WELCOME

COMMUNITY HEALTH
COURSE: ORTHOPAEDIC &TRAUMA MEDICINE
YEAR: Y1,S1
CLASS: SEPT 2024

MR.KEMBOI DENIS- BSCN,N.O,C.U

 UNIT OUTLINE
COMPETENCE: Designed to enable the learner apply the concepts and
principles of community health in the management of orthopedic and
trauma conditions.

OBJECTIVES: TO:-
1. Demonstrate understanding of the principles and concepts of
community health.
2. Utilize the concepts of Primary Health Care in the management of
orthopedic and trauma conditions.
Con’t
3. Carry out health education in the community.

4. Demonstrate the understanding of legal and policy framework in the

practice of orthopedic and trauma medicine.
 UNIT CONTENT
1.PRINCIPLES & CONCEPTS OF COMMUNITY HEALTH: definitions, basic
concepts, natural history of diseases, factors influencing diseases in the
community, levels of disease prevention, community challenges in
disease prevention, community diagnosis, assessment, social
mobilization, sensitization and advocacy, measurement of disease in a
community, organization of health care services.
2.PRIMARY HEALTH CARE (PHC): concepts of PHC, elements of PHC,
principles of health care and their interpretations, community –based
health rehabilitation, Millenium Development Goals (MDGs),
Sustainable Development Goals (SDGs) & vision 2030 health related
goals.
Con’t
3. HEALTH EDUCATION: teaching skills/methods, nutrition, immunizable
diseases, strategies in immunizations, waste management.

4.NATIONAL HEALTH POLICY SERVICES: Relevant professional

bodies/associations, regulation of medical professions, the constitution
and medical law, consent, medical negligence, care of refugees,
orthopedic management of refugees and internally displaced persons,
principles of disaster management.
UNIT 1. PRINCIPLES AND CONCEPT OF COMMUNITY HEALTH.
 (A) INTRODUCTION TO COMMUNITY HEALTH

• Community health is concerned with the promotion of health and prevention

of diseases through close community participation.
What is a Community?
A community is a group of people (a large or small group) living in a certain
geographical area and working together for a common goal. They share the
same resources such as water, climatic and geographic conditions, health
services, administration and leadership, as well as disadvantages such as
shortages, risks and dangers.
Community functions as a medium for the growth and development of its
individual members. It imposes the standards by which the individuals are
evaluated, if the community has high expectations of its members, their
performance also tends to be high.
• Health: The concept health may mean different things for different
people. Health may simply mean the absence of disease or it may
mean the soundness of body.
• The World Health Organization (WHO 1984) defined health as ― A
state of complete physical, mental and social wellbeing and not
merely the absence of disease or infirmity.
Health is a state of successful adaptation of the body to stresses and stimuli to
which it is subjected. :
The successful adaptation may be very optimal and the attributes of optimal
health are:
• Anatomical integrity to ensure the physical aspect of health.
• Ability to do normal duties at personal, family and community level.
• Ability to deal with stress whether this stress is physical, mental or social.
• Feeling of well being. This is the mental or psychological dimension of health.
• Freedom from disease and premature death.
• Spiritual and moral stability
(B) COMPONENTS OF A
COMMUNITY
• A community can be described as a complex whole resulting from the
combination of the environment, people health, quality of life,
and economics. The functionality of a community depends solely of
these key elements. Thus, the components of the community are as
follows;
• the environment,
• the people,
• the economy,
• the culture,
• health, and the quality of life.
People as a component of a Community
• A group of people is the most fundamental or essential component of
a community. This group may be small or large but community always
refers to a group of people. Because without a group of people we
can’t think of a community, when a group of people live together and
share common life and binded by a strong sense of community
consciousness at that moment a community is formed.
• Hence a group of people is the first pre-requisites of community.
The Environment as a Component of a Community
• Environment is everything that is a round us. It can be living or non-
living things. It includes physical, chemical and other natural forces.
Living things live in their environment, they constantly interact with it
and change in response to conditions in their environment. In the
environment there are interactions between animals, plants, soil,
water, and other living and non-living things. A community must
have, and be confined within a particular geographic location.
• Any geographical location is a combination of biotic and abiotic
factors and materials
• A group of people alone can’t form a community. A group of people
forms a community only when they reside in a definite territory. The
territory need not be fixed forever. A group of people like nomadic
people may change their habitations. But majority community are
settled and a strong bond of unity and solidarity is derived from their
living in a definite locality. The environment as a component,
influences lifestyle in any community setting and it is indispensable
component that cannot be overlooked.
The Economy/ Economic System as a Component of the Community
• Economics as a social science is chiefly concerned with the description
and analysis of the production, distribution and consumption of goods
and services. Since communities are made of people who will always
seek means for survival and ultimately interact with their physical and
social environment, there must be some form of transactions daily,
thus making the community good for business too.
Health as a Component of the Community
• Health is the level of functional and metabolic efficiency of a living organism. In
humans it is the ability of individuals or communities to adapt and self manage
when facing physical, mental psychological and social changes with
environment.
• The World Health Organization (WHO)defined health in its broader sense in its
1948 constitution as “a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity” (WHO, 2006).
• Health is an important component of a community. The health of the
community is a function of their environment, and the people. A community
cannot be described completely without due reference to the health of its
members.
Quality of Life as a Component of a Community
• Quality of life (QOL) is the general well-being of individuals and
societies, outlining negative and positive features of life. It observes
life satisfaction, including everything from physical health, family,
education, employment, wealth, religious beliefs, finance and the
environment. A community is not just a geographical location, but it
rather implies physical closeness, and relationships at a particular
location which in-turn, adversely or positively improve the quality of
life of its members.
Culture as a Component of the Community
• Culture is defined as the social behavior and norms found in human
societies and communities. Culture is considered a central concept in
anthropology, encompassing the range of phenomena that are
transmitted through social learning in human societies. Some aspects
of human behavior, social practices such as culture, expressive forms
such as art, music, dance, ritual, and religion, and technologies such
as tool usage, cooking, shelter, and clothing are said to be cultural
universals, found in all human societies.. A community is a small or
large social unit (a group of people) who have something in common,
such as norms, religion, values, or identity.
TYPES OF COMMUNITY
A number of ways to categorize types of community have been proposed. One
such breakdown is as follows:
• Location-based Communities: range from the
local neighbourhood, suburb, village, town or city, region, nation or even
the planet as a whole.These are also called communities of place.

• Identity-based Communities: range from the local clique, sub-culture, ethnic

group, religious, multicultural or pluralistic civilization, or the global
community cultures of today. They may be included as communities of need
or identity, such as disabled persons, or frail aged people.
• Organizationally based Communities: range from communities
organized informally around family or network-based guilds and
associations to more formal incorporate
associations, political decision- making structures, economic
enterprises, or professional associations at a small, national or
international scale. These organizations are often considered to
include churches, unions, schools, health care agencies, social-service
groups, fraternities, and clubs.
• Characteristics of a Healthy Community
• Safe and healthy environment, relatively free from natural and man-made hazards
• Community members have high standards of personal hygiene
• Adequate supply of wholesome water
• Availability of adequate nutritious food
• Suitable housing
• Harmonious interpersonal relationships among members
• Availability and accessibility of health care facilities
• Availability and accessibility of suitable educational, social and recreational facilities
• Gainful occupational activities (availability of stable or reliable sources of income)
• Sound communication infrastructure
• Communal approach to and participation in tackling community problems
Problems that Affect the Health of the Community

 Unsanitary environment
Overcrowding
Poverty
Unclean and inadequate water supply
Lack of nutritious food
Unsafe environment
Epidemic and endemic disease
Unstable family life
Illiteracy and ignorance
Poor leadership and lack of participation
Adverse weather conditions
Poor infrastructure
Political instability
COMMUNITY SUB-SYSTEMS
A community is made up of various subsystems, all of which have a bearing on
how people live and behave. For a community to function smoothly the various
sub-systems must work in harmony.
• 1. Socio-cultural System This system is made up of all the customs and beliefs,
family and kinships, leadership and power structures in society. This sub-
system exerts a powerful influence on the lifestyles of the community
members, their priorities and their attitudes and values towards health and
illness. For example some cultural factors promote either acceptance or stigma
towards a certain illness. High-risk behaviour may be a result of cultural
traditions.
• 2. Political System This sub-system is made up of the government and its
development policies as well as political organisations. If there is political
support towards improving health care delivery, the government provides the
mechanism and structure for the planning, implementation and evaluation of
the health care delivery system. The constitution of Kenya contains a
declaration for the elimination of poverty, ignorance and disease
• 3. Economic System The government’s ability to provide health and other
services to its citizens depends on the state of the economy. The poorer the
economy of the country, the more disadvantaged its people will be. Low
economic status is highly associated with malnutrition and communicable
diseases.
• 4. Education System Education is the main tool of changing behavior and
improving individual and community health. Low educational status
perpetuates underdevelopment, harmful traditions and superstitions. The
educational system can be effectively used to pass health related
information and messages that could significantly transform the perception
of the communities on healthy living and prevention of illnesses.
• 5. Religious System The religious system may be a source of health
promotion when its values and teachings positively influence lifestyles and
healthy behaviour, for example, forbidding smoking, alcohol consumption,
pre-marital and extramarital sex. On the other hand, religious teachings may
promote ill health, for example, by forbidding the followers from seeking
treatment in hospitals.
6. Environmental System Environmental sanitation is one of the leading
promoters of individual and community health. Clean water supply,
proper disposal of waste and adequate housing are key to community
wellness. Environmental pollution is a cause of various illnesses.
• Evaluate the impact of community health services/activities A
successful community health programme is one in which the
community and health care providers collaborate to achieve the
following benefits
COMMUNITY AND ITS FIVE
FUNCTIONS
The community has five functions: production-distribution-consumption,
socialization, social control, social participation, and mutual support.
• 1. Production, Distribution, Consumption
The community provides its members with the means to make a living. This may
be agriculture, industry, or services. No community can survive if it does not
provide some way for its people to make a living and obtain the material
resources that they need for living. This involves eg. the industrial sector (broadly
understood). Someone has to take raw material and fashion it into some sort of
useful product. It is also the transportation/warehousing/retail sector, since
somehow the goods that are produced have to be moved to and through the
market. Finally, production and distribution are useless if there is no one to buy
or use it, if there is no market.
• 2. Socialization
The community has means by which it instils its norms and values in its members.
This may be tradition, modelling, and/or formal education. No community can
survive if it does not arrange for its continuation. A way must be found for children
to learn what they will need to know to be adults; for workers to develop the
knowledge, skills and abilities to do their jobs; etc.
3.Social Control
The community has the means to enforce adherence to community values. This
may be group pressure to conform and/or formal laws. Communities are incredibly
complex systems. For all those players (whether human or corporate) are to move
around and do their thing, there have to be traffic rules to keep them from crashing
into each other. This function is also often referred to as boundary maintenance.
4. mutual support-is the function of families friends paters volunteers
ad professionals carry when they care for the sick , unemployed or
distressed.
5. Social participation- Includes Interaction with others the community
groups association and organization people are assumed to need some
form of social outlet and communities provide opportunities for people
to express this need and build natural helping and support network.
some find these outlet In local religious group some informal
neighborhood etc.
 Community Networks and Community
Development

Communities comprises of individuals, families, groups, organizations and institutions, all of

which, both individually and collectively, contribute to and effect the development of the
whole.
• How Community Involvement Influences Socialization
Physical Factors: Population, noise, community design/arrangement and of housing, play
settings.
For example, Is it safe to go out and ride a bike? Was it only safe to play inside? Is the subway
or bus the main transportation or is a personal car? Where does playing take place, on the
streets? In an enrichment class? All of these can affect the child's socialization. It affects what
they do, who they do it with, and where they do it.
Social and Personal Factors: The neighborhood setting, patterns of community interaction.
How do people interact with one another and build relationships? Do they do it at all? Are the
people loving and caring, or mean and neglectful? Are neighbors close or far apart? Again, the
people in the community and how they interact with one another is a socializing agent.
PRINCIPLES OF COMMUNITY HEALTH

• Before you explore the principles of community health, first look at

the definition of the word ‘principle’. A principle can be defined as: A
basic belief, theory, or rule that has a major influence on the way in
which something is done.
• Principles are the basic ideas of conduct or rules of action. They
provide the community health worker with a clear and rational
framework to guide their work.
Determinants of health of a
population
• Scientists generally recognize five determinants of health of a population:
• Genes and biology: for example, sex and age
• Health behaviors: for example, alcohol use, injection drug use (needles), unprotected
sex, and smoking
• Social environment or social characteristics: for example, discrimination, income, and
gender
• Physical environment or total ecology: for example, where a person lives and crowding
conditions
• Health services or medical care: for example, access to quality health care and having
or not having insurance
• Other factors that could be included are culture, social status, and healthy child
development.
Principles of community health (Alma Ata Declaration - WHO 1978)
• Availability of health care for all people and at a cost they can afford
• Promotive and preventive aspects of health care
• Integration of curative and preventive services
• Active participation of individuals and communities in the planning
and provision of care
• Development of maximum potential for self-care
• Utilisation of all levels and types of community manpower
• Inter-sectoral approach
• Principles of Community Health (Hentsch - 1985)
• Health care should be shaped around the life patterns of the population. It should meet the needs of
the community.
• Primary health care should be an integral part of the national health system.
• Health care activities should be fully integrated with the activities of the other sectors involved in
community development such as agriculture, education, public works, housing and communication.
• The local population should be actively involved in the formulation and implementation of health care
activities, so that health care can be brought into line with local needs and priorities.
• The health care offered should place a maximum reliance on available Community resources,
especially those that have hither to remain untapped and should remain within the cost limitations
relevant to each country.
• The majority of interventions should be undertaken at the most peripheral practice level of the health
services and by the workers most suitably trained for performing these activities.
•
(C) Natural history of a disease
• Disease is failure of the adaptive mechanism of the body to
overcome external stress and stimuli to which it is exposed, resulting
in abnormal structure and / or function of one or more of its tissues,
organs or systems. Such abnormality is either reversible or
irreversible.
• Natural history of disease
• The ―natural history of disease‖ refers to the progression of disease
process in an individual over time, in the absence of intervention.
• What are the Stages in the natural history of a disease? There are four
stages:
• Stage of susceptibility
• Stage of pre-symptomatic (sub-clinical) disease
• Stage of clinical disease
• Stage of recovery , disability or death
1. Stage of susceptibility
In this stage, disease has not yet developed, but the groundwork has been laid by
the presence of factors that favor its occurrence.
Example: unvaccinated child is susceptible to measles.
2. Stage of Pre-symptomatic (sub-clinical) disease
In this stage there are no manifestations of the disease but pathologic changes
(damages) have started to occur in the body. The disease can only be detected
through special tests since the signs and symptoms of the disease are not present.
Examples:
Detection of antibodies against HIV in an apparently healthy person.
Ova of intestinal parasite in the stool of apparently healthy children.
The pre-symptomatic (sub-clinical) stage may lead to the clinical stage, or may
sometimes end in recovery without development of any signs or symptoms
3.The Clinical stage
At this stage the person has developed signs and symptoms of the disease. The
clinical stage of different diseases differs in duration, severity and outcome. The
outcomes of this stage may be recovery, disability or death.
• Examples:
• Common cold has a short and mild clinical stage and almost everyone recovers quickly.
• Polio has a severe clinical stage and many patients develop paralysis becoming disabled
for the rest of their lives.
• Rabies has a relatively short but severe clinical stage and almost always results in death.
• Diabetes Mellitus has a relatively longer clinical stage and eventually results in death if
the patient is not properly treated.
• 4. Stage of recovery, disability or death
Some diseases run their course and then resolve completely either
spontaneously or by treatment. In others the disease may result in a
residual defect, leaving the person disabled for a short or longer
duration. Still, other diseases will end in death. Disability is limitation of
a person's activities including his role as a parent, wage earner, etc
Examples:
Trachoma may cause blindness
Meningitis may result in blindness or deafness. Meningitis may also
result in death.
The natural history of disease
• Factors Affecting Disease Spread
There are three main categories of factors which can affect disease
transmission.
• Pathogen factors
• Environmental factors
• Host factors
These factors may be influenced by humans intentionally through
things such as quarantine and vaccination, or it may be unintentional
such as agriculture, urbanisation or transport
• What are the pathogen factors affecting the spread of disease?
• Mechanism of transmission: This may restrict particular diseases to certain environments,
for example, Malaria is only present where mosquitoes thrive as it is a mosquito-borne
vector disease.
• Pathogen infectivity: The transmission of a pathogen is dependent on its ability to spread
from one host to another, i.e. how easily an infection can be established in a susceptible host.
• Incubation period: The period between infection and the presentation of symptoms may
increase transmission, as individuals don't feel sick but can still spread the disease.
• Asymptomatic carriers: These are individuals who carry the disease but don't present with
any symptoms, and so, similarly to people in the incubation period of a disease, may spread
the disease more as a consequence of not showing symptoms.
• Host persistence: The persistence of a pathogen within its definitive host or intermediate
host affects the spread of disease.
• What are the environmental factors affecting the spread of disease?
• Efficiency of infrastructure: Things such as water supply, roads and sewage symptoms, and the
general level of hygiene and degree to which a community has well-established, efficient
infrastructure can impact the transmission of disease.
• Climate change: The changing climate in terms of rising water/air temperatures means that
certain diseases may have an altered level of transmission, for example the increase in
temperature and change to rainfall effect the spread of diseases such as Malaria, which while
usually confined to tropical areas now has the opportunity to spread to more urban areas.
• Globalisation: The increasing rate of globalisation, meaning a greater level of interconnectedness
between other economies with our own in terms of trade, the movement of goods and services
and the movement of people between countries impacts the spread of disease.
• Natural disasters: Extreme climatic events may promote the spread of a disease, such as floods
in these situations, displacements of a population and breakdown of usual sanitation, food,
health infrastructure are major contributing factors.
• What are the host factors affecting the spread of disease?
• Age of the host: Elderly individuals and young children have either weakened or
undeveloped immune systems, and so they are more likely to contract a disease
and spread it to other susceptible hosts.
• Immunocompromisation: Individuals who are immunocompromised are more
susceptible to contracting a disease, and the symptoms will usually be more severe.
• Decision to get vaccinated: The choice to be immunised for diseases is a major
host factor influencing the spread of disease; if individuals do choose to be
vaccinated, this can create herd immunity which protects other non-immunised
individuals in the population. If individuals do not choose to be vaccinated, there
are more pathways for a disease to be transmitted and more people are likely to
contract said disease.
• Mode of transmission: Different infections are more likely to spread
in certain groups within a population; for example, a group of people
who share needles are more likely to contract hepatitis C and HIV.
• Travelling: When carriers of infected individuals travel into other
populations with no previous exposure, this allows for the spread of a
disease over a large geogrpahical area, and it has devastating effects
due to the population having no immunity
PREVENTION

• Prevention is to make the occurrence of something like disease, accident,

which is anticipated, impossible.
This can be achieved at three levels (levels of prevention):
1- Primary prevention
All measures that are applicable before the onset of disease through health
promotion and specific protection.
• Health promotion. ―The process of enabling people to increase control over
their health and its determinants, and thereby improve their health. Health
promotion consists of all the activities which are not aimed at any specific
diseases but serve to improve the host factor in epidemiologic triangle.
• Health education.
• Environmental modification (reducing air pollution, safe water, sanitary
latrines, control of insects and rodents, improving housing).
• Engineering lifestyle (antismoking campaign.).
• Genetic and marriage counseling (to prevent congenital diseases, i.e.
Thalassemia).
• Increasing the standard of living (i.e. the income, education and
occupational status).
• Health legislation, i.e. forming rigid standards of health care, sanitation
and issues relating to health
 Specific protection. The measures which target particular diseases. The idea
of specific protection, especially that killer diseases could be stopped by
simple interventions such as 1- Immunization.
• Nutrient supplementation (vitamin A, iodine).
• Chemoprophylaxis (prior medication to at risk population).
• Protection against occupational hazards (masks for workers).
• Avoiding allergens (for asthmatics).
• Quality control of consumer products (salt—For iodine deficiency diseases,
drugs—To avoid adverse drug reactions, cosmetics—To avoid allergy).
• 2- Secondary prevention
• This is applied after the onset of disease through early detection and prompt
treatment of disease.
Early detection
• Screening tests are done in healthy population of a community.
• Case finding means diagnosing something else in patient other than his chief
complaint.
• Special medical examination of risk groups.
Prompt treatment:
• A quick cure, helps the patient as well as stops further spread of disease.
• 3- Tertiary prevention
• Through limitation of disability and rehabilitation. There are four
dimensions of rehabilitation
• Medical: If possible restoration of function (i.e physiotherapy)
• Vocational: Restoration of capacity to earn a livelihood (training and
creating jobs)
• Social: Reintroduction into family, kins and society as a whole and
involving everyone to maintain the same relationship with this person.
• Psychic: Restoration of self-esteem and confidence.
(D)Community challenges in disease
prevention.

• In rural communities, many factors influence health.

• Rural communities experience a higher prevalence of chronic
conditions than their urban counterparts. Examples of chronic
conditions include heart disease, cancer, chronic respiratory disease,
stroke, and diabetes.
• Rural communities also experience higher rates of mortality and
disability than urban communities. Limited access to health
promotion and disease prevention programs and healthcare services
contribute to these health challenges.
• Examples of social determinant that are barriers for rural communities in accessing
healthcare include:
• Higher poverty rates, which can make it difficult for participants to pay for services or programs
• Cultural and social norms surrounding health behaviors
• Low health literacy levels and incomplete perceptions of health
• Linguistic and educational disparities
• Limited affordable, reliable, or public transportation options
• Unpredictable work hours or unemployment
• Lower population densities for program economies of scale coverage
• Availability of resources to support personnel, use of facilities, and effective program operation
• Lack of access to healthy foods and physical activity options
• These shared barriers provide context for the needs of rural
communities and an understanding of the strategies that will be most
effective to address rural barriers to care.
(E)community diagnosis
• 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
• Definition of Community Diagnosis
• 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
• The Community Diagnosis Process is application of techniques of
diagnosis of an individual to the community
Purposes 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
• Community Diagnosis is done using a tool called "Health Indicators"
which are the variables used for the assessment of community health.
Indicators must be: valid, reliable, sensitive, specific, feasible and
relevant
1.Indicators should be valid; they measure what they are supposed to measure
2.Indicators should be reliable and objective; the answers should be the same if
measured by different people in similar circumstances
3.Indicators should be sensitive; they should be sensitive to changes in the
situation concerned
4.Indicators should be specific; they should reflect changes only in the situation
concerned
5.Indicators should be feasible; they should have the ability to obtain the data
needed
6.Indicators should be relevant; they should contribute to the understanding of
the phenomenon of interest
• Community analysis:
Community analysis is the process of examining data to define needs
strengths, barriers, opportunities, readiness, and resources. The
product of analysis is the “community profile
Steps of community diagnosis
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 process
• 1. 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
• 3. Economic status
• 3.1 Sources of income
• 3.2 Indications of economic status: Employment; Income per capita;
Poverty level; Economic organizations
• 4. 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
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
• 5. Organized Community health programs
• Expanded program on Immunization
• Maternal and Child health
• Reproductive health
• Nutrition program
(F)Social mobilization
• Social mobilization is undertaken for the purpose of social change
and it involves masses.
• Social mobilization is not a single event.
• It sometimes a very long drawn process and may even take months or
years, however some takes a few days. All social mobilization does not
follow same path.
Nature of social mobilisatiion
• Social mobilization is a process of activating large group of people in
a given community to participate in an event activity or process of
social nature which is intended to bring about a change in people
attitude knowledge or actions.
• Social mobilization is essential for gaining support of masses for
activity which requires acceptance approval and adoption by majority.
benefits
• Enhance the capacity of individual group and community to identify
and fulfill their needs.
• Increases community participation.
• Helps to improve program design
• Help to improve quality and results of the programme
• Is a cost effective way to achieve sustainable results
• Increases community ownership
• Enables community to determine their own development
• Helps to build trust within the communities so they can work
effectively
• Increases capacity of communities to work together effectively.
• Increases capacity of communities to work with government and
other sectors health services , research)
Needs for social mobilization

• 1. creating awareness- the aware community can identify their

problems felt needs and can demand for interventions which will help
to develop culturally appropriate strategies and messages . This also
help to increase people skills knowledge and confidence and installing
them a belief that they can make a difference.
• 2. Community participation
• Involvement of community and stakeholders in the programme
increases effectiveness and efficiencies of intervention and obtain
additional resources and support to make the programme cost effective
.it also helps in reaching the most venerable and needy members in
society.
• 3.increasing community ownership and sustainability
• -SM is needed for developing community ownership and sense of
responsibility. This helps in increasing coverage and access to
information and services.
• 4. Empowering community
• SM activities increase the capacity of stakeholders in decision making
planning, programmed implementation and analysis.
• When a community is empowered people feel free to act within the
society and at the same time associate a sense of belonging to it.
Uses of social mobilization
• Gain public support for a policy programme, product or activity or
service.
• To involve people in a large scale activity which the agency wants to
be completed within a specific period of time e.g. camp and
campaign.
• To sustain development through involvement of people and
enhancing the process of behavior change.
• To ensure the desired change take place faster which is possible by
inducement of people.
• It helps to understand the felt needs of the people
• Its helps to empower the individual and group for actions
Types of social mobilization
• Controlled
• Specific/ general
controlled
• Controlled mobilization starts from outside the people who are part
of the process.
• The planning and initiative are done elsewhere and people are only
passive participants initially.
• They may be convinced enough to become more active forces later
even take hold of the movement and carry it forward.
• One example is immunization awareness about the benefits of
immunization and adopting its practice.
specific
• Specific issues related to a group of people or daily living are taken up
as the content of social mobilization.
• Eg mobilization support of polio or other national programme is a for
specific purpose.
• Most of these are very short process.
Pre requisites of social
mobilization
• Purpose or goal for which mobilization is required
• Leader who will inspire and encourage partipants and spearhead the
movement
• Symbols- for unification and building togethereness slogan banners
songs and badges.
• Messages- which are used for mobilization and the content of these
messages in the form of speech pamphlets booklets
• Network of managers and workers who will organize and take
responsibility for different components of the social mobilization.
• Funds which will help in keeping intentions and the actions closer
together and mae sure that the intended activities are carried without
obstacles.
Process of social mobilization at
village level
• Initiate dialogue with community members to understands their interest felts
resources , level of understanding their perceptions view about programme .
Indentify all available resources in the community. Plan the best use of available
resources.

• Form new or indentify existing community based organisatiions likes selp

help group etc provide training if needed.

• Try to create an environment in which the individual can empower themselves

to address their own and the community health needs.
• Promote community participation by developing partnership with community
• Promote good leadership and democratic decision making
• Enable the community to better govern itself better. ( play a catalyst
role)
(G)advocacy

• Advocacy in diseases prevention and control is a way of convincing

individuals or groups to take their share of responsibility in promoting
the health services.
• It can be carried through
• Hold seminars for opinion leaders and influential people to plan with
them how responsibility for disease prevention and control will be
shared in the community.
• Win the support of fellow H/WS, make them understand the benefits
of the services to the community.
• The adoption of a health advocacy model can focus on an educational
dimension when it identifies emerging public health issues that
require action.
• It encompasses gathering information on existing practice related to
public health, related legislation monitoring and providing feedback
on how specific regulations impact local groups and communities. It
may also help guiding health policy reforms.
• Advocacy is one strategy to raise levels of familiarity with an issue and
promote health and access to quality health care and public health
services at the individual and community levels.
• When trying to gain political commitment, policy support, social
acceptance and systems support for a particular public health goal or
programme, a combination of individual and social actions may be
used to try to affect change. This is one way of understanding Health
Advocacy.
• Often, health advocacy is carried out using mass and multi-media,
direct political lobbying and community mobilization. It may
materialize within an institution or through public health associations,
patients’ organisations, private sector and NGOs. All health
professionals have a major responsibility to act as advocates for public
health at all levels in society.
• Roles of a orthopedic technician
• Manager Organizing and managing health care programs, community activities.
• Implementer Implementing community health action/programs in collaboration
with the other stakeholders in community health Creating community awareness
and interest in their health Developing the community’s ability to assess their
health status and resources Sharing knowledge and skills with the community on
how to improve their health and to prevent illness
• Advocator Advise the health care providers, planners and other agencies on the
needs/problems of the community.
• Advisor Sharing technical health information with individual families and
communities and advising in matters health
• Health educator Teaching individuals and families how to prevent disease and
improve their health
• Assessor/Identifier Assessing the health status of the community and identifying
existing and potential health needs/problems and resources in the community
(H)Community assessment
• What is Community Assessment?
A process by which community members gain an understanding of
the health, concerns, and health care systems of the community by
identifying, collecting, analyzing, disseminating information on
community assets, strengths, resources, and needs.
Why do a Community Assessment
• Identify and set priorities based on the need
• Make decisions about how to improve the community or organization
based on needs and available resources
• Outline goals and objectives of a program
• Provide standards for an evaluation of a program
• Identify outside organizations or agencies that may help meet the
needs or provide resources
• To understand the determinants of a health issue
• Helps to decide how to best address a health issue
• Provide a systematic basis for which organizational decisions are
made
• Serve as a public relations tool
• Create an awareness of a community concern or problem
Benefits to Conducting CA
• Strengthening community involvement in decision making
• Better use of resources
• Improved communication with the public and other organizations
• Improving data quality
• Sustaining health initiatives
Challenges to Conducting CA
• Working across professional boundaries- tackling territorial attitudes
preventing power or information sharing
• Lack of shared language between community sectors
• Lack of commitment from key stakeholders or team members
• Difficulties in accessing relevant local data
• Difficulties in accessing the target population
• Difficulties in translating findings into effective action
What are the 3 components of community assessment?
• The main outcomes of a community needs assessment are in 3 main
categories:
• Policy Change
• Systems Change,
• Environmental Change.
Methods of community assessment
• Data for determining community needs can be collected through
Primary data- surveys, questionnaires, focus groups, public meetings,
direct observations, and interviews.
• Secondary data sources such as demographic data, vital statistics,
hospital records, morbidity and mortality reports, and literature
reviews also provide valuable information
(I)Measurements of disease in a
community
• ASSIGNMENT.

• Read and make notes

(J)Organization of Healthcare Service Delivery
System

• Kenya’s healthcare system is structured in a hierarchical manner that

begins with primary healthcare, with the lowest unit being the
community, and then graduates, with complicated cases being
referred to higher levels of healthcare.
• Primary care units consist of dispensaries and health centres. The
current structure consists of the following six levels:
 Level 1: Community
 Level 2: Dispensaries
 Level 3: Health centres
 Level 4: Primary referral facilities
 Level 5: Secondary referral facilities
 Level 6: Tertiary referral facilities
• Health is a devolved function as per the Constitution of Kenya 2010.
• This means that county governments are entrusted with all functions
related to healthcare while the national government is responsible for
health policy.
• The national government is also responsible for the national referral
health facilities such as Kenyatta National Hospital and Moi Teaching
and Referral Hospital.
• Generally, healthcare facilities in the country are grouped into six
different levels.
• The first five are managed at the county level, the sixth level by the
national government.
• In this system, the patients may move from one level to the next by
using a referral letter.
Level 1
• According to the categorization the community level are Level 1
facilities.
• These facilities are run by any registered and licensed health workers,
a Community Health Extension Workers or Community Health
Volunteers. They are mandated with the preventive aspect of
healthcare which involves health promotion and education on early
detection of conditions, screening and referral, enforcing adherence
to care and defaulter tracing
Level 2
• The facilities in this category include dispensaries and are run by nurse or
Clinical officer
• They do not have inpatient facilities but offer basic essential outpatient
services in dental, eye care, mobile clinics, VCT services, laboratory
services, Antenatal and Postnatal services, counseling services and baby
wellness clinics.
• They also offer home-based care services and in some cases, a standalone
funeral facility where dead bodies can be stored, and undergo autopsy
before cremation or burial.
• Where need be, they issue referral letters to other facilities.
 .
Level 3
• They comprise health centres and are run by at least one doctor, clinical officers and
nurses.
• These facilities generally offer preventive and curative services appropriate to local
needs.
• Basically, they offer comprehensive curative, preventive, promotive and rehabilitative
health services including maternity theatre services.
• These services include maternity in-patient, TB, diabetes and hypertension clinics,
pharmacy, comprehensive care clinics for patients living with HIV and laboratory services.
• They then do referral letters for patients who need advanced treatment in other health
facilities.
Level 4
• These are county hospitals and have the same services as the Level 3
hospitals, plus X-Ray services.
• They also include specialist standalone medical centres, medical
surgical, diagnostic and clinical laboratory centres.
• They offer holistic services and are ran by a director who is a medic
and at best a doctor by profession.
• These facilities act as the principal primary referral hospital and offers
services that complement primary health care services to allow for a
delivery of a more comprehensive care.
• Level 5
• These are the county referral hospitals, are run by a CEO who is a medic
by profession and have over 100 beds capacity for their in-patient.
• They provide services offered in a Level 4 facility and more
comprehensive set of services together with internship services for
medical staff, research and serve as training centres for paramedical
staff.
• Some of the advanced healthcare services they provide include
ultrasound, CT-Scan, surgery, physiotherapy, Orthopaedics and
occupational therapy. Where need be, they issue referral letters to
patients to seek further medical attention in other facilities.
Level 6
• These are the national referral hospitals which offer the same services
as those offered at Level 5 but also offer specialised treatment
services not just within the country but also serve the needs of
patients from across the region.
• They include the National Spinal Injury Referral Hospital and Mathari
Teaching and Referral Hospital.
Tiers/ grade
• The Ministry of Health, in the Kenya Health Sector Strategic and
Investment Plan 2013-2017 (KHSSIP), shifted emphasis from curative
to prevention and promotion of individual and community health.
This aggregates service delivery into Tiers.
• Kenya’s healthcare system is structured in a hierarchical manner that
begins with primary healthcare, with the lowest unit being the
community, and then graduates, with complicated cases being
referred to higher levels of healthcare. Kenya Health Policy).2014–
2030
• The tiers are organized from 1 to 4
• ; where
• Tier 1 is the community health services ;
• Tier 2- Dispensaries and Health Centres (primary care services);
• Tier 3 - Sub County and County hospitals;
• Tier 4 – referral hospitals including former provincial, national/tertiary
health facilities.
• The four tiers of health care represents increasing degrees of
specialisation and technical sophistication, generally with increasing
costs of care.
• The referral system has four levels of service: community, primary
care, county referral services, and national referral services.
• The Community Health Services (Level 1) which comprises all
community-based health activities, organized around the
Comprehensive Community Strategy (CCS). This is a nonfacility based
level.
• The Primary Care Facilities (Levels 2 and 3) comprises all dispensaries,
clinics, health centres, and maternity homes.
•
• The County Referral Health Facilities (Levels 4 and 5) comprise all level
4 and 5 facilities operating in and managed by the county. All of the
county-managed facilities form a county referral system, which shares
specific services to form a virtual network. The county referral
systems receive referrals from primary care facilities in its area of
responsibility, from other county facilities in the county, and from
facilities outside the county (horizontal referral) and community units
• The National Referral Health Facilities (Level 6) include the facilities
that provide specialized health care services, such as hospitals,
laboratories, blood banks, and research institutions. These facilities
operate with a defined level of autonomy