys.surveys.

CLINICAL DIAGNOSIS CLINICAL DIAGNOSIS - Arrived at based on s/s.Arrived at based on s/s.- Involves laboratory Involves laboratory

investigations.investigations.- Doctor decides treatment.Doctor decides treatment.- t/t is main aim.t/t is main aim.- Involves case follow up.Involves case follow up.- Doctor interested in Doctor interested in

technological case advances.technological case advances.

COMMUNITY DIAGNOSISCOMMUNITY DIAGNOSIS-Arrived at based on h/o dis.-Arrived at based on h/o dis.

-involves epidemiological -involves epidemiological investigationsinvestigations

-epidemiologist decides plan of -epidemiologist decides plan of action.action.

-prevention and promotion is the -prevention and promotion is the main aim.main aim.

-Involves evaluation of -Involves evaluation of programme.programme.

-epidemiologist is interested in -epidemiologist is interested in statistical values.statistical values.

Thank YouThank You