COMMUNITY

DIAGNOSIS
NAMUKASA SHAMIM
 DEFINITION OF A “COMMUNITY”

• A cluster of people with at least one common

characteristic (geographic location, occupation, ethnicity,
housing condition……)

• A group of people with a common characteristic or interest

living together within a larger society
COMMUNITY

• A community is a whole entity that functions

because of the interdependence of its parts or
subsystems. Eight subsystems plus the community
core are identified.
 COMMUNITY CORE

1. Community core: history, socio-demographic

characteristics, vital statistics,
values/beliefs/religions.
2. Core
 EIGHT SUBSYSTEMS

2. Eight subsystems:
• Physical environment
• Education
• Safety and transportation
• Politics and government
• Health and social services
• Communication
• Economics
• Recreation
 • Community analysis is the process of examining
data to define needs, strengths, barriers,
opportunities, readiness, and resources.

COMMUNITY • The product of analysis is the “community

DIAGNOSIS/COMMU profile”.
NITY SITUATION
ANALYSIS
• Community Analysis: Data needed
• Demographic
• Environmental
• Socioeconomic
• Health resources and services
• Health policies
• Study of target groups.
 CONTENT OF COMMUNITY
DIAGNOSIS (SAMPLE)
• General information/data from community leaders:
• Who lives in the community?
• Number of households/ families
• Number of adults/ male to female
• Number of children:- male to female
• Where do they live?
• Geographical location of houses
• How do they live?
• Source of income
• Source of food supply
• Income distribution
 CONTENT OF COMMUNITY
DIAGNOSIS (SAMPLE)
• What problems do they have?
• General problems including security
• Health related problems
• What resources do they have?
• Industrial or agricultural facilities
• Schools
• Markets/ business centers
• Health facilities
• Water supply
• Sanitary facilities
• Road network
• Access to information (radio or news papers)
 DEFINITION OF COMMUNITY
DIAGNOSIS
• Community diagnosis generally refers to the
identification and quantification of health problems in a
community as a whole in terms of mortality and
morbidity rates and ratios, and identification of their
correlates for the purpose of defining those at risk or
those in need of health care.
 COMMUNITY DIAGNOSIS
• Community diagnosis is "a quantitative and qualitative description of the health of
individuals, families and communities and the factors which influence

• OR: Community diagnosis: Identification and quantification of health problems in a

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

• OR: Refers to the identification and qualification of health problems in a

community as a whole.

• OR Is the process of collecting data about the community in order to identify

different factors that may directly or indirectly influence the health of the population.

• OR: Community diagnosis is also defined as a comprehensive assessment of the

state of the entire community in relation to its social, political, economic, physical and
biological environment.
 COMMUNITY DIAGNOSIS

• The type of information to be collected should be related to

health e.g. sanitation, nutrition, immunization, birth and death
etc, with other development issues.

• Information can be collected from house heads, health units,

local authorities, women clubs, youth clubs, and extension
workers among others.
THE COMMUNITY DIAGNOSIS
PROCESS
• “A means of examining aggregate and social
statistics in addition to the knowledge of the local
situation, in order to determine the health needs
of the community”
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Code 38144086
 GOAL

• The mission of community diagnosis is to:

• Analyze the health status of the community

• Evaluate the health resources, services, and systems of care
within the community
• Assess attitudes toward community health services and
issues
• Identify priorities, establish goals, and determine courses of
action to improve the health status of the community
• Establish an epidemiologic baseline for measuring
improvement over time.
 GOALS OF COMMUNITY
DIAGNOSIS

• Analyze the health status of the community.

• Evaluate the health resources of systems of care
within the community.
• Assess attitude towards community health
services.
• Increases levels of awareness about the prevailing
negative factors.
 OBJECTIVES OF COMMUNITY
DIAGNOSIS

• Analyze health status.

• Evaluate health resources, services, and systems of care.
• Assess attitudes toward community health services and
issues.
• Identify priorities, establish goals, and determine courses
of action to improve health status.
• Establish epidemiologic baseline for measuring
improvement over time.
 IMPORTANCE OF COMMUNITY
DIAGNOSIS
• Helps to identify community needs and problems
• It is provides data as a prerequisite for planning, implementation and evaluation
of successful community-based health and development programmes.
• Helps to decide strategies for community involvement
• It gives an opportunity for the community to learn about itself i.e. the
community become conscious of its existing problems and finds solutions.
• Helps to match project organizations and services to community needs.
• Helps to understand about the social, cultural and environmental
characteristics of the community.
 IMPORTANCE OF
COMMUNITY DIAGNOSIS
• Identification and quantification of health problem
• Identification of those who at risk
• Identification of community needs and problems
• Determine available resources

• Set priorities for planning

 IMPORTANCE OF COMMUNITY
DIAGNOSIS
• To create opportunities for Intersectoral collaboration and media involvement
• It helps to obtain up-to-date information about the community quality is
necessary for effective planning, Monitoring with evaluation for development.
• It helps to improve community level of awareness about the prevailing factors
that affect their health and general development.
• It helps community to priotise their problems before implementation.
• It fosters community participation.
 COMPARING INDIVIDUAL AND
COMMUNITY DIAGNOSIS

INDIVIDUAL (DIAGNOSIS) COMMUNITY DIAGNOSIS

• 1. Patient aware of the problem. • 1. Community may or may

not be aware of the problem.
• 2. Patient take initiative for
• 2. Community rarely takes
problem solving. initiative.
• 3. Pathological condition affects • 3. Can not be treated as
patient alone. isolated occurrences.
• 4. It may or may not be relate to • 4. Each condition is linked to the
the environment
inter-related factors in the
environment.
Characteristics of Community Diagnosis

• ability to address important community problems

• ability to identify most of the targeted health events
• adequacy in reflecting changes in distribution of events over
time, place and person
• participatory,
• uncomplicated,
• sensitive, timely, and inexpensive
BASIC DATA IN COMMUNITY DIAGNOSIS
• Background/ Setting

• 1.1 Local history

• 1.2 Geography – Part of which Region, Municipality/

City – Boundaries whether land locked, coastal or both –
Land area – Subdivisions, political, economic or social

• 1.3 Climate
2. DEMOGRAPHY

• 2.1 Geographic distribution Age –

sex\structure (Population pyramid)

• 2.2 Factors such as: Migration; Age

dependency (18-49 yr); Birth/death rate;
Ethnic dist; Density
 Apex= People living to old age

People ≥ 60 years=
Old dependency

Height= life span

Median age

People < 15 years=

Young dependency
Base= births
 POPULATION STRUCTURE:

• is the number of males and females in different age groups.

• The common method to show the structure is by a population pyramid.
• This diagram is made up by putting two bar graphs (one for male, one for
female) side by side.
• From this you can read off what percentage of a population is of a certain
gender and age range.
IMPORTANCE OF POPULATION PYRAMID

• Policy Planning
~ future housing estates
~ future schools
~ future jobs
• Comparison with other countries
~ developed (US) vs developing (Uganda)
WHAT DOES THE SHAPE OF THE
POPULATION PYRAMIDS TELL US?

• Information of birth and death rates

• Information of life expectancy
• People living in a particular country or
place
 POPULATION PYRAMID

• This shows the age structure in a certain population

• A population pyramid is a visual graph that represents gender and age structure
within a population. They are used by governments and other sectors to
anticipate current population needs and make population predictions for the
future. They can also provide information on birth rates, death rates, and life
expectancy.
• By looking at the shape, you will be able to get an idea about:
• Proportion age groups in a population
• Male to female ratio
3. ECONOMIC STATUS

• 3.1 Sources of income

• 3.2 Indications of economic status: Employment;

Income per capita; Poverty level; Economic
organizations
SOCIAL INDICATORS

• Education Housing, Communication,

Transportation, Sources of health care and
health information Public assistance Leadership
pattern
 Health data in community
diagnosis process
• 1. Health Status of the Community

• Top Mortality

• Top Morbidity

• 2. Environmental Indices

• Water Supply

• Excreta Disposal

• Insect Control

• Sanitation,

• Garbage Collection
 Health data in community
diagnosis process
• 3. Food / Nutrition

• Sources of food: Markets/ Public eating establishments

• Prevalence of Malnutrition

• 4. Health Resources

• Manpower / Health officer, nutritionist, Nurse, Doctor

• Health facilities

• Health financing: Public funds versus private funding

• Health related legislations: National; Local

 Health data in community
diagnosis process
• 5. Organized Community health programs

• Expanded program on Immunization

• Maternal and Child health

• Reproductive health

• Nutrition programs
SUMMARY OF STEPS TO CONSIDER WHEN
CARRYING OUT COMMUNITY DIAGNOSIS

• 1. Plan for the resources required for the activity

• 2. Decide the scope I areas to be studied
• 3. Design the relevant tools to be used in data collection
• 4. Conduct surveys to obtain quantitative and qualitative data
• 5. Collect and analyze the data
• 6. Form a community diagnosis and disseminate the report via different
channels
• 7. Establish and prioritize areas for improvement
• 8. Set work plans for implementation and indicators for evaluation
PROCESS / STAGES OF CARRYING
OUT COMMUNITY DIAGNOSIS

• Initiation
• Data collection and Analysis
• Diagnosis
• Dissemination
 INITIATION PHASE

• Define or identify the area of study from which the data is to be

gathered for community diagnosis (i.e. location, population size, sex
and age structure, climate condition, ethnicity, economic status,
education, standards of living, occupation, religion, infrastructure, etc).
• At an early stage, it is important to identify the available resources
needed to determine the scope of the diagnosis.
• In order to initiate a community Diagnosis, a dedicated committee
or working group should be net up to manage and coordinate the
project.
 INITIATION PHASE

• The committee should involve relevant parties such as government

departments, health professionals and non – governmental –
organizations
• Some of the common areas to be studied may include health status,
lifestyles, living conditions, socioeconomic conditions, physical and social
infrastructure, inequalities, as well as public health services and policies,
medical services, public health issues, education, housing, public security
and transportation
• Once the scope is defined, a working schedule to conduct the
community diagnosis, production and dissemination of report should be
set.
 DATA COLLECTION WITH
ANALYSIS
• Data collection refers to gathering data about the health problems present in the
community.
• Design the relevant tools to be used in data collection.
• Prepare for data collection using selected method e.g. these can be the
questionnaires, interview guide or observational checklists, focus group discussions.
The following sources of data can be used:
• Discussion with community members about their main health problems
• Reviewing records of the health services utilized by the community
• Undertaking a community surveyor a small-scale project
• Observing the risks to health present in the community
 DATA COLLECTION WITH
ANALYSIS

• Data analysis: Data analysis refers to categorizing the whole of the data you collected into
groups so as to make meaning out of it. For instance you can assess the magnitude of a disease
by calculating its prevalence and its incidence from the numbers of cases you recorded and the
number of people in the population in your community.

• Collected data can then be analyzed and interpreted by experts, Here are some practical tips
on data analysis and presentation:

✓ Statistical information is best presented as rates or ratios for comparison

✓ Trends and projections are useful for monitoring changes over a time period for future planning

✓ Graphical presentation is preferred for easy understanding

 DIAGNOSIS

• Diagnosis of the community is reached from

conclusions drawn from the data analysis. It should
preferably
Comprise three areas:
• Health status of the community
• Determinants of health in the community
• Potential for healthy community development
 DISSEMINATION

• The production of the community diagnosis report is not an end in itself; efforts
should be put into communication to ensure that targeted actions are taken.
• The target audience for the community diagnosis includes policy-makers, health
professionals and the general public in the community.
• The report can be disseminated through the following channels: presentations at
meetings of the health boards and committees, or forums organized for voluntary
organizations, local community groups and the general public through press release
or meetings.
• It is important to realize that Community Diagnosis is not a one-off project, but
is part of a dynamic process leading to health promotion in the community.
 DISSEMINATION

Target audience for report can be disseminated to;-

• Policy makers
• Press release
• Health professionals
• Presentation
• Meetings of health boards
• General public committees
 PRIORITIZING HEALTH
PROBLEMS

• As a health professional working in a community affected by

several health problems at the same time it is difficult to address all
the problems at once. Therefore, you should give priority to the
most important ones first.
• Health problems which have a high magnitude and severity, which
can be easily solved, and are major concerns of the community and
the government, are given the highest priority.
• After prioritizing which disease (or diseases) you will give most
urgent attention to, the next step is to develop an action plan.
 ACTION PLAN (WORK PLAN)

• An action plan sets out the ways in which you will

implement the interventions required to prevent and control
the disease or solve a problem.
• It contains a list of the objectives and corresponding
interventions to be carried out, and specifies the responsible
bodies who will be involved.
• It also identifies the time and any equipment needed to
implement the interventions.
•How is the
community
diagnosed?
• Community is diagnosed using:

Health Indicators
 COMMUNITY DIAGNOSIS

• Community Diagnosis is done using a tool called

• "Health Indicators" which are the variables used for the

assessment of community health.

• Health indicators/health variable/health index: Are quantifiable

characteristics of a population that describes the health of a
population
• Indicators must be:

valid, reliable, sensitive, specific, feasible and relevant.

 CHARACTERISTICS OF INDICATORS:

• a. should be valid, i.e., they should actually measure what they are
supposed to measure;
• b. should be reliable and objective, i.e., the answers should be the same if
measured by different people in similar circumstances;
• c. should be sensitive, i.e., they should be sensitive to changes in the
situation concerned,
• d. should be specific, i.e., they should reflect changes only in the situation
concerned,
• e. should be feasible, i.e., they should have the ability to obtain data
needed, and;
• f. should be relevant, i.e., they should contribute to the understanding of
the phenomenon of interest.
 IMPORTANCE OF HEALTH
INDICATORS

• They are used as a basis in health policy formulation.

• They reflect changes in the health profile over a specified time span,
• They help to diagnose community needs and perceptions.
• They are helpful to program planners and health administrators I'm
changing ow progress.
• They allow evaluation of health services and specific interventions,
• They allow projections for the future
 TYPES OF HEALTH INDICATORS

• Health Indicators are categorized as vital and behavioral indicators

• Vital indicators
These include:
1. Mortality indicators e.g.
• Crude death rare: the number of deaths due to any cause divided by general population> 1000.
• Infant mortality rate (lMR) - the number of infant deaths (deaths under one year) per 1000 live births in one
year in a community/country.
• Maternal mortality rate- the number of maternal deaths (deaths associated with complication of pregnancy,
labour and puerperium) per 100,000 live births in a year in a community or country,
• Perinatal mortality rate- the number of perinatal death (death occurring after 28 week : of gestation and
within 7 days after birth) during a year per 1000 live births,
• Neonatal mortality rate- the number of neonatal deaths (deaths occurring under 2g days of age during a
year per 1000 live births.
 CLASSIFICATION OF HEALTH
INDICATORS
• Mortality indicators
• Morbidity indicators
• Disability rates
• Nutritional status indicators
• Health care delivery indicators
• Utilization rates
• Indicators of of social and mental health
• Environmental indicators
• Socio-economic indicators
• Health policy indicators
• Indicators of quality of life
• Other indicators
 Mortality Indicators
➢ Mortality Rates
- The traditional measures of health status.
- Widely used because of their ready availability.( death certificate is a legal requirement
in many countries)
➢ Crude death rates/All cause death rate
➢ Specific death rates: age/disease
➢ Infant mortality rate
➢ Maternal mortality rate
➢ Proportionate mortality ratio
➢ Case Fatality rate
 Morbidity Indicators

➢ Morbidity rates ➢ Incidence and prevalence

- Data on morbidity are preferable,
although often difficult to obtain.
➢ Notification rates
➢ Attendance rates: out-patient
clinics or health centers.
➢ Admission and discharge rates
➢ Hospital stay duration rates
 Disability Indicators

➢ Disability rates ➢ No. of days of restricted activity

➢ Bed disability days
➢ Work/School loss days within a specified
period.
➢ Expectation of life free of disability
 Nutritional Indicators

➢ Nutritional Status ➢ Anthropometrics measurements

Indicators
- It is an indicator of positive health
➢ Height of children at school entry
➢ Prevalence of low birth weight
➢ Clinical surveys: Anaemia,
Hypothyroidism, Nightblindness
 Health Care Delivery Indicators
➢ Health Care Delivery
Indicators
- Reflect the Equity / Provision of
health care
➢ Doctor / Population ratio
➢ Doctor / Nurse ratio
➢ Population / Bed ratio
➢ Population / per health center
 Utilization Indicators
➢ Health care utilization
Rates
- Extent of use of health services
- Proportion of people in need of service
who actually receive it in a given
period
➢ Proportion of infants who are fully
immunized in the 1st year of life.
i.e..immunization coverage.
➢ Proportion of pregnant women
who receive ANC.
➢ Hospital-Beds occupancy rate.
➢ Hospital-Beds turn-over ratio
 Social/Mental Health Indicators
➢ Indicators of Social and ➢ Suicide & Homicide rates
Mental Health ➢ Road traffic accidents
- Valid positive indicators does not often ➢ Alcohol and drug
exist
abuse.
- Indirect measures are commonly used
 Environmental Indicators
➢ Environmental health
Indicators
- Reflect the quality of environment
➢ Measures of Pollution
➢ The proportion of people
having access to safe water
and sanitation facilities
➢ Vectors density
 Socio-economic Indicators
➢ Socio-economic
Indicators
- Is not a direct measure of health
status.
- For interpretation of health care
indicators.
➢ Rate of population increase
➢ Per capita GNP
➢ Level of unemployment
➢ Literacy rates - females
➢ Family size
➢ Housing condition e.g. No. of
persons per room
 Health Policy Indicators
➢ Health Policy Indicators
- Allocation of adequate resources.
➢ Proportion of GNP spent on
health services.
➢ Proportion of GNP spent on
health related activities.
➢ Proportion of total health
resources devoted to primary
health care
 Other Indicators
➢ Other health indicators ➢ Indicators of quality of life.
➢ Basic needs indicators.
➢ Health for all indicators.
 MORBIDITY INDICATORS

• Prevalence indicators and incidence of disease-

means occurrence of new cases of a disease during
a specified period or time.
• Prevalence of disease- includes both old and new
cases that existed during il defined period.
 INDICATORS

• Service indicators: Indicators reflect the provision of health facilities:

Examples are proportion population served by health centres doctor
population ratio. Proportion of population having access to safe drinking water,
literacy rate etc
• Comprehensive indicator: these indicators encompass many facets
hence provide a better measure for health. Examples include: Life
expectancy the expected average life span of an individual expectancy at birth is
the expected average life span 01' babies born in a given year at a given place.
• Growth rates- Annual growth rate- is the increase in population
percent per year.This is obtained by deducting death rate from birth rate
and dividing with 10.
 INDICATORS

• Fertility rates- General fertility rate- this is the number of live births at a
place during a year divided by the women in the age group 15-45 of the same
place and year multiplied with 1000.
• Couple protection rate (CPR) - this is a proportion of married couples
who are practicing temporary or permanent contraception. CPR-Couples
practicing temporary permanent contraception x 100 Total number of married
couples higher the couple protection rate the lower the fertility.
• Birth rates- crude birth rate- is the number of live births divided by the
media population and multiplied with 1000
 BEHAVIORAL HEALTH
INDICATORS
• These measure the utilization of services provided, rates of
compliance and attitude of populations.
• Examples are; Bed occupancy rates.
• Proportion of population receiving antenatal care,
• Proportion of population visiting primary health centres.
• These indicators show whether the health facilities provided
are adequate, relevant. Accessible and acceptable.
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