UNIT THREE
Working With Communities
Objectives
At the end of this chapter, the students will be able to;
Explain the concept of community and community participation,
in public health in general and health education and promotion in
particular.
Describe the benefits of community participation in the achievement of
health education programs.
Explore the mechanisms of achieving community mobilization for
common goal and the role of community leaders towards such an effort.
What is community?
Community could be defined as organized groups of
people who share a sense of belonging, beliefs, norms,
and leadership and who usually interact within a defined
geographical area.
E.g. People living in a “village.
People organized under one religion etc.
DEFINITION
“ A community is a social group determined by
geographical boundaries and/ or common values and
interest.
Its members know and interact with each other.
It functions within a particular structure and shows and
creates certain norms, values and social institutions”..
WHO expert Committee (1974)
CHARACTERISTICS.
The community has a defined geographical boundaries which
has the beginning and the end.
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.
The people in the community interact with each other and have
free communication.
The concept of community participation.
The health of the community will improve only if the
people themselves become involved in planning,
implementing, and having a say about their own health
and health care.
Many people emphasize the importance of community
participation for any development issues, including health
promotion, to become a success.
In health education, we are concerned about how people
actually feel.
We are interested in how people look at their own
problems, not only in the problems we see ourselves.
We want people to develop the confidence and skills to
help themselves.
The traditional approach in planning health care or health
education program involves the decision to be made by
experts.
The following are examples of actions that does not
indicate genuine participation.
Involvement of individuals from the community in
responding to health assessment survey questionnaires,
Requesting the community members to contribute labor
to dig a latrine for the school in its village,
Holding a meeting to ask people’s opinions on the issue
of uncontrolled population growth.
Requesting mothers to bring their children to a clinic for
communities are participating when they are actively
involved in:
The assessment of the situation/needs.
Problem identification.
Priority setting and making decisions.
Sharing responsibility in the planning, implementing,
monitoring and evaluation.
The role of experts should be limited to helping them
identify their problems and to point out methods for
Identifying the degree of participation in a
program:
Is the community involved in planning, management,
control and evaluation of the health program at community
level?
Were the felt needs of the community well interested in the
planning?
Is there a mechanism for dialogue between health system
personnel and community leaders?
Are community representatives nominated in decision-
Is there any evidence of the external agents changing
their plans as a result of criticism from the community?
Are deprived groups, such as poor, landless, unemployed,
and women, adequately represented in the decision
making process?
Are local resources such as labour, buildings, money
etc… exhaustively used?
Benefits of community participation.
It leads development endeavors to success.
Changes the emphasis from the individual to the community.
e.g. If all members of a community are convinced of the benefits
of cleanliness, they will help each other to find pure water
sources and keep such sources clean.
They will build and use latrines everywhere in the community
and keep them clean as well.
As communities often have detailed knowledge about their
surroundings, their participation makes programs relevant to
Cont.…
Ensures community motivation and support.
If the community is involved in choosing priorities and
deciding on plans it is much more likely to become
involved in program implementation and take up of the
services because they are seen to be meeting their
needs.
Promotes self-help and self-reliance.
The Role of Health Extension Workers
Success in community participation involves a series of
overlapping stages.
They include:
Knowing the community.
Learning about the community (its structure and
pattern)
Contacting with families, leaders and community groups.
Discussing on concerns and felt needs.
Taking some actions:
Actions on achievable, short-term aims based on felt
needs which bring the community together and build
confidence.
Further activities and organization building
Build up-on existing community organization or
associations.
Formation of committee.
e.g. Health committee.
Educational in-puts.
Select and train volunteers.
Decision making on priorities.
Further actions by the community themselves.
OBJECTIVE OF COMMUNITY HEALTH
1 Promotion and protection of health.
i.e. PRIMARY LEVEL PREVENTION.
2. Early diagnosis and treatment and control of further spread of disease
i.e. SECONDARY LEVEL
PREVENTION.
3. Control of disability and rehabilitation
3. Control of disability and rehabilitation
ie. TERTIARY LEVEL OF PREVENTION.
COMMUNITY IDENTIFICATION HELPS
TO
Prepare community map showing geographical
boundaries, housing patterns, streets, roads, important
landmark : Health center, 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/COMMUNITYHEALTH
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.
Effects of problems on health of people at large.
Felt needs & problems of the community.
Community resources and capabilities.
Health agency’s objectives and policies.
AIMS OF COMMUNITY HEALTH.
Maintain the quality of life to live productive life.
Improving standard of living to protect the health
against diseases.
Who are the leaders?
A leader is a person whose ideas or actions influence
others to get things done that the people want done.
Could be a person of wisdom and sound judgment.
Might be one whose advice has been valuable in the
past.
Might be wealthy and powerful.
Is known to be religious.
Why are leaders important?
Usually make decisions that result in success or failure of
a project.
They are trusted and the community members are ready
to work with them.
Help people in the community know you and gain
confidence in you.
Serve as an officer in an organization or chairperson of a
committee.
Leaders or influential people of the community need
to be involved in carrying out health related
activities.
Thank you