COMMUNITY HEALTH

There is an outbreak of cholera in Katanga slum, as a community health worker, what is your
responsibility towards that problem
 A pre-control survey so the local frequency and distribution of the disease is known
 source of infection is identified
 report to the higher authorities (district health office and ministry of health)
 mobilization of community leaders and members
 mobilize for resources
 stool sample
 health education on preventive measures
 Water protection and purification by either boiling or chlorination
 Inspection of food supplies, markets and shops
 Sanitary control of public toilets
 Treatment of all cases and restriction of carriers / contacts
 Referral of cases
 Proper disposal and treatment of infected fecal waste water produced by cholera victims and all
contaminated materials e.g clothing, beddings e.t.c. all materials that come in contact with
cholera patients should be sanitized by washing in hot water, using chlorine bleach. Hands that
touch cholera patients or their clothing, beddings, e.t.c should be thoroughly cleaned and
disinfected with chlorinated water or other effective antimicrobial agents
 evaluate and make report

What is school health?

School health is defined as an organized set of policies, procedures and activities designed to protect,
promote and improve the health and well being of students, staff and the surrounding community thus
improving student’s ability to learn.
OR
This is the provision of PHC services in nursery, primary, secondary and tertiary schools

Outline components of school health

1. Sanitation and hygiene
2. Safe water
3. Medical and dental services for schools
4. School child nutrition and feeding practices
5. Health education in schools through curricular activities
6. sexual and reproductive health
7. drug abuse
8. counseling and guidance
9. Physical education and sports
10. The school physical environment
11. Health promotion for teachers

Explain activities carried out during implementation of school health programme

What is the importance of school health?

1. Helps to strengthen health education in schools which leads both to awareness and behaviour
change among school children, staff and other school management members.

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 2. It promotes provision of proper use and maintenance of water supply
3. School health ensure good sanitation in schools
4. It helps promote better nutrition and feeding practices in schools by ensuring that both day and
boarding schools have proper feeding programs like good meals, fruits
5. and drinks
6. School health also provides counseling and adolescent health services in schools where children
will learn life saving skills
7. It helps to promote health care to school staff
8. It also ensures adequate and appropriate arrangement for physical education, sports and
recreation
9. It promotes adequate maximization of the school- community link which involves the
community based PHC activities such as cleaning, protecting water sources, cleaning pathways,
promoting immunization in schools and communities and similarly community school based
activities such as construction works, inspections, learning services, passing by-laws, e.t.c.
10. It also promotes provision of medical and dental care services to school children, the staff and as
well as periodic de-worming to especially primary school pupils.

What is community participation?

Community participation refers to active involvement of members of the community in problem
identification, prioritization, planning, implementation, monitoring, evaluation and decision making on
matters related to health.

Explain the importance of community participation?

i. It creates a sense of ownership, greater confidence and unity among the people especially when they
see the success out of their contributions
ii. It brings the spirit of self reliance in terms of finance, labor, time and material which helps in
sustainability of PHC activities or programs
iii. It leads to acquisition of skills and abilities to sustain PHC activities through training
iv. Leads to efficiency and effectiveness in PHC activities e.g. in planning, implementation since each
member properly understands the activities right from start, what they are doing and why
v. Contributes to equal distribution of resources
vi. Encourages transparency and accountability
vii. It reinforces bottom up planning where everything starts from the community members and finally to
the service providers
viii. There is easy mobilization of resources
ix. Creates awareness in the community
x. Encourage division of labour
xi. It encourages assessment of community needs not individual needs
xii. It leads to community empowerment and capacity building because people get the opportunities to
exercise the skills they have acquired during the process and can sustain the interventions
xiii. • Extended service (coverage)
xiv. • Programs are affordable and acceptable
xv. • Promote self – reliance and confidence
xvi. • Create sense of responsibility
xvii. • Consideration of real needs and demands
xviii. • Promote local community initiatives and technologies
xix. • Reduce dependency on technical personnel
xx. • Builds the community’s capacity to deal with problems.
xxi. • Helps to choose correct strategy.
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Mention factors that may hinder community participation
• Social: community organization leader, status of women, education
• Cultural: Values, beliefs taboos etc.
• Political – ideology, policy etc.
 Poor mobilization
 Insecurity
 Poor leadership which leads to corruption- making the people think that their resources can be
put to bad use and not accountable for
 Poor planning brought about by failure to involve community members right away from the
beginning
 High level of stigma, discrimination and denial where by individuals are not allowed to
participate in any activity e.g. women, the disadvantaged
 Misunderstandings of the project’s goals and objectives and different roles of the stakeholders
which makes people not understand what is required from them
 Inadequate knowledge and skills towards the activity which leads to poor performance and this
makes people run away from work
 Negative attitudes towards the activity may be due to political differences which finally disrupts
cooperation among the members
 Population outflow (migration) in the community brought about by different reasons like
unemployment, natural calamities (floods, famine, drought, e.t.c)
 Weak networks, poor coordination and lack of trust among the community members and their
leaders
 Abrupt change of set schedule which can lead to poor turn up of people towards a certain activity
 Conflicts among the beneficiaries and service providers which leads to negligence
 Disrespect towards community members by the stakeholders hence running away of members
from the activity
 Higher expectations where by community members expect benefits with in the shortest time
possible and failure to achieve them leads to activity failure
 Poor motivation leading to loss of interest in an activity
 Conflict with community’s culture and traditions which can cause rebellion among the people
 Lack of political will in supporting PHC activities
 Alcoholism
 Lack of gender balance in selection of community members
 Lack of transparency from the leaders
 Seasonal activities which may come at the same time with the programs of the community like
harvesting
 Poverty
 Political instability e.g. wars which make it difficult to sensitize and mobilize the community
members on the activities to be carried out
 Lack of guidance in priority areas
 Lack of platform to debate and discuss about community issues e.g. members are not allowed to
express themselves
 Change in government
 Poor mobilization

How would you promote full community participation?

 Good leadership. It makes people trust their leaders and become sure that their resources will be
put to good use and accounted for
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  Ensure transparency which will make the members develop trust in them selves hence easy
resource mobilization
 Exercise mature politics which can’t lead to segregation among the community members
 Ensure good planning and clean realistic objectives for the people to understand right away from
the beginning
 Stick to scheduled or if there is a change, make early communications by putting notices may be
on radios
 Ensure openness on self reliance and volunteerism by helping people to understand their
responsibilities at any point
 Proper continuous sensitization is paramount since it makes people to understand their
responsibilities at any point
 Maximum motivation with encouragement, recognition and appreciation of everybody’s
contribution towards the activity
 Ensure proper knowledge of community’s culture and traditions and offer them maximum
respect
 Enforce bi-laws in some societies which are hard to change. For instance the drunkards can be
stopped from drinking alcohol by closing the bars and putting a fine to those who do not comply
 Ensure maximum respect for community members
 Ensure good and adequate mobilization; if possible do home to home visit to ensure that every
member gets the information
 Democracy in selection of leaders to enhance bottom up planning
 Gender balance in choosing members and leaders
 Regular meetings should be held with the community members concerning the activity
 Advocate for decentralization of health services hence developing a sense of ownership among
the community members
 Community involvement right from problem identification to sustainability

Define community assessment

A community is a group of people living together in the same geographical area sharing the same
resources, cultures, norms, beliefs and interests.

The process of collecting and evaluating data/information about a community’s health status to discover
existing or potential needs as a basis for planning.

Is the process of determining the real or perceived needs of a defined community of people.

What parameters would you consider during community assessment?

Statistical data (total population in the area, children below 5 years, birth rate, death rate
Physical Environment
Health services (number of health centers and their levels, staffing)
Sanitation (personal and home hygiene, water source, solid waste disposal, sewage
and air quality)
Common diseases
Nutritional status of especially children
Communication system
Economy- income generating activities
Education (number of schools in the community)

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Explain the process of community assessment.
1. Determine the information that you need to collect
2. Pre-visit the leaders at all levels and share with them about the support that the trainer would
need
3. Organize sensitization meetings with all the local councils and other people that you may need to
work with in the community
4. Develop an information collection tool if needed e.g. a questionnaire or a survey tool
5. Identify the resources and the support in anyway
6. Prepare for data collection
7. Collect the data at the convenience of the community
8. Analyze and interpret the information received
9. give feedback to community members and allow them to prioritize their health problems
10. Plan for implementation
11. Evaluation and report writing

The importance of community assessment

To the community
 It stimulates the community member to participate in PHC activities
 Enables the community members to detect their own health problems
 Promotes identification and utilization of community resources
 It helps in creating a sense of ownership and sustainability of the health programs by the
community
 It creates awareness of the health services available in the community

To health workers
 Helps health workers to decide where efforts and emphasis should be put in delivering health
care
 Helps health workers to plan their health strategies or goals in terms of preventing diseases and
health promotion
 Provides health workers with information about the community they care for
 Proper allocation of resources

Explain the concept of PHC

Essential health care provided through PHC is basic and indispensable

Practical - appropriate and realistic

- Selection of priorities based on available resources

Universally accessible – the approach is to bring health care as close as possible to where people live
and work.

Scientifically sound
- The strategy we use to implement PHC should be scientifically explainable and should be understood.

- PHC should not entertain quack medicine

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Socially Acceptable Methods and Technology
- Not every method and technology is acceptable to societies. In order to implement PHC the method
and technology we are using should be accepted by the local community. We need to consider the local
value, culture and beliefs etc.

Universally Accessible
- Collective expression of political will in the spirit of social equity.

- Because of the inequitable distribution of the available resources, the services are not reachable
(approachable) by all who need them.

Community involvement
- Active involvement of people in the planning, implementation and control of PHC

- Individuals and families assume more responsibility for their own health.

It was wrongly conceived that health for communities can achieved through the efforts of health workers
alone.

- Health is not a gift that could be given to communities by health professionals.

- Communities can achieve better health status through their own efforts and the health workers role is
to help them identify their problems and to point out methods for dealing with the problems.

Cost that the community or country can afford

- Health services are expensive because of professional costs and the cost of equipment and capital
expenses.

- PHC demands the use of methods which are cheap or with in the cost the community can afford to pay.

Self reliance and self determination

- Implies that individuals, families, and community’s initiative in assume - responsibilities for their own
health development

- Adopting measures that are understood by them & accepted by them.

- Knowing when and for what purpose to turn to others for support and co-operations.

Principles of PHC

There are five basic principles of Primary Health Care (PHC):

1. Equitable Distribution of PHC:
2. Community Participation toward achievement of PHC:
3. Manpower Development:
4. Use of Appropriate Technology:
5. Multi-sectoral Approach:

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One of the pillars of PHC is the political will. Briefly explain how this pillar affects the
implementation of PHC programs
Political will is the support provided to promote PHC by the leaders who influence decision making at
various levels. The decision may affect PHC programs positively or negatively
Positive effects
- The political leaders should make policies that help in implementation of primary health care programs
- Ensure adequate budget allocation of PHC activities accordingly and ensure that they are done
- Monitoring and evaluation of PHC activities
Community mobilization
- Soliciting for resources both internally and externally- this helps to raise enough funds for a PHC
program.
- Active involvement and participation in the actual implementation of specific PHC activities like
construction of bore holes
- Setting a day for observing PHC e.g. National PHC day

Negative effects
- Poor attitude of political leaders towards PHC program leads to poor mobilization of community
members and this will hinder PHC activities
- Embezzlement of funds
- Civil wars
- Delay of PHC services due to top down approach bureaucracy
- Self centeredness- during decision making, people who are planning for PHC services will give the
first priority to their home areas. This will not meet the PHC goal (health for all) since other areas will
be left unplanned for.
- Conflicting of ideas- in case of misunderstandings between the politicians, it will mean that the funds
will not be delivered to the targeted areas/ communities.

Explain why the major funders of PHC (UNICEF) decided to use selective PHC strategy during
implementation of PHC programmes
With all the difficulties and economic restrictions that exist, some health planners have advocated
concentrating on selective PHC activities such as growth monitoring, oral rehydration, breastfeeding,
immunization, supplementary feeding, family planning and female literacy (GOBIFFF).
 To reduce child mortality in developing countries
 Shortage of resources
 Shortage of manpower
 Inadequate infrastructure

Health for all by 2000 was not achieved owing to the following reasons and limitations
Inadequate resources which includes manpower and money
 Lack of community participation and involvement in health program
 Tendency to use the Top down approach in this case decisions are made by top officials and they
are brought to the community for implementation hence not being effective
 Instability in the community made it difficult for provision of PHC services rendering the goal
for health for all not to be achieved
 Natural disasters e.g. floods, droughts and many others
 Inappropriate technology being used to implement PHC services. For instance health centres are
equipped with laboratory equipments but no reagents
 Dependence on government for example when boreholes collapse, they wait for the government
to repair them hence no sustainability
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  Poor communication systems roads and network
 Health workers put more emphasis on curative services than preventive services
 Cultural beliefs and practices
 Heavy dependency on donors
 Embezzlement of funds by government officials e.g. global funds
 Poverty/ ignorance
 PHC has been more of theory than practice
 Emergency of new morbidities e.g. HIV. Ebola
 Emergency of new disease causing organisms e.g. Hepatitis E and C

a) Define community based health care (CBHC).

b) Give objectives of CBHC programme.
c) Compare and contrast CBHC and PHC.
d) Outline the advantages of CBHC over specialized medical services.

Community based health care is the approach of providing health services that are client oriented with
their full participation and involvement of individuals, families and communities

Objectives of CBHC
To build the capacity of each community to care for its own health i.e. being self reliant and working
together for their own development
To have health for all people through their full participation in preventing ill health in their communities
through approved preventative and curative methods
Giving people power to control over their own health
Build capacity for sustainable PHC implementation
Similarities of PHC and CBCH
Both PHC and CBCH consider improving people’s health standards in the community with their full
participation and involvement
In both the main aim is health for all the people in the community through preventive and curative
methods
They both target the community to enable them fully contribute and participate in health activities and
share the benefits including marginalized groups of people like women, children and people with
disability.
Both aim at reducing inequalities in health by involving marginalized group of people in sharing power
and responsibilities thus reducing injustice and promoting equality in health
Differences between CBHC and PHC
PHC CBHC
1. PHC uses top to bottom approach i.e. 1. CBHC uses bottom to top i.e. from
from ministry to the community community to ministry of health
2. PHC delivers health services to the 2. Empowers the community to take
community responsibilities of their own health through
full participation
3. PHC is planned by technical health 3. Planned by community owned
workers resource persons
4. PHC is supported by 4 pillars 4. supported by the community and only
5. Planning, implementation, monitoring links with health workers/participants
and evaluation is done by the experts 5. Planning, implementation, monitoring
and evaluation is done by the community

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Advantages of PHC over specialized medical services
Accessible to majority of people than specialized medical services
Does not require high technology and professional curative services
Does not require high capital investments
People oriented with emphasis to full participation and involvement in matters concerning their health
which is highly required in prevention not as in specialized medical services where people are not
involved

Write short notes on the following

Levels of health delivery in Uganda
Household level- at LC1 level
VHT
Activities done
Carry out follow up of patients in the community
Mobilizing and sensitization of the village members on health related issues
Distribute essential drugs like anti-malarials
Offer family planning services like community based distribution of condoms
Offer DOT services for TB

Health centre II
Headed by enrolled nurse/ midwife or ECN and works with nursing assistants
Activities done
Antenatal services and health education
Family planning services
Treatment of minor infections and injuries
YCC
Simple lab tests like RDT
Referrals

Health centre III

A clinical officer or nursing officer as the in-charge of the unit.

Activities
All those at health centre II
RCT
OPD
In patient
Common lab tests like RPR, blood grouping and cross matching, RDT, urinalysis, stool analysis, HCG

Health centre IV (health sub-district)

Medical officer is the in-charge
Activities done
All those at health centre III plus
Minor and major operations e.g C/S, I/D, circumcision

District hospital
Headed by medical officer

Activities done
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All those at health centre IV
All district programs are centered here
Consultation services
Mentoring services (training institutions)

Regional referral hospital

Headed by a hospital director who is always a consultant in any medical speciality

Activities
All those in district hospitals plus
Special clinics e.g. ENT, EYE, DENTAL
Special services like TB, orthopedics, physiotherapy, mental health, TASO services

National referral hospital

All those done at regional referral hospital
Special clinic like heart clinic
Intensive care unit

Give an outline of the following

10 components of primary health care

5 importance of health education

Importance of giving health education talk
1. It increases the level of awareness in the community
2. It helps the people to prioritize their problems
3. It helps the community to keep up to date information about their health problem and concerns
4. It improves the standards of living
5. It builds good relationship between the health worker and the community
6. It helps people to acquire knowledge and skills

Importance of health education in a health care delivery

 It helps in providing knowledge about health problems and solutions
 It encourages people to seek for health services
 It helps people to change behaviors and beliefs about health
 It introduces health behaviors in a community
 It promotes sense of responsibility for their own health through community participation and
involvement.
 It is essential in promoting the use of preventive health services like ANC and immunization
 It alters some cultural beliefs which might have directly or indirectly influenced health
 It helps the government to implement its services through sensitization.

How can you make communication in health education to be more effective?

The health education should base on problems/needs obtained through a community diagnosis.

The educator must be aware of the customs, beliefs and attitudes of the local community

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Use appropriate, practical and stimulating methods and teaching aids and materials to encourage people
to participate

Know your audience (slow learners, low levels of education, capacity to concentrate, language which is
understandable).

Should start from the known thing to unknown thing (simple to complex)

Provide opportunity for the people to learn by doing (practice). The content should be practical or
doable.

Should have prior knowledge of people’s customs and provide information in an attractive and portable
way.

Should maintain good educational approach i.e. not to be harsh. Community leaders should be taken into
consideration of any programme and educator should be accepted by the community.

The time place and target group must be carefully considered, the topic and methods to use must meet
people’s needs.

The most important and essential points must be given first priority

Reinforce the message using different methods and media

Explain the difference between morbidity and mortality

Morbidity refers to a state of being diseased or unhealthy within a population.
Mortality refers to the incidence of death or the number of people who died with in a population

Explain any 7 common causes of morbidity and mortality in perinatal and neonatal babies
Perinatal death- death of fetus or neonate
Neonatal death is when a baby dies with in 28 days of life
 Preterm birth is the most common cause of perinatal mortality
 Infections: sepsis, pneumonia.
 Tetanus.
 Diarrhoea.

 Birth asphyxia (lack of oxygen before or during birth)
 Complications of pregnancy such as pre-eclampsia
 Birth defects e.g. heart defects, lung defects, chromosomal abnormalities
 Birth injuries

Outline any 5 roles of DHO in the prevention of perinatal and neonatal deaths
1. Community mobilization
2. Resource allocation
3. Capacity building through training health workers in neonatal resuscitation
4. Monitoring and evaluation
5. supervision

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State the pillars of primary health care

Describe an ideal homestead

Characteristics
Must have a main house
Compound
Kitchen
Food store/ granary
Refuse pit
Drying rack
Animal house
Safe water source and storage
A garden
Bathroom
Must be near the hospital/ health center
Near the road side
Near a market

Components/ qualities
Pit latrine
Must be 30 feet, 10 meters away from the house
10 feet deep
Smooth floor plastered
Should have a door to provide privacy
Have a wind pipe to carry away the smell
Height of the wall should not be less than 6 1/2
Well ventilated

Compound
Should be large, at least 30 feet radius or round
Must have trees
Should be with a flower garden
Compound should be with a fence for protection

Rubbish pit
Must be dug 8 feet deep and 4 feet wide
30 meters away from the house
100 meters away from the water source
When it is full, it must be covered with a thin layer of soil when full to prevent flies from laying eggs
and to aid decomposition

Main house
Should be built with strong materials
Must have enough rooms to accommodate family members
It must be well ventilated
It must be plastered or smeared
It must be raised 6 inches above the ground level to prevent water from entering the walls

Walls
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Should not be less than 7 feet

Ventilation
Should be well ventilated

Kitchen
Should be large enough
Above than 30 feet
Should have raised fire places
Should have a rack for utensils
Must have a place for fire woods
Should be near the main house
Walls should be 5-7 ft
Should be plastered and smeared
Must have a chimney
Must have well fitting doors
Must have windows

Explain the effects of poverty on health

Poverty is both a cause and a consequence of poor health. Poverty increases the chances of poor health.
Poor health in turn traps communities in poverty.
 The effects of poverty are passed across generations through pregnancy. Women from poor
families are more likely to be short, be in poorer health and have significant psychological
problems when they are pregnant – all of which are important determinants of pregnancy
outcome. During pregnancy poorer women are more likely to gain less weight, to have genital
infections and to smoke. Infants born to poor mothers are more likely to be born small and/or
early. Birth weight and gestational age are the main determinant of perinatal survival
 Homelessness, or extreme poverty, carries with it a particularly strong set of risks for families,
especially children. Homeless children are less likely to receive proper nutrition and
immunization. Hence, they experience more health problems. Homeless women experience
higher rates of low birth weight babies, miscarriages, and infant mortality, probably due to not
having access to adequate prenatal care for their babies.
 Growth in childhood increase with increasing social advantage. Children born in poor families
are most likely to be stunted. Children who grow up in poverty suffer more persistent, frequent,
and severe health problems than do children who grow up under better financial circumstances.
 Children raised in poverty tend to miss school more often because of illness. These children also
have a much higher rate of accidents than do other children, and they are twice as likely to have
impaired vision and hearing, iron deficiency anemia, which can impair brain function.
 Marginalized groups and vulnerable individuals are often worst affected, deprived of the
information, money or access to health services that would help them prevent and treat disease.
 Very poor and vulnerable people may have to make harsh choices – knowingly putting their
health at risk because they cannot see their children go hungry, for example opting for being a
sex worker.
 The cost of doctors’ fees, a course of drugs and transport to reach a health centre can be
devastating, both for an individual and their relatives who need to care for them or help them
reach and pay for treatment. In the worst cases, the burden of illness may mean that families sell
their property, take children out of school to earn a living or even start begging.

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  Poverty leads to failure to obtain proper education. Missing out on education has long-term
implications for a woman’s opportunities later in life and for her own health.
 Overcrowded and poor living conditions can contribute to the spread of airborne diseases such as
tuberculosis and respiratory infections such as pneumonia.
 Reliance on open fires or traditional stoves can lead to deadly indoor air pollution.
 Lack of clean water and poor sanitation in slums where poor people live provides breeding
grounds for infectious disease which can be fatal to their health.
 Lack of food due to poor socio-economic status leads to malnutrition. Less money means less
nutritious food
 Most poor families cannot afford the medicine and antibiotics they need to treat these diseases
and they certainly cannot afford to visit the doctor. These diseases continue to spread at a rapid
rate and complications result.
 Living in poverty heavily influences stress levels and mental health. The constant worry of
poverty can lead to depression and anxiety as well. Stressors include uncontrollable situations,
illness, financial status, social isolation, lack of sleep, and work overload. When these are
experienced over a long period of time, it can be very harmful in that it increases the likelihood
of developing a disease, being obese, or experiencing a heart attack.
 Studies during economic recessions indicate that job loss and subsequent poverty are associated
with violence in families, including child abuse. Abusive violence is more likely to occur in poor
homes. Poor young parents who are raising young children have an elevated risk of using the
most abusive forms of violence toward their children, as do poor single mothers.
 The other way that poverty can affect health is through obesity; this is especially a problem in
the United States today, Food options in poor neighborhoods are severely limited: it’s a lot easier
to find cheap foods at the corner than fresh fruits and vegetables. These cheap foods are loaded
with fat, sugar, and empty calories. Low-income workers may also have less time to cook their
own meals, less money to join sports clubs, and fewer opportunities to exercise.
 Infectious and neglected tropical diseases kill and weaken millions of the poorest and most
vulnerable people each year.

Explain the factors that can influence health

Keywords- this refers to cause change positive or negative
Health- is the state of complete physical, social and mental well being of an individual not merely the
absence of disease or infirmity.

Factors that change, improve, or worsen the health of individuals and the community

Geographical features (Topography, climate, natural events)

Topography
Hills, mountains, islands, valleys are described as hard to reach areas. Which worsen delivery of health
services; transport and living standards become poor hence poor health.

Climate
Some diseases depend on seasons e.g rainy seasons favor mosquito breeding and hence malaria. Dry
seasons are related to drought and famine hence malnutrition.

Natural events

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Floods, earthquakes, storms and droughts they cause injury and death. They lead to destruction of lives
and also lead to malnutrition due to famine.

Population (size, age groups, birth rate, death rate, life expectancy)

Life expectancy
is the approximate number of years a person should live. Low life expectancy is an indicator of poor
health conditions e.g low developed countries have low life expectancy (Uganda is 47 years)
Developed countries like Canada have high expectancy of 70 years and above because of good health
conditions.

Size
Communities and families with many people tend to have poor sanitation and many recurring diseases
than small families.

Birth rate
This is the number of children a woman is expected to have during her reproductive age. Countries like
Uganda with a birth rate as high as 6.9 have poor health. In Canada where birth rate is as low as 1-2
children, the health status is good. Therefore, high birth rates negatively influence health and viceversa.

Death rate
A high death rate is an indicator of poor health status. In Uganda it is estimated that over 99% of the
disease burden is preventable e.g HIV, diarrheal disease, acute RTI, e.t.c. these are diseases of high
morbidity and mortality. High death rate implies decline in population.

Age groups
Developed countries as in Europe and America have many old people to support, few youths who care
for fewer children hence better health. The opposite is for developing countries in Africa with few old
people to support many youth who have very many children hence poor health.

Environmental factors
Safe water sources and coverage, sanitation, proper disposal of excreta and refuse reflect good quality of
life and health of the people. A dirty environment has relationship with occurrence of disease hence poor
health.

Industrialization- the chances of accidents and disasters reduce because of advanced technology hence
good health. But the impact of any single disaster becomes relatively big e.g. collapsing houses and fire
outbreaks in cities like Kampala and Nairobi.

Housing
Poor ventilated houses can increase cross infection among family members e.g. TB, Common cold and
measles.

Communication
There is a positive relationship between health and access to communication media such as telephones,
radios, TVs, newspapers e.g mass media can be used to mobilize, announce epidemics and also for
health education.

Education
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High level of education is an asset to better health. This is because education increases awareness which
is important for good health practice and behaviour i.e. most of the disease burden is because our
population has little or no education. Therefore, they find it difficult in appreciating and interpreting the
benefits of improved technology and affording quality consultancy services. Low education is related to
poor income hence poor affordability of health services.

Transport
Availability and affordability of road, air, railway and water transport have positive bearing on health
especially in emergency referrals.

Social gradient/ ladder

This refers to a position a person holds in society e.g rich/poor, Bishop, lawyer, nurse, RDC, LC5 or
president. Position goes with benefits and can prevent or increase the chances of getting a disease.
People with high social ladder have access to quality care compared to the poor in low social gradient

Social behaviors
The way how people live, eat and work affects their health e.g smoking has relationship with bronchitis
and pulmonary TB. Over eating predisposes to DM, hypertension and obesity.

Government programs
e.g. supplying essential drugs to all health centres and hospitals in time and which are for the people
helps in quick service delivery. Training of health workers in higher institutions and also in rural areas
will help to provide improved services. Motivation of health worker and provision of health facilities in
hard to reach areas.
Multi-sectoral collaboration will help in providing different services which will improve the health of
the community.

Occupation
Some diseases are related to the job one does e.g. sexually transmitted infections among sex workers,
long distance drivers, bar maids. Nurses are prone to cross infection from patients e.g. needle stick
injury even when post exposure prophylaxis to HIV is possible.

Define millennium development goals

List the millennium development goals
What has Uganda done to the millennium development goals

Definition
The millennium development goals are 8 goals to be achieved by 2015 that respond to the world’s main
development challenges.

They are:
1. Eradicate extreme poverty and hunger
 Reduce by half the proportion of the people living on less than a dollar a day
 Achieve full and productive environment and decent work for all including women and
young people
 Reduce by half the proportion of people who suffer from hunger
2. Achieve universal primary and secondary education
 Eliminate gender disparity in primary and secondary education preferably by 2005
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3. Promote gender equality and empower women
 Eliminate gender disparity in primary and secondary education preferably by 2005
 Share of women in wage employment in the non-agricultural sector
 Increase proportion of seats held by women in national parliament
4. Reduce child mortality
 Reduce by 2/3 the mortality rate among children under five
5. Improve maternal health
 Reduce by ¾ the maternal mortality ratio
 Achieve by 2015 universal access to reproductive health
 Contraceptives
 Antenatal care coverage (at least 4 visits per pregnancy)
 Increase proportion of births attended by skilled health personnel
6. Combat HIV/AIDS, malaria and other diseases
 Halt and begin to reverse the spread of HIV/AIDS
 Condom use
 Comprehensive correct knowledge on HIV/AIDS
 Achieve by 2010 universal access to treatment for HIV/AIDS for all those who need it
 Halt and begin to reverse the incidence of malaria and other major diseases
7. Ensure environmental sustainability
 Integrate the principles of sustainable development into country policies and programs
 Reverse loss of environmental resources
 Reduce biodiversity loss by planting trees
 Reduce by half the proportion of people without sustainable access to safe drinking water
 Achieve significant improvement in lives of at least 100 million slum dwellers by 2020.
8. Develop a global partnership for development
 Develop non-discriminatory trading and financial system
 Address the special needs of the least developed countries
 Enhance program for debt relief for heavily indebted poor countries and cancellation of debts
 Address the special needs of land locked developing counties
 Deal comprehensively with the debt problems of developing countries through national and
international measures in order to make debt sustainable in the long term
 In cooperation with pharmaceutical companies, provide access to affordable essential drugs
in developing countries
 In cooperation with the private sector, make available the benefits of the new technologies,
especially information and communications

Health has undergone many changing concepts

Briefly describe the changing concepts of health
Outline 5 ethical dilemmas
What is the concept of community about health

a) Define a disaster.
b) Outline the types of disaster.
c) Explain the stages of disaster management.
d) Explain the principles of disaster management.
e) Give the effects of disaster to the community.

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55. Sample –question approach

Solutions

a) Define disaster.

 Is a sudden calamity bringing great damage, loss and destruction to life and property and can’t be
managed by local resources.
 A disaster is any natural or human made incident that causes destruction and devastation that
can’t be relieved without assistance.
 A disaster is any event that causes much suffering or serious loss of the life and property.

b) Outline the types of disaster.

There are two major types of disasters and they include:

(i) Natural disaster

These results from the effects of earth’s natural hazards processes and their examples include;

 Earthquakes
 Drought
 Flooding
 Landslides
 Volcanoes
 Forest fires
 Tsunami
 Thunderstorms and Lightening
 Hailstorms
 Tornado
 Hurricanes

Man-made disasters

These are disaster that has an element of human intent, negligence or error or involving a failure
of a man-made system and their examples include.
 Fires
 Explosion and bombing
 Transportation accidents
 Wars
 Terrorism
 Airplane crashes
 Structural collapse
 Electric power outage.

N.B Some disaster are cross-cutting that is both natural and man-made disasters.

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c) Explain the stages of disaster management.

Depends on which stage of disaster management, however, most of principles can fall under all
stages or phases.

The following are the phases or stages of disaster management.

o Mitigation
These are activities that actually eliminate the probability of an emergency or disaster to occur –
policies and by laws.
Mitigation refers to those measures and policies put in place to reduce the impacts of a disaster. The
process involves hazard identification, vulnerability analysis, putting in place the right infrastructure and
ensuring up-to-date logistics. Proper education and public awareness are useful tools to engage
community in disaster mitigation.

o Preparedness

This involves plans and activities to handle the emergency where mitigation has failed.

Planning how to respond. Readiness to respond to any emergency situation. These measures can be
described as logistical readiness to deal with disasters and can be enhanced by having response
mechanisms and procedures, rehearsals, developing long-term and short-term strategies, public
education and building early warning systems. Preparedness can also take the form of ensuring that
strategic reserves of food, equipment, water, medicines and other essentials are maintained in cases of
national or local catastrophes.
During the preparedness phase, governments, organizations, and individuals develop plans to save lives,
minimize disaster damage, and enhance disaster response operations. Preparedness measures include:
 Preparedness plans
 Emergency exercises/training
 Warning systems
 Emergency communications systems
 Evacuations plans and training
 Resource inventories
 Emergency personnel/contact lists
 Mutual aid agreements
 Public information/education

o Response
These are activities done following an emergency or disaster. They include evacuation, shelter, and
relief supply.
Initial actions taken as the event takes place. It involves efforts to minimize the hazards created by a
disaster. Examples: evacuation; search and rescue; emergency relief. Removal from hazardous place to
another that is safe.
Warning
Logistics and supply
Communication and information management
Security

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The focus in the response phase is on meeting the basic needs of the people until more permanent and
sustainable solutions can be found.
Humanitarian organizations are often strongly present in this phase of the disaster management cycle.

o Recovery/Rehabilitation.
Returning the community to normal. Ideally, the affected area should be put in a condition equal to or
better than it was before the disaster took place. Examples: temporary housing; grants; medical care, re-
integration.

d) Explain the principles of disaster management

 Disaster management is a responsibility of all spheres of the government –all sectors.

 Departments and ministries should work together to achieve comprehensive disaster
management.
 Disaster management should use resources that exist for day today purposes.
-Municipalities, bodies and organizations should use the available resources and at least should
have minimum budget allocation to enable appropriate response.
 Organizations should function as an extension of their core business –The involved
organizations, bodies; NGOs should specifically serve to their core role.
 Individuals are responsible for their safety-individuals should be aware of warning signs and
hazards that can affect their community and county –interact earlier enough to reduce their
effects once they have occurred.
 Disaster management planning should focus on large scale events-in planning, consider the
profuse effects of the disaster as it will be easy to handle if a small event /disaster occurs .i.e.
think big.
 Disaster management planning should recognize the difference between incidents and disasters.-
Incidents are not as serious as disasters .However, they can also be fatal and therefore it is
important to differentiate between the two when planning and responding.
 Disaster management must take account of the type of physical, environmental and structure of
the population-this involves putting in consideration the nature of the environment and the size
of population that may or is affected once a disaster has occurred.
 Disaster management arrangements must recognize the involvement and potential role of NGOs-
which work independently and have a core role to play in disaster management.
 Disaster management operational arrangements are additional to and do not replace incident.

e) Give the effects of disaster to the community?

i. Loss of human lives.

ii. Loss and destruction of property.
iii. Displacement and evacuation of people.
iv. Famine
v. Diseases in displaced people.
vi. Disabilities and deformity.
vii. Lowered economy of the community.

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viii. Psychological effects on the community e.g. stress, depression, Suicide and post traumatic stress
disorder.
ix. Infrastructure damage
x. Telecommunication loss
xi. Power disruption
xii. Water problems
xiii. Agricultural damage
xiv. Loss/damage to housing
xv. Damage to inland and coastal environments
xvi. Disruption of standard of living, lifestyle, etc.

Community emergency “Is a situation generated by the real or imminent (about to happen) occurrence
of an event that requires immediate attention”.
Floods
Fire
Electric outage
Thunderstorms
Extreme heat waves
Droughts
Tornadoes
Hurricanes
Chemical spills
Earth quakes
Rabies
Terrorist attacks
Blizzard (snow storm)
Landslides
Volcanic eruptions
Tsunami
Tornadoes
Outbreaks refer to flu epidemics, viruses and other contagious vdiseases, cholera
Radiations
Accidents-
Pandemics (a pandemic is any disease or condition that affects people in many countries at the same
time)

COMMUNITY HEALTH

SHORT AND LONG ESSAY QUESTIONS:

1a). Discuss in detail how the elements of primary health care (PHC) have been implemented in
Uganda.
b). How useful is the strategy of universal primary education (UPE) to the Alma Ata declaration
of 1978?

2a) Community Based Health Care (CBHC) strategy can help to achieve the goal of Health for all
by the year 2015. Using relevant examples, give your views in for or against the statement.

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 3a). How has Uganda used the pillars of primary Health Care to improve the immunization
coverage and malaria prevention?
b). The village is puzzled about the definition and concepts of primary Health Care. Using the
PHC point of view and relevant examples, please help them know.

4). Hurry up, there is a cholera outbreak in “Kako senior secondary school, Masaka ‘’. The head
teacher gives you such a phone call.
a). Briefly describe how you can help him.
b). List any five (5) questions you would ask the Head teacher on arrival?

5a). Outline any 10 elements of primary Health Care according to the 1978 Alma Ata
international conference?
b). In detail explain the immunization schedule?

6a). Describe the following concepts of primary health care?

i). Full community participation
ii). Self determination
iii). Self reliance
iv). socially acceptable methods

7). The government of Uganda and beyond are finding it very difficult to implement “Health for
all’’
a). Is the statement above TRUE or FALSE?
b). Support the answer for 7 (a) above?
c). Outline the four (4) pillars of primary Health Care (PHC).

8) With an example for each, define the following as applied in a certain element of PHC?
a i). Natural immunity
ii). Artificial immunity
iii). Herd immunity
iv). Artificially Acquired immunity
v). Passively Acquired immunity

9. You study to implement PHC. Discuss how you will be applying the PHC knowledge to benefit
the Nation and beyond?
d). Explain why the major funders of PHC (UNICEF) decided to use selective PHC
strategy in the implementation of PHC programs.

11) a). Define school Health.

 Is an organization set of policies, procedures and activities designed to protect promote and
improve the health and wellbeing of students, staff and the surrounding community thus
improving students’ ability to learn.
or
 School health is a broad spectrum of school related health activities and services.

b). Outline the components of school Health.

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  Health education
 Life skills’ education
 Water and sanitation
 Sexual and reproductive health
 School feeding and nutrition
 Sexual and drug abuse
 Violence and safety in school
 Physical education and sports
 Counseling and guidance
 Medical services
 Community health promotion services
 Family and community involvement
 Health promotion of staff.

c). Explain the activities carried out during implementation of school health.
o Through screening of new students who have just been admitted in school to rule out infectious
diseases like T.B.
o Provision of nutritious foods and balanced diet to school children.
o Carrying out health education talks in school to change the behavior of the students, staff and
surrounding community.
o Activities such as demonstration gardens, trees, planting like mangoes tree, should be practiced
in the schools.
o To teach health science as separate examinable subjects in school.
o Checking students on assemblies on specific days for hygiene
o Opening of school clinics where by medical services will be available for students, staff and
surrounding community like first aid medication and screening
o School physical exercises like athletics, football, volleyball, net ball and are encouraged for the
wellbeing of students.
o Counseling and guidance should be carried out for the wellbeing of students through skilled
people like matrons, senior woman and man teaches to make students to overcome problems.
o Implementation of school rules and regulations to avoid harmful practices like bullying,
fighting, alcohol and drug abuse.

d) Explain the importance of school health.

 Promotes proper growth and development of school children.

 Helps over come high spread of diseases within the community like diarrhea and malnutrition.

12 a) Define health education

b) Outline ten categories of people who should be given priority for health education.
c) Explain the principles of health education.
13a) choose any two methods of health education and describe the advantages and disadvantages
for each.

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 14 a) Describe the procedure of giving a successful health education talk.
b) Explain the procedure of counseling a 25 year old woman who is depressed.

15. Discuss the millennium development goals.

17 Describe how a health education talk to a group of ten (10) pregnant mothers about malaria
prevention can be organized?

Describe the different levels of PHC structures in Uganda

Give three new vaccines in Uganda, their schedule, doses and site of administration
Briefly explain how safe male medical circumcision plays a role in prevention of HIV/AIDS.

An ideal homestead

Dwelling place
Garden
Animal house
Kitchen
Bath shelter
Food store
Near safe water source
Latrine
Rubbish pit
Drying rack
Location of the home
Near the road for easy access to means of transport

List 10 characteristics of poor house holds

Explain how you would mobilize a community to participate in health promotion activities
Steps for community mobilization
Defining the problem
The first step in community mobilization is to collect the basic information about the issue. This will
give an idea of the extent of the problem and what the underlying causes are.

Establishing community mobilization group

The aim is to establish a group that can influence community mobilization activities. It usually consists
of influential groups and members of the community such as formal and informal leaders, religious and
traditional leaders.

Designing strategies, setting objectives and selecting target groups

To achieve planned change at community level, resources need to be mobilized from the community and
other external partners. After obtaining resources, the community mobilization group should design
strategies to address the identified problem with objectives that are SMART (specific, measurable,
achievable, relevant and time bound). The objectives should be assessed for their impact on the targeted
groups in the community.

Developing an action plan with a time line

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An action plan links the general community mobilization plan with time lines for the actual
implementation of the planned activities, and the deadlines set for goals to be achieved. This enables the
progress of activities to be monitored against the targets set during the planning phase.

Building capacity
Capacity building involves identifying existing capacity resources and assessing the gaps that exist to
implement the community mobilization. The gaps identified should be supplemented by capacity
building of the community groups and other relevant stakeholders in the community involved in
community mobilization.

Identifying partners
In the community there are various partners that work independently to achieve similar goals. Therefore
it is important to identify relevant partners through a simple mapping exercise. Examples of partners
include religious institutions, local non-governmental organizations

Implementing the planned activities

Based on the action plans developed with all the relevant community level partners, implementation of
the community mobilization activities is the main task. In the implementation process, a clear role for
any partners that are involved should be put in place and communicated to all of them.

Monitoring and evaluation

Monitoring and evaluation is the last but essential element of community mobilization. It enables you to
check whether the action plan has been implemented effectively and the specific objectives are met with
respect to the issue the community is mobilized to achieve

Outline any 5 roles and responsibilities of a community health worker

1. Home visiting
2. Information collection and use
3. Planning and participating in community activities
4. Holding sensitization/ awareness community meetings
5. Organizing simple and appropriate health talks
6. Identifying house holds with health problems
7. Identifying possible solutions to the problems
8. Assisting in mobile reproductive health clinic days
9. Mobilizing community resources
10. Monitoring the use of community resources
11. Making referrals for patients for further management
12. Make follow up of patients in homes
13. Identifying people with severe health conditions like pregnant women and the mentally ill
patients for further and early management
14. Assisting and participating in organizing health development functions e.g world AIDS day,
world food day, water and sanitation day
15. Advocating for health improvement at household level
16. Monitoring and evaluation of community based activities
17. Report activities and results
18. Distributes prescribed drugs if trained
19. Re-plan where necessary

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