COMMUNITY HEALTH — MBPH 3700 Dr. J. Muchiri 0719802082 703 Alumni mailto:jmuchiri@mku.ac.ke --- LEVELS OF CARE △ Tertiary → Rehabilitative △△ Secondary → Curati
COMMUNITY HEALTH — MBPH 3700 Dr. J. Muchiri 0719802082 703 Alumni --- LEVELS OF CARE △ Tertiary → Rehabilitative △△ Secondary → Curative (prevent complications / loss of capacity) △△△ Primary → Preventive --- OBJECTIVES - Define community & community health - Conduct community health diagnosis - Develop & learn community health programs - Monitor community health programs - Do community mobilization & advocacy - Do proper health communication & lobbying - Understand basics of primary healthcare --- BASIC CONCEPTS 1. Community — Group of individuals who: - Live within a similar geographical jurisdiction - Have interrelationships - Have shared values (security, clean environment) - Relate to each other through social structures 2. Community Health — Both the status and activities geared towards improving health of community members 3. Public Health — Science and art of protecting & improving the health of communities through education, policy-making & research 4. Population Health — Health outcomes of a group of individuals, including the distribution of those outcomes within the group 5. Global Health — Interconnected field of study, research & practice where parties achieve health equity, improve population health & manage environmental sustainability for all people worldwide 6. Environmental Health — Branch of public health concerned with assessing, controlling & preventing environmental factors (biological, chemical & physical) that can adversely affect human health --- BASIC PRINCIPLES OF COMMUNITY HEALTH 1. Holistic approach 2. Population focus — Different population segments vary in how they define health needs; their differences must be considered 3. Equity & justice — Ensuring access to healthcare is equitable across all segments of the population in all geographic areas 4. Intersectoral collaboration — Health is not a preserve of MoH alone; includes education, transport, communication, finance 5. Evidence-based operation — Collect & analyse data → make decisions 6. Cultural competence — Ability to distinguish between cultures & understand that cultural differences exist and are not necessarily harmful 7. Continuous monitoring --- COMMUNITY DIAGNOSIS Systematic data collection, analysis, interpretation and formulation of community health interventions Knowledge pyramid: W → Wisdom / Decision K → Knowledge I → Information / Analysis D → Data (raw facts) It is a scientific process that seeks to systematically collect raw data (facts) , analyse it to get information (processed data) — in terms of proportions & % — that helps in developing knowledge for future decision-making in community health issues. --- Functional Reasons for Community Diagnosis 1. Identify community health (CH) needs 2. Prioritize CH needs — CH services operate with limited resources; not all health needs can be addressed at once - Priority based on: numbers affected, available dedicated resources, political feasibility, democratic approach 3. Create epidemiological baseline to monitor and evaluate the project 4. Determine prevailing attitudes among community members 5. Determine resource requirements/availability within the community --- Steps in Community Diagnosis Community diagnosis follows specific steps aimed at generating objective data that will enable CH workers to arrive at accurate decisions after data is analysed, synthesised and recommendations made. Step 1 — Community Entry - Identify the community where data will be collected - Establish its geographical location, categorisation (rural/urban) - Describe the community (social, economic, ethnic background) - Identify key persons (gatekeepers) that must be contacted first - Identify/spell out the scope regarding type of data requirements Step 2 — Objectives - Must be SMART (Specific, Measurable, Achievable, Realistic, Time-bound) - e.g. "To determine Igegania community health needs, Gatundu North, Kiambu County, Kenya" Step 3 — Data Collection - Methods: questionnaires, interviews, observation checklists, FGD (Focus Group Discussion) - Data types: Quantitative & Qualitative - FGD = qualitative; homogeneous groups; max 15 per group; number of FGDs determined by data saturation - Study design: - Longitudinal (follows subjects over time) - Cross-sectional (snapshot at one point) - Retrospective (past data) vs. Prospective (future/ongoing) Sample Size - Unit: Community Health Unit (CHU) — 1 CHU = 100 households - Should be big enough — the bigger the better - Determined by: size of population, level of accuracy, heterogeneity & homogeneity of population - Sampling: Probability-based / Non-probability-based Step 4 — Data Analysis - Quantitative → Statistical methods - Qualitative → Thematic methods Step 5 — Report Writing - Title, Introduction, Objectives, Literature Review, Study Design/Methodology Step 6 — Findings & Conclusions Step 7 — Conclusion --- TOOLS & FRAMEWORKS Frameworks/models enable a researcher/CH worker to identify the information they need to look for/collect in order to establish the health status of the community. a) PEST Framework Letter Stands for Relevance -------- ----------- ----------- P Political Politics influence resource allocation; important for policy-making E Economic Understanding economic factors influencing CH; median household income, poverty rate S Social Social context influences acceptance & adaptability of health interventions T Technological Level of proficiency in technology use within a community; TAM (Technology Acceptance Model) b) SWOT Framework Letter Meaning Example -------- --------- --------- S Strengths Churches, good community structures W Weaknesses Low income, poor infrastructure O Opportunities Churches, old buildings repurposed T Threats Political instability, policy gaps c) PRECEDE–PROCEED Model - Model of health program implementation that looks into designing and evaluating health programs - Helps health workers understand underlying factors for health status ( PRECEDE ), then design, implement and evaluate a health program ( PROCEED ) PRECEDE acronym: - P — Predisposing (knowledge, attitude) - R — Reinforcing (social environment — family, friends) - E — Enabling (things that allow persons to adopt behaviour) - C — Constructs - E — Educational diagnosis - D — Diagnosis - E — Evaluation Steps for PRECEDE: 1. Social assessment — identify social concerns of the community 2. Epidemiological assessment 3. Behavioural & environmental assessment 4. Educational and ecological assessment 5. Ecological factors PROCEED acronym: - P — Policy - R — Regulatory - O — Organizational - C — Constructs - E — Educational - E — Environmental - D — Developmental Focuses on: how interventions will look, determination & evaluation of progress, what other changes happen after intervention --- INDICATORS OF COMMUNITY HEALTH Indicators are signals that, when observed, indicate something — in this case, community health status. Used to determine, quantify & describe health in terms of person, place, and time — for the purpose of prevention and control. 1. Demographic Indicators (Measures different aspects of population) Indicator Formula ----------- --------- Crude Birth Rate (CBR) (Total live births ÷ Total mid-year population) × 100,000 Crude Death Rate (CDR) (Total deaths ÷ Total mid-year population) × 100,000 Under-5 Mortality Rate (Deaths of children Prioritise needs using democratic criteria — document as percentage --- Example: Health Program for HIV/AIDS — Thika East Community Goal: Reduce the impact of HIV/AIDS in the community Objectives (SMART): 1. To reduce number of new HIV infections in Thika East Community 2. To improve quality of life for HIV/AIDS patients in Thika Community 3. To educate on safe measures of prevention of STIs among the Thika East Community Activities & Resources: Activity Resources Needed ---------- ----------------- 1. HIV/AIDS education Human resource; IEC materials; Health campaign — vehicles/venues 2. Access to ARVs Human resource; Commodity; Infra