COMMUNITY

PARTICIPATION
COURSE: PRIMARY HEALTH CARE I (GNS 123)
LECTURER: YEMISI OYENIRAN – RN, RNT, Msc. Nursing
Introduction
• Community participation is a foundational principle of primary health
care.
• This is one of the strategies of Primary Health Care.
• The community is involved right from the planning stage of a program
to implementation and even evaluation stage, thus decision-making
process is revolved around the community.
 Definition
• Community Participation/Community involvement is a social process where
by people living in a specified geographical setting come together in
identifying their own problem and mobilizing their own resources to solve
their own problem.
•
The community should be actively involved in:
• The assessment of the situation
• Problem identification
• Priority setting and making decisions
• Sharing in the planning ,implementing, monitoring and evaluation processe
Advantages of Community
Participation
1) It allows communities to exert effective administrative supervision over
health service
2) It makes use of part time unremunerated community/village heath
workers.
3) It promotes local insurance scheme for purchasing pharmaceutical
products.
4) It provides a communal labor for the construction of health care
facilities for example toilets, water supply and cleaning of the community.
5) It improves communication between the population and the heath
service.
6) It improves coverage and access to health care.
Advantages of Community
Participation
7) It enables people to be more aware of their own potential
contributions to health and to engage in health promoting activities.
8) It eases the government constraints and resources by sharing the
burden with community resources by sharing the burden with
communities themselves.
9) If allows for a better understanding of traditional values, beliefs and
structures for example if the role of traditional healers in health care is
understood and accepted, they can be utilized in health care delivery.
 Types of Approach in the Community
Participation
•
A. Top-down approach

• It is an approach whereby people have a problem and the Community Health Nurse
identify the problem and induced participation/involvement of the people to solve the
problem.

B. Bottom- up

• We are trying to see the root of the problem by wearing the eyeglass of the people.

• Living with people and trying to identify their problem using their own eyes.
Socio-cultural assessment of the community
• Socio- cultural assessment enables us to interpret our
surrounding and the actions of people around us and to
behave in ways that make sense.
• It is important for nurses not to consider their own way the
best and otherwise ideas as ignorant or inferior
(Ethnocentrism) .
 Pertinent socio-cultural factors to be assessed in the
community

• Existing influences that divide people into groups within the

community, such as ethnicity, religion, social class, occupation,
place of residence, language, education, sex, race, and age
• Conditions that lead to social conflict and/or social cohesion
• Attitudes toward minority groups, youths, and the elderly males and females.
• Division of the community into neighborhoods or districts and the
characteristics of these.
• Formal and informal channels of communication between health programs
and community.
• Barriers that may be the result of differences in cultural beliefs and practices.
Pertinent socio-cultural factors to be assessed in the
community
• Political orientation in the community.
• Pattern of migration either in or out of the community and their effect
on health care services.
• Relation of religion and medicine within the community.
• Types of diseases or illnesses thought by various members of the
community to exist – culture-specific conditions such as illnesses
caused by imbalances in hot or cold or disease of magical origin.
 Community as partner model
• Assessment
1. Socio-demographic characteristics
- Age
- Sex distribution
- Income level
- Occupation
- Educational level
- Ethnicity
- Marital status

2. Physical environment
- Housing, open space
- Boundaries, shops, bars, churches, mosques, schools
 Community as partner model
• 3. Health and Social services
- Hospitals, health centers, health stations
- Counseling, food, shelter, special needs
4. Economic-Average household income
- Percentage of household below poverty level
- Employment status
• 5. Safety and transportation
- Fire, police, sanitation
6. Politics and government
- Group and business people
- Farmer association, youth group, women’s group, professional group, ethnic
group
 Community as partner model
• 7.Communication
- Newspapers
- Radio, TV, post, telephone
- Roads
- Pamphlets, posters

8. Education
- Schools, colleges
- Level of education

9. Recreation
Type of recreational facility
 Community as partner model
• Analysis and Interpretation
- Categorize the data
- Summarize the information
- Make inference
• Community nursing diagnosis.
• It is focused on the community instead of the individual
- e.g. - Low antenatal care coverage
- High rate of infant mortality
- Low family planning coverage
 Community as partner model
• Planning
1)Establishing priority
2) Establishing goals and objectives
3) Identifying intervention activities that will accomplish the objectives

1. Criteria for priority

• Community concern
• Severity
• Feasibility
• Magnitude
 Community as partner model
2.Establishing goals and objectives
• Characteristics of good objectives

• Relevance-fits with the general policy

• Feasible-achievable within the capacity of available resources
• Observable-When the results are clearly seen
• Measurable-when the results are stated in terms of numbers
• Time targeted-all objectives should be drawn with in a specific time frame
• Specific-Target specific population
 Community as partner model
• Intervention activities
The means by which objectives are met are the strategies that clarify
what must be done to achieve the objective, the way changes will be
effected and the way the problem cycle will be interrupted.

• Evaluation-is the process by which the impact of the program is assessed.

- Process evaluation-The way in which various programs carried out are

evaluated by comparing with the predetermined standard.

- Outcome evaluation-This is concerned with the end results.

Social-Political Factors Affecting
Community Participation
1) Unfavorable Socio/political factors:
a) Rural poor communities and landless workers.
b) Monopoly of productive crops.
c) No opportunity for formal/ informal leadership among the poor.
d) Repression of trade unions by the powers that be.
e) Concentration in curative health services and greater percentage of
health care resources spent in rural areas.
f) High tax rate and poor payment for secondary heath service.
Social-Political Factors Affecting
Community Participation
2) Favorable Socio/Political circumstances
g) Rural family relatively homogenous.
h) Government showing concern for rural development and
improvement of living standards in rural areas.
i) Local people and NGOs showing initiative for health care.
 SITUATION ANALYSIS
• It is a process of finding out the actual status of health in a given community
and determining the ability of the available health services to respond to the
problem identified.
• It is a comprehensive review and assessment of the community/
District/LGA in other to determine or come into conclusion about the
situation of the communities which may have direct or indirect impact on
the health of the people.

• Situation analysis is conducted usually on the health services provided to

determine the ability of health services to respond to problems found
during community diagnosis.
INFORMATION GATHERED IN SITUATION
ANALYSIS

• The analysis consists of a complete survey of health facilities in the

local Government area, their distribution, category of personnel in the
facilities and number in each category.
• It provides information in the number on the type and volume of
services provided in the facilities.
• Information on the number of settlements in each local Government
area, their population, presence of basic infrastructures that affect
health e.g. roads, electricity telephones, portable water supplies and
schools.
ROLE OF SITUATION ANALYSIS IN
PRIMARY HEALTH CARE

• To provide baseline data for implementation of community health

services/primary health care at local government level, district and
community levels.
• To know the real health status of the people in the community
• To know where immediate attention is needed
• For proper planning
• For proper monitoring and evaluation.
 INSTRUMENTS USED FOR
SITUATION ANALYSIS
a) House Hold Questionnaire (Form H) used for holding information e.g.
members of the household, demographic characteristics and documented
illness episodes in the past month.
b) Child questionnaire used to collect child information e.g. immunization
status, episodes of diarrhea.
c) Female questionnaire – information to be collected will be on marital status,
under 50 years, child bearing status, and women who have never been
pregnant, number of children (dead or alive), knowledge on certain vital health
matters necessary for the survival of her children e.g. immunization and
nutrition, type of maternal and health services (Antenatal, delivery & Post
Paternal Services) during her last pregnancy.
 Equipment Needed
• Tally and Coding sheets
• Shakir’s strip
• Haemoglobinometer
• Weighing scale
• Thermometer
• Pulsometer
• Blood Pressure Apparatus.
 PLAN FOR SITUATION
ANALYSIS
1. Contact the local Government Area
2. Obtain instruments from (FMOH, SMOH, and NPCHDA)
3. Train interviewers
4. Conduct situation analysis by collecting information on the:
• Local Government Area population by district and age.
• Health facility by type, location and ownership
• Health personnel by type & location
• School population by type and location
 PLAN FOR SITUATION
ANALYSIS

• Socio economics status

• Public utilities and services
• Local government Primary Health Care (PHC) activities
• Local government area logistics and information supports
5. Collate data from the field
6. Write report using FMOH guidelines
7. Give feedback to the community and other health workers
8. Submit report to Local Government Area.