COPAR

Ailyn Brillo Pineda

Community Health Nursing Practice Utilizing COPAR

Dr. Alberto Romualdez, former DOH secretary described the Philippine health status as “ on continuing shift towards positive change despite age-old problems..”Some infectious degenerative diseases are on the riseCorrelation of poor health with low socio-economic

status is well documentedFilipinos are still living in the remote areas, where it

is difficult to deliver the health services they needScarcity and exodus of MD’s, RN’s and RM’s add to

the poor delivery of the health care to the poor and deprived who comprise the majority of the country’s 80 million or so total population

INDICATORS MALE FEMALE BOTH SEXES

Population 41, 612, 133 41, 015,428 82, 663,561

Life Expectancy 72.78 years 67.53 years

Crude Birth RatePer 1000 population

24.63

Crude Death Rate per 1000 population

5.66; 4.8 in 1998

Infant Mortality Rate

29 per 1000 live births

Maternal Mortality Rate

138 per 1000 live births

Total Fertility Rate

3.5

Age Female Male

Number Percent Number Percent

0-4 4,721,115 5.6 4,937,632 5.9

5-9 4,643,067 5.5 4,832,467 5.7

10-14 4,500,519 5.3 4,792,979 5.7

15-19 4,229,087 5 4,418,572 5.2

20-24 3,905,441 4.6 3,983,027 4.7

25-29 3,541,009 4.2 3,557,779 4.2

30-34 3,160,534 3.8 3,141,953 3.7

35-39 2,776,133 3.3 2,756,653 3.3

40-44 2,374,323 2.8 2,374,463 2.8

45-49 2,006,520 2.4 2,006,056 2.4

50-54 1,631,337 1.9 1,629,315 1.9

55-59 1,319,097 1.6 1,296,672 1.5

60-64 1,013,026 1.2 963,875 1.1

65-69 767,324 0.9 704,079 0.8

70-74 546,329 0.6 475,228 0.6

75-79 374,459 0.4 298,154 0.4

80+ 330,630 0.4 232,487 0.3

Total 41,839,950 49.7 42,401,391 50.3

Source: 1995 Census-Based National, Regional and Provincial Population Projections: National Statistics Office

AREA No. of Livebirths

Philippines 1,766,440

NCR (Metro Manila) 303,631

CAR (Cordillera) 33,017

Region 1 (Ilocos) 101,310

Region 2 (Cagayan Valley) 59,585

Region 3 (Central Luzon) 200,361

Region 4 (Southern Tagalog) 299,872

Region 5 (Bicol) 117,979

Region 6 (Western Visayas) 123,299

Region 7 (Central Visayas) 153,080

Region 8 (Eastern Visayas) 61,873

Region 9 (Western Mindanao) 55,931

Region 10 (Northern Mindanao) 59,659

Region 11 (Southern Mindanao) 103,555

Region 12 (Central Mindanao) 44,231

ARMM 39,616

CARAGA 9,327

Foreign Countries 114

Residence not stated -

CARAGA 9,327

Source: Philippine Health Statistics, 2000

CAUSE 5 Year Average (2000-2004) 2005*

No. Rate No. Rate

1. Acute Lower RTI and Pneumonia

694,209 884.6 690,566 809.9

2. Bronchitis/ Bronchiolitis

669,800 854.7 616,041 722.5

3. Acute Watery Diarrhea

726,211 928.3 603,287 707.6

4. Influenza 459,624 587.0 406,237 476.5

5. Hypertension 314,175 400.5 382,662 448.8

6. TB Respiratory 109,369 139.7 114,360 134.1

7. Diseases of the Heart

43,945 56.2 43,898 51.5

8. Malaria 35,970 46.1 36,090 42.3

9. Chickenpox 79,236 41.1 30,063 35.3

10. Dengue Fever 15,383 19.6 20,107 23.6

** Pneumonia only from 2000-2002* reference yearLast Update: June 29, 2009

CAUSE MALE FEMALE BOTH SEXES

Rate** Rate** Number Rate*

1. Acute Lower RTI and Pneumonia

888.8 868.0 776,562 929.4

2. Bronchitis/ Bronchiolitis

651.8 817.1 719,982 861.6

3. Acute Watery Diarrhea

668.5 651.5 577,118 690.7

4. Influenza 400.7 444.6 379,910 454.7

5. Hypertension 338.2 442.1 342,284 409.6

6. TB Respiratory 137.7 93.9 103,214 123.5

7. Chickenpox 51.5 56.2 46,779 56.0

8. Diseases of the Heart

38.5 45.1 37,092 44.4

9. Malaria 24.0 20.0 19,894 23.8

10. Dengue Fever 17.8 17.1 15,838 19.0

Source: 2004 Philippine Health Statistics** rate/100,000 of sex-specific population Last Update: February 11, 2008

AREA Total Deaths

Philippines 366,931


CAR (Cordillera) 5,041

Region 1 (Ilocos) 26,469

Region 2 (Cagayan Valley) 13,250

Region 3 (Central Luzon) 40,534


Region 5 (Bicol) 24,867

Region 6 (Western Visayas) 35,589


Region 8 (Eastern Visayas) 16,250

Region 9 (Western Mindanao) 9,650

Region 10 (Northern Mindanao) 10,700

Region 11 (Southern Mindanao) 20,045

Region 12 (Central Mindanao) 7,543

AREA Fetal Deaths

Philippines 10,360


CAR (Cordillera) 163

Region 1 (Ilocos) 725

Region 2 (Cagayan Valley) 143

Region 3 (Central Luzon) 824


Region 5 (Bicol) 620

Region 6 (Western Visayas) 699


Region 8 (Eastern Visayas) 247

Region 9 (Western Mindanao) 242

Region 10 (Northern Mindanao) 279

Region 11 (Southern Mindanao) 397

Region 12 (Central Mindanao) 203

ARMM 161

CARAGA 15

Foreign Countries -

Residence not stated -

Cause Number Rate Percent

TOTAL 1,732 1.0 100.0

1. Complications related to pregnancy occurring in the course of labor, delivery and puerperium

819 0.5 47.3

2. Hypertension complicating pregnancy, childbirth and puerperium

510 0.3 29.4

3. Postpartum hemorrhage

263 0.2 15.2

4. Pregnancy with abortive outcome

138 0.1 8.0

5. Hemorrhage in early pregnancy

2 0.0 0.1

Cause Number Rate Percent

1. Bacterial sepsis of newborn 3,161 1.9 14.6

2. Respiratory distress of newborn 2,298 1.4 10.6

3. Pneumonia 2,013 1.2 9.3

4. Disorders related to short gestation and low birth weight, not elsewhere classified

1,610 1.0 7.4

5. Congenital Pneumonia 1,510 0.9 7.0

6. Congenital malformation of the heart 1,444 0.9 6.7

7. Neonatal aspiration syndrome 1,146 0.7 5.3

8. Other congenital malformation 1,012 0.6 4.7

9. Intrauterine hypoxia and birth asphyxia

971 0.6 4.5

10.Diarrhea and gastro-enterities of presumed infectious origin

900 0.5 4.2

Infant Mortality: Ten (10) Leading Causes Number & Rate/1000 Live births & Percentage Distribution

Philippines, 2005

Cause

5 Year Average (2000-2004)

2005*

Number Rate No. Rate

1. Diseases of the Heart 66,412 83.3 77,060 90.4

2. Diseases of the Vascular system

50,886 63.9 54,372 63.8

3. Malignant Neoplasm 38,578 48.4 41,697 48.9

4. Pneumonia 32,989 41.4 36,510 42.8

5. Accidents 33,455 42.0 33,327 39.1

6. Tuberculosis, all forms 27,211 34.2 26,588 31.2

7. Chronic lower respiratory diseases

18,015 22.6 20,951 24.6

8.Diabetes Mellitus 13,584 17.0 18,441 21.6

9. Certain conditions originating in the perinatal period

14,477 18.2 12,368 14.5

10. Nephritis, nephrotic syndrome and nephrosis

9.166 11.5 11,056 3.6

Cause No. Rate

1. Diseases of the Heart 43,809 102.1

2. Diseases of the Vascular system 30,531 71.2

3. Accidents 27,281 63.6

4. Malignant Neoplasms 21,993 51.3

5. Tuberculosis, all forms 18,229 42.5

6. Pneumonia 18,145 42.3

7. Chronic lower respiratory diseases 14,450 33.7

8. Diabetes Mellitus 8,912 20.8


7,385 17.2


6,548 15.3

Cause No. Rate

1. Diseases of the Heart 33,251 78.5

2. Diseases of the Vascular system 23,841 56.3

3. Malignant Neoplasms 19,704 46.5

4. Pneumonia 18,365 43.3

5. Diabetes Mellitus 9,529 22.5

6. Tuberculosis, All Forms 8,359 19.7

7. Chronic lower respiratory diseases 6,501 15.3

8. Accidents 6,046 14.3


4,983 11.8


4,508 10.6

Based on these statistics what are the challenges that nurses, doctors or midwives and other health agencies face in relation to health profile and growth rate of the Philippine population?

What preventive measures can be done?What can be done to promote and restore health?What health education can be administered by the

community health workers, doctors, nurses, midwives, etc.?

How can we improve the health care deliver system?

How can increase the number of health workers?What can be done for people in the far flung areas

to prevent the occurrence of diseases and health hazards?

Community Health Organizing Utilizing COPAR

Was developed and sponsored by the Philippine Center for Population and Development (PCPD)

To make health services available and accessible to depressed and underserved communities in the Philippines

PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutions and agencies through programs and projects geared toward the social human development of rural and urban communities

Formerly known as The Population Center Foundation

HRDP ITrained the faculty, medical/nursing students

to provide health care services to the far flung barrios because of lack of man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health

The PCPD provides seed money for the income generating projects

The CO uses his/her own strategy or method in developing the community

Short-term service

HRDP IIThe 2nd cycle uses the same strategy but the program

could not be sustained by the schools or hospitals and the income-generating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects

Both HRDP I and HRDP II have brought about some changes in the community life of the people

Established basic health infrastructure; basic health services were increased; there were trained workers and organized health groups to take care of the needs of the community

HRDP IIIPCPD refined the program and resulted to what is

now called HRDP III, which has these unique features:Comprehensive training of the staff and faculty of the

participating agency in which the community work was initiated

Periodic training program and regular assistance to the participating agency were provided to strengthen the health outreach program to become community oriented

PHC as the approach with which all nursing/medical students, their CI’s and indigenous health workers are trained for community health work and around which all other project inputs will revolve

Community organizing as the main strategy to be employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the community health programs

Organizing work in the communities were done in 3 phases

PAR as fascinating strategy for maximum community involvement through collective identification and analysis of community health problems and collective health action

Available funds to finance community initiated projects

Since Management Leadership and Jurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts as leaders of the different levels of the students who were involved in COPAR

Principles of management were applied in carrying out primary health care

The community members, CHW’s and leaders were empowered to manage their own health projects

Conducted seminars and trainings as well as health education and services needed by community(exposure and immersion 6-8 weeks)

A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community.

A collective, participatory, transformative, liberative, sustained and systematic process of building people’s organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference)

A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967)

A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term problems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards solving their long-term problems (CO: A manual of experience, PCPD)

1. COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities.

2. COPAR prepares people/clients to eventually take over the management of a development programs in the future.

3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.

People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change.

COPAR should be based on the interest of the poorest sectors of society

COPAR should lead to a self-reliant community and society.

A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them.

Consciousness- raising through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action.

COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed.

COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity.

Pre- entry Phase is the initial phase of organizing process where the

community/organizer looks for communities to serve/help

It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it

Activities include Community consultations/dialogues Setting of issues/ considerations related to site selection Development of criteria for site selection Site selection Preliminary social investigation (PSI) Networking with LGU’s, NGO’s and other departments

Entry Phase Social preparation phase Activities done here includes:

Integration with the community Sensitization of the community; information

campaigns Continuing social investigation Core group formation:

Development of criteria for the selection of CG members Defining the roles/functions/tasks of the CG

Coordination /dialogue/consultation with other community organizations

Self-awareness and Leadership training (SALT), action, planning

This phase signals the actual entry of the community worker/organizer into the community

Community Study/Diagnosis Phase (Research Phase)Selection of the research teamTraining on the data collection methods and

techniques; capability-building (includes development of data collection tools)

Planning for the actual gathering of the dataData gatheringTraining on data validation (includes tabulation and

preliminary analysis of data)Community validationPresentation of the community

study/diagnosis/recommendationsPrioritization of community needs/problems for action

Community meetings to draw up guidelines for the organizations of the CHO

Election of officersDevelopment of management systems and

procedures, including delineation of the roles, functions and task of officers and members of the CHO

Team building/Action-Reflect Action (ARA)Working out legal requirements for the

establishment of the CHOOrganization of the working committees and task

groups(e.g. education and training, membership of committees)

Training of the CHO officers/community leaders

Community Action PhaseOrganization and training of the community

health workers (CHW’s)Development of criteria for the selection of CHW’sSelection of CHW’sTraining of CHW’s

Setting up of linkages/network referral systemsInitial identification and implementation of

resource mobilization schemes

Sustenance and strengthening phaseOccurs when the community organization has

already been established and the community members are already actively participating in community-wide undertakings

Strategies used may include:Education and trainingNetworking and linkagesConduct of mobilization on health and development

concernsImplementation of livelihood projectsDeveloping secondary leaders

Activities in Building People’s Organization

A CO becoming a par with the people in order to:Immerse himself in the poor communityUnderstand deeply the culture, leaders, history,

rhythms and lifestyle in the communityMethods of Integration includes:

Participation in direct production activities of the people

Conduct of house visitsParticipation in activities like birthdays, fiestas,

wakes, etcConversing with people where they usually gather

such as stores, water, walls, washing streams, or churchyards

Helping out in the household chores like cooking, washing the dishes, etc

A systematic process of collecting, collating, analyzing data to draw a clear picture of the community

Also known as the COMMUNITY STUDYPointers for the conduct of SOCIAL INVESTIGATION

Use of survey or questionnaires is discouraged Community leaders can be trained to initially assist the

community worker/organizer in SI Data can be more effectively and efficiently collected

through informal methods-house visits, participating in conversations in jeepneys and others

Secondary data should be thoroughly examined because much of the information might already be available

SI is facilitated if the CO/ community worker is properly integrated and has acquired the trust of the people

Confirmation and validation of community data should be done regularly

CO choose one issue to work in order to begin organizing the people

Going around and motivating the people on an one on one basis to do something on the issue that has been chosen

People collectively ratifying what they have already decided individually

The meeting gives the people the collective power and confidence

Problems and issues are discussed

Means to act out the meeting that will take place between the leaders of the people and government representatives

It is a way of training the people to participate what will happen and prepare themselves for such eventually

Actual experience of the people in confronting the powerful and the actual exercise of the people power

The people reviewing the steps 1-7 so to determine whether they were successful or not in their objectives

Dealing with deeper, on going concerns to look at the positive values CO is trying to build in the organization

It gives the people time to reflect on the stark reality of life compared to the ideal

The people’s organization is the result of many successive and similar actions of the people

A final organizational structure is set up with elected officers and supporting members

COPAR

Documents

Transcript of COPAR