PLANNING COMMUNITY HEALTH INTERVENTION

Priority Setting WHO Special Consideration

• WHO has suggested the following criteria (involve fonts) to decide to a
community health concern for intervention.
1. Significance of the problem - based on the number of people in the
community affected by the problems. It's significance is determined by estimating
the number of people at risk of developing of the disease.
2. Community awareness- when people are aware of the risk arising from a
condition pervasive in the community, they are likely to have the motivation to
deal with the condition and give it priority.
3. The ability to reduce the risk - this criteria also involves the health
team's level of influence in decision making related to action in resolving the
community health concern.
4. Cost of reducing risk- the nurse has to consider economic, social, and
ethical requisites and consequences of the planned actions.
5. Ability to identify the target population - there should be
availability of data sources such as FHSIS, census, survey, reports and case
finding.
6. Availability of resources - accessibility of outside resources and the
link to these resources are taken into account. [for realistic and useful outcome
the priority setting process requires the joint effort of the community, the nurse
and other stakeholders, such as other members of the health team).

Formulating Goals and Objectives

•Goals are the desired outcomes at the end of the interventions, where as
objectives are the short-terms changes in the community. Objective should be SMART.

Deciding on Community
Interventions/Plan Actions
•Because of their inherent differences what may work from one community may not
work in another.

Implementing Community Health

Intervention
• Importance of Partnership and Collaboration
• Activities involved in collaboration and advocacy
• Community Organization and social mobilization
• Core Principles in community organizing
• Goals of community organizing COPAR
• Proper excreta
• Disposal
• Food safety
• Sanitation
• Vermin and vectors
• Built Government

Importance of partnership and Collaboration

• The aim of partnership and collaboration is to get people to work
together in order to address problems or concerns thataffect them.
• It gives people the opportunity to learn skills in group relationship,
interpersonal relations, critical analysis and most important of all, decision-
making process in the context of democratic leadership
• Working together enables organizations to accomplish their goals much
quicker because resources, skills and views are pooled together.

Organization can commit and work together in different ways (ICHSP, 2000)
• Networking
• Coordination
 • Cooperation
• Collaboration
• Coalition or Multi-sector Collaboration

Networking
• Is a relationship among organizations that consist of exchanging
information about each other's goals and objectives, services or facilities.
• This results in organizations becoming aware of each other's worth and
capabilities and how each can contribute to the accomplishment of the network's
goals and objectives.
• Networking requires small amount of time, yet it has great potential in
terms of joint activities.

Coordination
• Is a relationship where organizations modify their activities in order
to provide better service to the target beneficiary.
• This level of organizational relationship becomes time -consuming as it
requires more involvement and trust on the part of the committed organization
• Modification of activities that are more responsive to community's
needs may significantly improve people's lives.

Cooperation
• Is a relationship where organizations share information and resources
and make adjustments in one's own agenda to accommodate the other organization's
agenda.
• In this type of relationship, organizations share ownership of the
success, rewards as well as problems and hassles that go with working together.

Collaboration
• Is the level of organizational relationship where organizations help
each other enhance their capacities in performing their tasks as well as in the
provision of services.
• At this point, people become partners rather than competitors.
• Collaboration entail a lot of work but the potential for change can be
great.

Coalition or multi-sector collaboration

• Is the level of relationship where organizations and citizens form a
partnership.
• All parties give priority to the good of the community.
• It requires great investment in terms of effort, time, trust and the
will to make a change.

The following are general ideas for the nurse on how to get started in partnership
and collaboration work:
• 1. it is imperative for the nurse to involve all the stakeholders in
the process of forging partnership and collaboration with the community.
• 2. in working together, the nurse and the community face risks
together. It is important therefore, that they need to know and trust each other.
• 3. determine how the organization views the problem, how it proposes to
solve the problem and how it perceives an organizational relationship can help
solve the problem.
• 4. organizations should agree on the kind or level of relationship that
will help best accomplish the group goals considering needs and available
resources.
• 5. when the organizations have agreed on the type of organizational
relationship, formulate ground rules that will become the bases for decision-
making.
The following are the most important points:
 • Listen to what each has to say. Points of agreement can only be reached
if there is an exchange of information.
• Take time to listen to people who voice different opinions or concerns.
Keep an open mind. Try to identify points of unity from diverse opinion.
• Don't force organizations work together for a common good.They do not
work together just so they can outdo each other.

Advocacy
• Advocacy work is one way the nurse can promote active community
participation. the nurse helps the people attain optimal degree of independence in
decision-making in asserting their rights to safe and better community.
• Advocacy work in nursing has gone to along way from one who just acts
on behalf or intercedes for the client to one who assists rights as priority.
• The nurse as advocate helps empower the people to make decisions and
carry out actions that have the potential to better their lives.

Advocacy work involves:

• Informing the people about the rightness of the cause.
• Thoroughly discussing with the people the nature of the alternatives,
their content and possible consequences.
• Supporting people's right to make a choice and to acton their choice.
• Influencing public opinion.

Community Organizing
• Is the process of educating and mobilizing members of the community to
enable them to resolve community problems.
• It means to build the community's capacity to work for the common good
in general and health goals particular.
• In the context of community health nursing, community organizing is
teaching the community to apply the nursing process (assess, diagnose, plan,
implement, and evaluate) on its own, utilizing resources that are available to it,
thereby allowing the community to be an active participant in the process of
development, rather than just being a passive recipient of services or care.

Social mobilization
• Social mobilization is the process of bringing together all societal
and personal influences to raise awareness of and demand for health care, assist in
the delivery of resources and services, and cultivate sustainable individual and
community involvement.
• In order to employ social mobilization, members of institutions,
community partners and organizations, and others collaborate to reach specific
groups of people for intentional dialogue. Social mobilization aims to facilitate
change through an interdisciplinary approach.(WHO)

How can we achieve social mobilization?

• Agenda 2030 requires a new way of working, harnessing the considerable
synergies across goals. The ambitious and broad scope of Agenda 2030 will only be
achieved by bringing together a range of stakeholders, as envisioned in Goal 17.
• Social mobilization is the backbone for strengthening this global
partnership and ensuring that it remains accountable to people's overlapping needs
and demands, whether in health, gender equality, labour or otherwise.
• Examples of roles for stakeholders in ensuring that strategic alliances
are formed to advance the SDGs, by leveraging health promotion, include:

Examples of roles for stakeholders in ensuring that strategic alliances are formed
to advance the SDGs, by leveraging health promotion, include:
Government
• Expand space for civil society engagement in decision-making, taking
necessary precautions to protect against the efforts of industry-backed front
groups to interfere with healthy public policy making.

Civil society
• Explore opportunities and innovative means to build cross-constituency
partnerships for overlapping injustices and common causes, with an emphasis on
south-south and triangular cooperation amongst CSOs.

Media (including social media)

• Work with civil society to ensure that governments are committed to do
as the have stated. Media platforms both new and old can be used to engage a wide
population on decision-making processes related to health and sustainable
development.

Organizations of the UN system

• Support the development of win-win policies and programmes to scale up
advocacy and community mobilization for health and the SDGs, engaging as
appropriate with media and civil society.
Community leaders
• Mobilize affected communities and constituencies to respond to health
and development injustices, supporting their capacity to push back and organize,
and build cross-cutting capacities within change agents.
Research and academic institutions
• Develop and improve methods to evaluate social mobilization using an
evidence-based approach as both a process and an outcome. Valid and reliable tools
are especially needed to measure the (often complex) social and organizational
aspects of social mobilization as these pertain to a range of SDGs.
Moving forward
• As we scale up efforts to implement Agenda 2030, we are by no means
starting from scratch. The SDGs are a major opportunity to bring together and build
upon the range of experiences and successes that have already accrued - whether in
access to medicines, climate change action, tearing down discriminatory laws or
addressing inequities more broadly.
• The potential for health promotion to amplify the power of social
mobilization and bring together different stakeholders in pursuit of sustainable
health and well-being is enormous. For this potential to be realized in full,
governments must ensure that community-centred approaches are always equally
included alongside top-down interventions, and societies must empower their
citizens, through a new partnership, to actively achieve the SDGs.

Core Principles in community organizing

Community Organizing is:
• People-centered
• Participative
• Democratic
• Developmental
• Process oriented

Goals of community organizing

•1. People's empowerment
•2. Building relative permanent structures and people's organizations.
•3. Improve quality of life

Phases of Community Organizing (COPAR)

•Pre-entry phase
•Entry phase
•Organizing building & implementation phase/
Community Organizing
•Sustenance and strengthening phase/ Action phase
• Exit and expansion phase
COPAR
•PROPER EXCRETA
•DISPOSAL
•FOOD SAFETY
•SANITATION
• VERMIN AND VECTORS
• BUILD GOVERNMENT

MONITORING AND EVALUATING

COMMUNITY HEALTH PROGRAM IMPLEMENTED

Designing and Implementing Evaluation Program

• The plan for a health intervention should include the plan for
monitoring and evaluation. Although monitoring is done while intervention is still
being implemented to provide feedback on its current status, evaluation is done at
the end of the project to assess whether or not its objectives were achieve.
Monitoring: is an ongoing activity during program implementation to assess the
current status of its implementation in terms of compliance to the design of the
program, timelines, and attainment of midterm goals (kettner et al., 1999).

The result of monitoring, the project management team is able to:

• Assess the progress of program implementation.
• Identify problems
• Take corrective action
• Have a tool for quality assurance and management,
• Lay the groundwork for program.
Evaluation : Is a process that systematically and objectively assess compliance to
the design of the program, the performance, relevance and success of a project,
that is, the extent to which a project accomplishes its intended results (outcomes)
and achieves measurable impacts.

Evaluation
• The primary purpose of evaluation is to provide feedback on the results
(outcomes) and impact of the project I order to inform policymakers and planners
about the efficacy of the intervention.
• It answer the questions as:
• Did the program work as intended?
• What results (outcomes) did the program accomplish?
• What measurable impacts did the program achieve?
• Is the program cost effective?

Working with Groups towards Community

Development

Introduction
• One of the expectations of a nurse as a change agent in the community
is to work effectively with groups. However, a common experience is failure of
group projects or inability of the group to carry out the program as planned.
• The group undergoes dissolution before members learn to marshal
available resources to achieve a sustained and productive relationship.
• A family oriented behavior among community members places the group
task and concerns second in the priority to those of the family.
• Another common experience that affects the group's potentials for
effective teamwork is the tendency to gather people in a big crowd during a
community meeting.
• The big group becomes smaller and smaller in time, as members do not
feel the need to attend meetings and discussions. In time the group undergoes
dissolution.
Stages of Group development
• Specific interventions in developing work groups in community nursing
practice can be used by the nurse to engage the community and its resources in a
partnership for the attainment of health goal.
• She can develop the skills of a collection of people to work together
as a productive functioning unit.
• The required skills result from the group's experiences as it
progresses from one stage of development to the next,
• The stages of group development constitute the natural phenomena
occurring in small group processes.
• The nurse can learn to develop work groups by understanding and using
to full advantage these natural phenomena.

The stages of Group Development

• Like an individual, a group must move through developmental stages
before it becomes a productive, functional unit.
• The group members must deal with the issues, problems, and tasks that
occur in each stage before progressing on to the next.
• These stages are characterized by specific behavioral patterns and
areas of concern.
• The characteristics and behavior and concerns of the group by stage can
be utilized as guidelines to maximize its growth.

According to Yalom (1975, pp.303-312)

There are 5 Stages of Development:
1. The stage of Orientation and dependency
2. The Stage of Conflict
3. The Stage of Cohesiveness
4. The work Group Stage
5. The Termination Stage

The Stage of Orientation

• The Two Tasks confronting group members during the initial stage:
1. First, they must determine a way of achieving their primary tasks-
purpose for which they joined the group;
2. Second, they must find a place for themselves in the group, one that
will not only provide the comfort necessary to attain their primary task, but will
also result in additional gratification from the pleasure of group membership.
• In achieving these two tasks, the group member's behavioral patterns
are basically attempts at warding off anxiety.

The Stage Conflict

• This stage is characterized by the group's concern over dominance,
control and power.
• The experience on conflict is between members or between members and
leader. Each member tries to establish for himself his preferred amount of
imitative and power, and gradually a control hierarchy within the group is
established.
• Members become judgmental of others. Negative comments and inter-member
criticism become more frequent. Members make suggestions or give advice, not as a
manifestation of acceptance and understanding but as part of their attempts to
establish their places in the control hierarchy within the group.

The Stage of cohesiveness

• Following the previous period of conflict, the group gradually develops
into cohesive unit. During this stage, there is an increase of morale and mutual
trust as members feel group belongingness.
• Consequently, members are willing to share more about themselves to
others in the group. There is intensification of personal involvement, a growing
awareness and mutual recognition of the significance of the group experience in
terms of personality growth and change.

The Work Group stage

• During this stage, the uniqueness of the members and the leaders are
seen and expected. Members can accept one another's differences without associating
"good" and "bad" with the differences.
• They become aware of their own involvement, and of the other aspects of
group process, without being overwhelmed or alarmed.
• Conflict exists but these are on substantive issues rather than
emotional ones.
• Consensus is reached from a rational discussion rather than from a
compulsive attempt at unanimity.

The Termination Stage

• After being together and working on specified "task", members of groups
experience a sense of ending.
• Sometimes this can be temporary as when a particular session or meeting
ends.
• At other times this can be a permanent one, when the group's reason for
being ends, as when a project or program has accomplished.
• According to Dunphy (1965, pp.384-399), the tasks of the group at this
stage may include: finishing the agenda, establishing key decisions and completing
the group product, tying up loose ends and writing of unfinished business.
• The key emotions are joy and sadness.
• The group celebrates for the work and achievements done. However, there
is emotional coping with the loss of valued personal relationships.

Intervention to facilitate Group Growth

Major Interventions, tasks and techniques:
1. Provide the necessary Orientation, Structure, and Direction.
2. Help meet member's interpersonal needs.
3. Process, Negotiate, and Resolve conflicts to everyone's satisfaction.
4. Be aware of the effects of behavior on the group; use the self for group growth.
5. Derive opportunities to apply learning to another situation

Collaboration ideas on how to work as a team

PARTNERSHIP AND COLLABORATION
• Health and health -related problems in the community are varied. Most
often, the problems are complicated and too many for the nurse and the people or
their organization to handle. They cannot solve the problems alone. They must work
with other people or groups to increase the probability of accomplishing the goals
that they have set. As the saying goes, there is strength in numbers.
• The nurse must plan to establish and maintain valuable working
relationships with people such as people's organizations, health organizations,
educational institutions, the local government units, financial institutions,
religious groups, socio-civic organizations, sectoral groups and the like.